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Darke S, Hall W, Ross M, Wodak A.
Benzodiazepine Use and HIV Risk-Taking Behaviour Among Injecting Drug Users.
Drug and Alcohol Dependence 1992; 31: 31-36.
" Given the associations between benzodiazepine use and injecting drug use found in this study, the high prevalence of benzodiazepine use is cause for concern. " [p. 35]
" In summary, this study found a high prevalence of benzodiazepine use among IDU ("injecting drug users") and that the use of benzodiazepines was associated with more HIV risk-taking. The demographic and drug use profiles of this group indicate them to be a more dysfunctional group of IDU. "
[Key words; addiction, abuse, dependence, withdrawal]
De la Fuente JR, Rosenbaum AH, Martin HR, Niven RG.
Lorazepam-Related Withdrawal Seizures.
Mayo Clinic Proceedings 1980; 55: 190-192.
" To our knowledge, there has been only one study in which discontinuing the use of lorazepam was reported to cause severe symptoms. It was performed in Brussels by De Buck and published in 1973. Two of his
patients who were taking therapeutic dosages of lorazepam had epileptic-like seizures as withdrawal symptoms. This dangerous side effect has been overlooked in the American literature, perhaps because De Buck's study was conducted overseas some time before
lorazepam was introduced in the United States and because this drug still is used less frequently as compared with tranquilizers of similiar chemical composition. "
" As with barbiturates, withdrawal of minor tranquilizers can precipitate seizures as the major clinical manifestation of the abstinence syndrome; because of a cross tolerance phenomenon, epileptic-like convulsions are prevented only by administration of the same drug or another drug from a related group. "
" This report adduces further testimony that severe withdrawal symptoms can occur with this class of tranquilizers and that lorazepam is, in this respect, like other benzodiazepine derivatives. Any patient being treated with lorazepam should be reevaluated
continually for the development of psychological or physical dependence. As these and other psychoactive drugs are used increasingly in general medicine, there is a need for close
attention to not only their clinical indications but also their possible side effects. " [p. 192]
[Key words; Ativan, lorazepam, addiction, abuse, dependence, seizures]
Dimascio A, Shader RI, Harmatz J.
Psychotropic Drugs and Induced Hostility.
Psychosomatics 1969; 10: 46-47.
" We generally call it a "paradoxical reaction" of the drug when a patient responds in a manner inconsistent with - or opposite to - our conception of how he or she should respond to a psychotropic agent. But it is only our lack of knowledge - or our limited conception of what these drugs do and in whom the do what that
necessitates the label "paradoxical". With knowledge, these actions should not remain "paradoxical" but become "predictable drug effects. " [p. 46]
" These drugs are also supposed to calm and quiet agitated and irritable individuals. Indeed, if you
remember, when chlordiazepoxide was first introduced, it was publicized as being able to tame even the wildest and most ferocious of animals, without reducing their ability to move about. The initial expectation, therefore, was that it would do the same in
man. However, even from the beginning of the use of the drug, it was noted that in some patients a state of increased anger, irritability and overt aggression was induced or unmasked.
Because it was not expected, the phenomenon was labelled as "paradoxical". [p. 46]
" We have seen a number of previously quiet patients become assaultive and break up furniture in an office, shortly after being placed on chlordiazepoxide or another benzodiazepine, diazepam (Valium). In fact, even acts of violence such as murder have been
attributed to the rage reaction induced by these drugs (Georgia vs Robinson 1962 and Ohio vs Page 1967). "
" When prescribing for patients with anxiety states the potential action of these drugs on hostility and aggression has to also be considered. " [p. 47]
[Key words; Librium, Valium, chlordiazepoxide, diazepam, aggression, hostility, disinhibition, paradoxical effects]
Drummond LM, Matthews HP.
Obsessive-Compulsive Disorder Occurring as a Complication in Benzodiazepine Withdrawal.
Journal of Nervous and Mental Disease 1988; 176: 688-691.
A case history of obsessive-compulsive disorder occurring in
a 32-year-old woman after benzodiazepine withdrawal is presented. The possible biochemical and neuropsychological mechanisms involved in the etiology and maintenance of this condition are reviewed. [SUMMARY p.688]
[Key words; Valium, diazepam, addiction, dependence, withdrawal, protracted withdrawal syndrome, OCD]
Some Problems with Benzodiazepines.
Drug and Therapeutics Bulletin 1985; 23: 21-23.
" Short-term administration of benzodiazepines impairs psychomotor function and can produce anterograde amnesia. Chronic benzodiazepine users takers have lower scores on some psychological tests than controls matched for age and sex. Such test performances were more impaired than simpler tests of psychomotor function. Whether these findings indicate that long-term use impairs intelligence is unknown, as pre-benzodiazepine tests were not available; there may
well be other reasons for a difference between benzodiazepine users and non users. " [p. 22]
[Key words; cognitive impairment, amnesia, memory impairment, long-term effects]
Benzodiazepines and Dependence.
Statens Offentliga Utredningar 1993; 5 bilaga 4: 135-140.
" Internationally concern has been translated into warnings about careful usage, but the current legal actions in the UK, particularly, indicate that in a country which has the most stringent warnings, there is a perceived current problem of dependence arising from the therapeutic use of these drugs.
This perception may be both an under- or over-estimate of the real risk from the bz's. because of the unknown balance between under-reporting and over estimates related to disease recurrence rather than withdrawal per se. Whatever the nature of the dependence on these drugs there may be considerable individual suffering when attempts are made at bz. withdrawal, unless it is done very carefully and caution dictates that these drugs should be used with great discrimination. [p. 138]
[Key words; dependence, withdrawal]
Adverse Effects of Antianxiety Drugs.
Drugs 1981; 22: 495-514.
" The behaviour of patients in whom one suspects benzodiazepine dependence is alo notheworthy.
In practice we see patients who claim that benzodiazepines have cured their anxiety, while at the same time they continue to demand drugs. Many refuse a trial period without medication. Patients who have been successfully treated with antidepressants or antispychotic drugs, although experiencing relief from equally distressing symptoms (including anxiety secondary to the underlying disorder), generally seem not so reluctant to have their treatment stopped. The situation with benzodiazepines is reminiscent of that encountered with other drugs of dependence.
Physicians who carried out ratings on the severity of addiction, blind to the type of drug, changed their opinions when it was revealed that the drug in question was diazepam (Maletzky and Klotter, 1976). This showed a reluctance to accept that benzodiazepines are drugs of addiction. It is perhaps humiliating for us to realise that we have learnt little from history. Is it possible that having previously contributed to barbiturate and other addiction we are now reluctant to accept that we may have also contributed to benzodiazepine addiction ?
[Key words; addiction, dependence]
Ericsson HR, Holmgren P, Jakobsson SW,
Lafolie P, De Rees B.
[ Benzodiazepine Findings in an Autopsy Series
A Study Showing Interacting Factors at Death.]
Lškartidningen 1993; 90: 3954-3957.
" The paper consists in a report of a retrospective study (of data from 1987) on the prevalence of benzodiazepines in blood at the time of death. Of 2,007 autopsies, forensic chemical analyses were performed in 1,587 cases, in 159 of which benzodiazepines were found. Of these 159 deaths, 22 were considered to be due to natural causes, and in another 22 cases the cause of death was still unclear after examination; the remaining 115 deaths were
due to accidents (N16), suicide (N60), drug addiction (N29) or alcoholism (N10). Multiple benzodiazepine intake was found in 37 cases, a subgroup including all 29 cases of death due to drug addiction. In a comparison of suicides and natural deaths, the concentrations both of flunitrazepam and nitrazepam were significantly higher among the suicides (---). In four cases, the sole cause of death was benzodiazepine intake.
It is concluded that some benzodiazepines, particularly flunitrazepam, may be more toxic than previously supposed. "
[Key words; Rohypnol, flunitrazepam, poisoning, suicide]
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