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Benzodiazepines
The benzodiazepine
family of depressants is used therapeutically to produce sedation, induce
sleep, relieve anxiety and muscle spasms, and to prevent seizures. In
general, benzodiazepines act as hypnotics in high doses, anxiolytics in
moderate doses, and sedatives in low doses. Of the drugs marketed in the
United States that affect central nervous system function, benzodiazepines
are among the most widely prescribed medications. Fifteen members of this
group are presently marketed in the United States, and about 20 additional
benzodiazepines are marketed in other countries. Benzodiazepines are controlled
in Schedule IV of the CSA.
Short-acting benzodiazepines
are generally used for patients with sleep-onset insomnia (difficulty
falling asleep) without daytime anxiety. Shorter-acting benzodiazepines
used to manage insomnia include estazolam (ProSom®), flurazepam
(Dalmane®), temazepam (Restoril®), and triazolam (Halcion®).
Midazolam (Versed®), a short-acting benzodiazepine, is utilized
for sedation, anxiety, and amnesia in critical care settings and prior
to anesthesia. It is available in the United States as an injectable preparation
and as a syrup (primarily for pediatric patients).
Benzodiazepines with
a longer duration of action are utilized to treat insomnia in patients
with daytime anxiety. These benzodiazepines include alprazolam (Xanax®),
chlordiazepoxide (librium®), clorazepate (Tranxene®), diazepam
(Valium®, halazepam (Paxipam®), lorzepam (Ativan®),
oxazepam (Serax®), prazepam (Centrax®), and quazepam (Doral®).
Clonazepam (Klonopin®), diazepam, and clorazepate are also used
as anticonvulsants.
Benzodiazepines are
classified in the CSA as depressants. Repeated use of large doses or;
in some cases, daily use of therapeutic doses of benzodiazepines is associated
with amnesia, hostility, irritability, and vivid or disturbing dreams,
as well as tolerance and physical dependence. The withdrawal syndrome
is similar to that of alcohol and may require hospitalization. Abrupt
cessation of benzodiazepines is not recommended and tapering-down the
dose eliminates many of the unpleasant symptoms.
Given the millions
of prescriptions written for benzodiazepines (about 100 million in 1999),
relatively few individuals increase their dose on their own initiative
or engage in drug-seeking behavior. Those individuals who do abuse benzodiazepines
often maintain their drug supply by getting prescriptions from several
doctors, forging prescriptions, or buying diverted pharmaceutical products
on the illicit market. Abuse is frequently associated with adolescents
and young adults who take benzodiazepines to obtain a "high."
This intoxicated state results in reduced inhibition and impaired judgment.
Concurrent use of alcohol or other depressant; with benzodiazepines can
be life threatening. Abuse of benzodiazepines is particularly high among
heroin and cocaine abusers. A large percentage of people entering treatment
for narcotic or cocaine addiction also report abusing benzodiazepines.
Alprazolam and diazepam are the two most frequently encountered benzodiazepines
on the illicit market.
Flunitrazepam (Rohypnol®)
is a benzodiazepine that is not manufactured or legally marketed in the
United States, but is smuggled in by traffickers. In the mid-1990s, flunitrazepam
was extensively trafficked in Florida and Texas. Known as "rophies,"
"roofies," and "roach," flunitrazepam gained popularity
among younger individuals as a "party" drug. It has also been
utilized as a "date rape" drug. In this context, flunitrazepam
is placed in the alcoholic drink of an unsuspecting victim to incapacitate
them and prevent resistance from sexual assault. The victim is frequently
unaware of what has happened to them and often does not report the incident
to authorities. A number of actions by the manufacturer of this drug and
by government agencies have resulted in reducing the availability and
abuse of flunitrazepam in the United States.
Newly Marked Drugs
Zolpidem (Ambien®)
and zaleplon (Sonata®) are two relatively new, benzodiazepine-like
CNS depressants that have been approved for the short-term treatment of
insomnia. Both of these drugs share many of the same properties as the
benzodiazepines and are in Schedule IV of the CSA.
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