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.