The epidemiology of benzodiazepine misuse: A systematic review

Abstract

Background: Benzodiazepine misuse is a growing public health problem, with increases in benzodiazepine-related overdose deaths and emergency room visits in recent years. However, relatively little attention has been paid to this emergent problem. We systematically reviewed epidemiological studies on benzodiazepine misuse to identify key findings, limitations, and future directions for research. Methods: PubMed and PsychINFO databases were searched through February 2019 for peerreviewed publications on benzodiazepine misuse (e.g., use without a prescription; at a higher frequency or dose than prescribed). Eligibility criteria included human studies that focused on the prevalence, trends, correlates, motives, patterns, sources, and consequences of benzodiazepine misuse. Results: The search identified 1,970 publications, and 351 articles were eligible for data extraction and inclusion. In 2017, benzodiazepines and other tranquilizers were the third most commonly used illicit or prescription drug in the U.S. (approximately 2.2% of the population). Worldwide rates of misuse appear to be similar to those reported in the U.S. Factors associated with misuse include other substance use, receipt of a benzodiazepine prescription, and psychiatric symptoms and disorders. Benzodiazepine misuse encompasses heterogeneous presentations of motives, patterns, and sources. Moreover, misuse is associated with myriad poor outcomes, including mortality, HIV/HCV risk behaviors, poor self-reported quality of life, criminality, and continued substance use during treatment.

Treatment patterns and sequences of pharmacotherapy for patients diagnosed with depression in the United States: 2014 through 2019

“…Furthermore, use of anxiolytics, anticonvulsants, and hypnotics/sedatives were commonly used as the first treatment choice in these patients newly diagnosed with depression, potentially pointing to a reluctancy of physicians to prescribe antidepressants [17] but being more comfortable using other classes of drugs such as anxiolytics [18,19]. High use of benzodiazepines, which comprised the majority of anxiolytic use in this study, is concerning because they are not recommended as a first-line therapy [15] and they carry concerns of abuse [20][21][22] and risk of overdose [23,24].…”

Benzodiazepines in the oral fluid of Spanish drivers

“…Benzodiazepines, which are used in the treatment and control of various disorders such as anxiety, insomnia, panic attacks, epilepsy, muscle spasms and pre-surgical stress [7], are sometimes misused by patients (used longer than recommended or in combination with alcohol) and also sometimes used illicitly (for recreational purposes or to minimize unwanted effects of other illicit substances) [8][9][10][11]. Furthermore, in the last decade, an increasing number of new nonmedical-use benzodiazepines, the so-called "designer benzodiazepines", have been introduced into the recreational drug market [12].…”

Treatment Patterns and Sequences of Pharmacotherapy for Patients Diagnosed with Depression in the United States: 2014 through 2019

“…Furthermore, use of anxiolytics, anticonvulsants, and hypnotics/sedatives were commonly used as the first treatment choice in these patients newly diagnosed with depression, potentially pointing to a reluctancy of physicians to prescribe antidepressants [14] but being more comfortable using other classes of drugs such as anxiolytics [15,16]. High use of benzodiazepines, which comprised the majority of anxiolytic use in this study, is concerning because they are not recommended as a first-line therapy [12] and they carry concerns of abuse [17][18][19] and risk of overdose [20,21].…”