Benzodiazepine: Usage trends

Last modified: Thursday, 25. December 2008 - 7:16 am

Benzodiazepines are very commonly prescribed, and have consistently made the annual list of drugs most prescribed by physicians for many years. According to Pharmacy Times, the category of benzodiazepines ranked seventh in the list of the “Top 20 Product Categories,” according to the total number of new prescriptions of benzodiazepines that were dispensed that year, which was 39,322,000. They ranked ninth on Pharmacy Times list of the “Top 20 Leading Product Categories for 2000,” according to the total prescriptions dispensed, which were 66,564,000 for that year.

Alprazolam (Xanax), which was developed and introduced in 1981, is still the most prescribed benzodiazepine. It causes fewer side effects, because the body can eliminate it in less than 12 hours. Chlordiazepoxide (Klonopin) is the second most commonly prescribed benzodiazepine.

Benzodiazepines are most commonly prescribed for women and elderly patients. This may be partially due to the fact that women, in general, seem to be more willing to seek psychological help than men. In addition, four out of five people who experience panic attacks are women. Elderly patients are commonly afflicted with other conditions, such as insomnia and depression, which respond well to treatment with benzodiazepines.

Although benzodiazepines are the most commonly prescribed psychoactive drugs in the world, they are rarely used as recreational drugs because they have only mild to moderate euphoriant effects. According to reports from the United States Drug Enforcement Agency, these drugs are not valued on the street in the same way cocaine, heroin, or even alcohol is; therefore they are relatively inexpensive. Abuse of benzodiazepines is high among heroin and cocaine abusers. Abuse is found among adolescents and young adults as well, who may take these drugs to get buzzed. According to an in-depth review of the benzodiazepines in American Family Physician in 2000, about 80% of benzodiazepine abuse is in those who use other drugs, opioid users being the most common.

The dark side to benzodiazepines is that they are the most commonly implicated substances in drug overdoses, many of which are a result of combining benzodiazepines with other drugs, including alcohol. Two of the benzodiazepines commonly prescribed for sleep — flurazepam (Dalmane) and temazepam (Restoril) — were associated with the most deaths per million prescriptions.

Hospital admissions due to benzodiazepine abuse have been studied as well. According to the Treatment Episode Data Set (TEDS) from the Substance Abuse and Mental Health Services Administration (SAMHSA) of the United States Department of Health and Human Services, tranquilizers such as the benzodiazepines were the primary substance of 0.3% of TEDS admissions in 1998. In addition, 39% of patients admitted for tranquilizer use reported abuse of alcohol as well as tranquilizers. Admissions for tranquilizer abuse were mostly female (48%) and white (90%).

A full 61% of the hospital admissions were aged 35 and older. Interestingly, the data also show that 32% of tranquilizer admissions patients first used tranquilizers after the age of 30. This is consistent with other data and surveys, which also show that the use of tranquilizers, including benzodiazepines, increases with age.

Patterns of benzodiazepine use in young adults can be found in a survey entitled Monitoring the Future: National Survey Results on Drug Use, 1975-2000. Volume II: College Students and Adults Ages 19-40. This is a compilation of data from a long-term research program conducted by the University of Michigan’s Institute for Social Research, with funding from the National Institute on Drug Abuse.

The survey consists of a series of ongoing national annual surveys of high school seniors (begun in 1975) and of eighth and tenth grade students (begun in 1991). Follow-up surveys of the previous participants from each high school senior class were also conducted, starting with the class of 1976. Volume 2 of the survey is a compilation of the resulting surveys from graduating high school seniors (from the classes of 1976 through 1999) as they moved into adulthood through age 40. These data were used to determine the most updated prevalence rates of benzodiazepine use in young adults.

Overall, the survey found that there were steady increases in the use of all agents that were CNS depressants, such as benzodiazepines among high school seniors, college students, and young adults. From the 1970s through the early 1990s, usage of these drugs declined. A small increase in the use of these drug, however, has become evident from the early 1990s through 2000.

According to the survey data, the annual prevalence of the use of benzodiazepines among college students dropped by 50% between the years of 1980 to 1984 (6.9% to 3.5%, respectively), and then dropped by another 50% between 1984 and 1994 (to 1.8%). Then, usage rates began a steady increase, reaching 4.2% by 2000. In young adults not considered to be college students, these rates dropped more sharply during the early 1980s. Similarly, in high school seniors, the use of benzodiazepines also dropped from 1977 to 1992 (from 10.8% to 2.8%, respectively), and then rose to a total of 5.7% in 2000.

According to this same survey, the lifetime prevalence of use of tranquilizers in the year 2000 for full-time college students was low, at 8.8%, as compared to young adults who were one to four years beyond high school in the same age group, which was 12.7%. This was higher among full-time college students who were male than in those who were female (10.0% vs. 7.9%, respectively). These drugs were most likely to be used by non-collegiate males (14.5%), and to a lesser degree, females (11.3%).

In this survey, college students were defined as high school graduates who were one to four years past high school and who were enrolled full-time in a two-year or four-year college at the beginning of March of the year reported on. For each year of the survey, roughly 1,100 to 1,500 respondents comprised the college student sample, and about 1,000 to 1,700 respondents comprised the group of young adults not considered college students.

Young men not enrolled in college were the most common users of benzodiazepines in the year 2000. Young adults who were not in college were also more likely than college students to use these drugs. Annual use of benzodiazepines was again most likely in young adult men who were not full-time college students (7.6%), followed by women who were not students (6.3%), compared with only 4.8% of full-time college males and only 3.8% of full-time college female students. Overall, the annual prevalence of the use of benzodiazepines in all young adults enrolled full-time in college was 4.2%, compared with 6.8% in young adults not enrolled in full-time college.

In this same survey, many young adults reported that benzodiazepines were readily available to them (37-38%). This availability was decreased in the long term among young adults aged 19-22 years, with 36.5% saying that these drugs were “fairly easy” or “very easy” to get in 2000. This was a decrease from the 37.1% who reported this availability in 1999, and a decrease from the 67.4% who reported this in 1980.

Among 19-22 year olds, the percentage of youths reporting that most or all of their friends used benzodiazepine increased, from 1.9% in 1980 to 2.1% in 2000. There was also an increase of 0.9% in the number of 19 to 22 year olds who reported that most or all of their friends used benzodiazepines from 1999 to 2000.

The percentage of young adults aged 19-22 years who reported that they had any exposure to benzodiazepines also increased from 14.3% in 1999 to 18.5% in 2000, an increase of 4.3%. This was decreased, however, from responses in 1980, when a full 29.6% of young adults in this age group reported having any exposure to benzodiazepines. In those saying they were often exposed to benzodiazepine use, the percentage again increased, from 1.5% in 1999 to 1.7% in 2000, an increase of 0.2%.

Lifetime use of benzodiazepines has decreased slighty over the years, but this reduction has been minimal. According to the results from an annual survey done by SAMSHA (Substance Abuse and Mental Health Services Administration, of the United States Department of Health), use of tranquilizers or benzodiazepines has decreased. Data from SAMSHAs 2000 National Household Survey on Drug Abuse shows that in persons aged 18-25, lifetime use of tranquilizers decreased from 7.9% in 1999 to 7.4% in 2000. Past year usage of tranquilizers in this age group also decreased, from 3.1% in 1999, to 3.0% in 2000. Finally, past month usage of tranquilizers in the 18 to 25-year-old respondents to the survey decreased, from 1.1% in 1999, to 1.0% in 2000.

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