Balancing the Risks and Benefits of Benzodiazepines

Medication Management of Anxiety and Depression by Primary Care Pediatrics Providers: A Retrospective Electronic Health Record Study

“…Benzodiazepines have limited evidence for beneficial effect in pediatric patients. 15,18,21 There are also concerns about safety and the potential of diversion. 22,23 Further study is needed to understand the rationale for use of these medications by PCPs in this network.…”

Benzodiazepines for the long-term treatment of anxiety disorders? – Authors' reply

“…We agree with Tibrewal and colleagues that benzodiazepines can disorders and should be judiciously considered after screening of relevant risk factors for negative outcomes, including history of substance abuse, current use of opioids and alcohol, older age (65 years or older), risk of falls, and cognitive impairment. 4 In contradistinction to Penninx and colleagues' findings, 1 we believe that the risks of benzodiazepines have been overestimated, while the benefits have been minimised, which could result in clinicians underprescribing for carefully selected populations with refractory anxiety disorders.…”

“…2,3 Also, on benzodiazepine withdrawal, anxiety symptoms often recur, leading to long-term benzodiazepine use. In line with pertinent guidelines by the National Institute for Health and Care Excellence, 4 we therefore do not consider benzodiazepines to be a first-line treatment option due to poor acceptability, their potential for adverse interactions with alcohol and opioids, the potential for addiction and dependence in groups at high risk, and increased risk for falls and cognitive impairment. Our views also consider the announcement from the US Food and Drug Administration in September, 2020, concerning an update to the boxed warning on all benzodiazepines to explicitly "address the serious risks of abuse, addiction, physical dependence, and withdrawal reactions" 5 among this class of medications.…”

Benzodiazepines for the long-term treatment of anxiety disorders?

“…John Henryism is a useful analogy here. First described by epidemiologist Sherman James to explain racial disparities in hypertension, 4 John Henryism is a behavioural predisposition characterised by active coping against persistent, enduring social disadvantages (eg, racial discrimination and inequity) resulting in long-term negative health outcomes. As James notes, John Henryism illustrates that survival in the face of disadvantage is possible but not without cost.Rather than focusing on dismantling the systems of oppression that debilitate Black communities, the solutions espoused by Namer and Razum place the responsibility for managing anti-Black oppression on Black communities.…”