Benzodiazepine Use, Misuse, and Harm at the Population Level in Canada: A Comprehensive Narrative Review of Data and Developments Since 1995

Abstract

Benzodiazepines are commonly prescribed psycho-pharmaceuticals (e.g., for anxiety, tension, and insomnia); they are generally considered safe but have potential adverse effects. Benzodiazepine use in Canada versus internationally is comparably high, yet no recent comprehensive review of use, misuse, or related (e.g., morbidity, mortality) harm at the population level exists; the present review aimed to fill this gap. We searched four key scientific literature databases (Medline, CINAHL, EBM Reviews, and Web of Science) with relevant search terms, and collected relevant "gray literature" (e.g., survey, monitoring, government reports) data published in 1995-2015. Two reviewers conducted data screening and extraction; results were categorized and narratively summarized by key sub-topics. Levels of benzodiazepine use in the general population have been relatively stable in recent years; medical use is generally highest among older adults. Rates of non-medical use are fairly low in general but higher in marginalized (e.g., street drug use) populations; high and/or inappropriate prescribing appears common in older adults. Benzodiazepines are associated with various morbidity outcomes (e.g., accidents/injuries, cognitive decline, sleep disturbances, or psychiatric issues), again commonly observed in older adults; moreover, benzodiazepines are identified as a contributing factor in suicides and poisoning deaths. Overall there is a substantial benzodiazepine-related health problem burden-although lower than that for other psycho-medications (e.g., opioids)-in Canada, mainly as a result of overuse and/or morbidity. National benzodiazepine prescription guidelines are lacking, and few evaluated interventions to reduce benzodiazepine-related problems exist. There is a clear need for reducing inappropriate benzodiazepine use and related harm in Canada through improved evidence-based practice as well as monitoring and control.

Patients reasons for obtaining psychotropic medications without a prescription at retail pharmacies in Central Saudi Arabia

“…Recently, there has been growing concern on the addictiveness of pregabalin 34. Interestingly, none of the benzodiazepines in our study was ranked among the most commonly used psychotropic medications without a prescription, although, benzodiazepine abuse remains common problem worldwide 35,36. Benzodiazepines in Saudi Arabia are grouped under the category of controlled and Narcotics medication, therefore, they are strictly prescribed and available mostly in hospitals 37…”

Paper-Based Electrochemical Devices for the Pharmaceutical Field: State of the Art and Perspectives

“…This configuration can represent a positive perspective for pharmaceutical purposes, as well as furnish advantages over conventional three electrode systems, as these are easy to prepare, economical, portable and disposable after use. Benzodiazepine group is a significant segment in anesthetic drugs, generally prescribed as psycho-pharmaceuticals (e.g., for anxiety, tension, insomnia) (Murphy et al, 2016). In recent years, their abusing in combination with opioids and alcohol caused many emergency department visits and related deaths (Schmitz, 2016).…”

Beyond Prescriptions Monitoring Programs: The Importance of Having the Conversation about Benzodiazepine Use

“…Short-term, paradoxical effects such as increased anxiety, agitation, disinhibition, and aggression have also been observed [29,30]. Despite overwhelming evidence that over-time harms associated with BDZs may come to outweigh the benefits, the prescribing of BDZs long-term is endemic, and a problem reported globally [31][32][33][34][35][36]. In 2011, Professor Malcolm Lader asked the question "will we ever learn?…”