Primary prevention
BZDs lead to dependence and tolerance in a short period of time. They should only be prescribed for a limited time. However, some physicians may disregard this recommendation.
Although tolerance to BZDs is common, it does not typically result in a need for increased dosage in stable patients.[19] Therefore, patient requests for increasing dosage should be examined for evidence of abuse or diversion.
Since one in every ten high school seniors have reportedly taken prescription BZDs, either medically or nonmedically, prescriptions for adolescents should be monitored closely, stored safely, and disposed of properly in order to reduce BZD diversion.[20]
For outpatient treatment of BZD withdrawal, it is recommended that the drug should first be replaced with an equivalent dose of another BZD with an intermediate or long-acting effect. The dose should then be reduced weekly.[21]
While BZDs are generally intended for short-term use, the proportion of patients on long-term BZD treatment increases with age from 14.7% (18-35 years) to 31.4% (65-80 years). In all age groups, around 25% of individuals receiving BZD involved long-acting BZD use.[22] Some investigators attribute the long-term prescriptions to primary care physicians who are beleaguered by patients requesting hypnotic and anxiolytic medication, and who find it extremely difficult to persuade these patients to use nonpharmacologic approaches.[23]
The chronic use of BZDs causes numerous adverse effects, including cognitive impairments, falls, dependence, and tolerance.
Chronic BZD use is associated with an increased risk of being involved in a traffic accident.[24]
Chronic BZD users have an increased risk (adjusted hazard ratio 3.15; 95% CI 2.37 to 4.20) of benign brain tumor compared with non-users.[25]
Chronic obstructive pulmonary disease is present in about one third of all BZD users, who are typically also treated with medications for insomnia, anxiety, depression, and dyspnea, which greatly increases the risk of drug interactions.
Because BZDs are respiratory depressors, physicians should be alert for refractory dyspnea.[26]
BZD use is associated with an increased risk of Alzheimer disease.[27]
BZD use, particularly in the elderly, increases the risk of hip fracture; the risk increases by 60% within the first 2 weeks of use, and 80% after 1 month.
Patients with chronic BZD use often report a significant reduction in their quality of life with physical and emotional impairment. Overuse, in particular, reduces social functioning, and causes high levels of psychological distress.[24]
Further dependence or addiction is associated with higher neuroticism, introversion, and less effective coping mechanisms to adverse life events.[28]
In 2021 the CDC launched an education campaign aimed at preventing drug overdose deaths. The campaign targets young adults and provides information about the dangers of fentanyl (an opioid analgesic), the risks of polysubstance abuse, the effects of naloxone (an opioid receptor antagonist) and the importance of reducing stigma around drug use.[29]
Use of this content is subject to our disclaimer