Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-586b7cd67f-l7hp2 Total loading time: 0 Render date: 2024-11-22T18:28:49.709Z Has data issue: false hasContentIssue false

Chapter 4 - Addiction to Prescription Medication: Benzodiazepines, Z-Drugs and Gabapentinoids

Published online by Cambridge University Press:  02 November 2021

By
Emma Rourke  and
Fergus Law
Edited by
Ed Day
Get access

Summary

Benzodiazepines, Z-drugs and gabapentinoids are commonly prescribed medications with multiple indications that have the potential for misuse and dependence. Benzodiazepines enhance the effect of the neurotransmitter gamma-aminobutyric acid (GABA) at the GABA-A receptor, resulting in sedative, anxiolytic, hypnotic, anticonvulsant and muscle relaxant properties. The ‘Z-drugs’ (zopiclone and zolpidem) are non-benzodiazepine hypnotics that also have an agonist effect at the GABA-A receptor. The gabapentinoids (pregabalin and gabapentin) act to decrease central neuronal excitability by binding to α2-δ protein subunits of voltage-activated calcium channels on the neuronal membrane. They were initially marketed as antiepileptic drugs, but are now licensed for use in neuropathic pain and generalised anxiety disorder. This chapter considers each class in turn, exploring the pharmacokinetics, metabolism and potential desired effects that lead to misuse. A practical method for assessing people with potential dependence is described for each substance, as well as strategies to support stabilisation, withdrawal and relapse prevention.

Keywords

benzodiazepinezopiclonezolpidempregabalingabapentindependencestabilisationdetoxificationwithdrawal
Type
Chapter
Information
Seminars in Addiction Psychiatry , pp. 68 - 96
Publisher: Cambridge University Press
Print publication year: 2021

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

de las Cuevas, C., Sanz, E., de la Fuente, J. Benzodiazepines: more ‘behavioural’ addiction than dependence. Psychopharmacology. 2003; 167 (3): 297–303.Google Scholar
Gossop, M., Marsden, J., Stewart, D., Kidd, T. The National Treatment Outcome Research Study (NTORS): 4–5 year follow-up results. Addiction. 2003; 98: 291–303.Google Scholar
National Institute for Health and Care Excellence. Generalised anxiety disorder and panic disorder in adults: management (CG113). In: Clinical Guideline. NICE, 2011.Google Scholar
Baldwin, D. S., Aitchison, K., Bateson, A., Curran, H. V., Davies, S., Leonard, B. et al. Benzodiazepines: Risks and benefits – A reconsideration. Journal of Psychopharmacology. 2013; 27 (11): 967–71.Google Scholar
National Institute for Health and Care Excellence. Guidance on the use of zaleplon, zolpidem and zopiclone for the short-term management of insomnia: Technology appraisal guidance (TA77). In: Technology Appraisal. NICE, 2004.Google Scholar
Wilson, S., Anderson, K., Baldwin, D., Dijk, D.-J., Espie, A., Espie, C. et al. British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders: An update. Journal of Psychopharmacology. 2019; 33 (8): 923–47.Google Scholar
Office for National Statistics. Deaths Related to Drug Poisoning in England and Wales, 2019. ONS, 2020.Google Scholar
National Records of Scotland. Drug-Related Deaths in Scotland in 2019. National Statistics for Scotland, 2020.Google Scholar
NHS Business Services Authority. Prescription Cost Analysis – England 2019. NHSBSA, 16 April 2020.Google Scholar
Cumming, R. G., Le Couteur, D. G. Benzodiazepines and risk of hip fractures in older people: A review of the evidence. CNS Drugs. 2003; 17 (11): 825–37.CrossRefGoogle ScholarPubMed
Ford, C., Law, F. Guidance for the Use and Reduction of Misuse of Benzodiazepines and Other Hypnotics and Anxiolytics in General Practice. SMMGP, 2014.Google Scholar
Parsaik, A. K., Mascarenhas, S. S., Khosh-Chashm, D., Hashmi, A., John, V., Okusaga, O. et al. Mortality associated with anxiolytic and hypnotic drugs: A systematic review and meta-analysis. Australian and New Zealand Journal of Psychiatry. 2016; 50 (6): 520–33.Google Scholar
Zhang, T., Yang, X., Zhou, J., Liu, P., Wang, H., Li, A. et al. Benzodiazepine drug use and cancer risk: A dose–response meta-analysis of prospective cohort studies. Oncotarget. 2017; 8 (60): 381–91.Google Scholar
Iqbal, M. M., Sobhan, T., Ryals, T. Effects of commonly used benzodiazepines on the fetus, the neonate, and the nursing infant. Psychiatric Services. 2002; 53 (1),39–49.Google Scholar
Kan, C. C., Breteler, M. H., van der Ven, A. H., Timmermans, M. A., Zitman, F. G. Assessment of benzodiazepine dependence in alcohol and drug dependent outpatients: a research report. Substance Use and Misuse. 2001; 36 (8): 1085–109.Google Scholar
de Wit, H., Doty, P. Preference for ethanol and diazepam in light and moderate social drinkers: A within-subjects study. Psychopharmacology (Berl). 1994; 115: 529–38.CrossRefGoogle ScholarPubMed
Lingford-Hughes, A. R., Welch, S., Peters, L., Nutt, D. J., Ball, D., Buntwal, N. et al. BAP updated guidelines – Evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: recommendations from BAP. Journal of Psychopharmacology. 2012; 26 (7): 899–952.Google Scholar
Independent Expert Working Group. Clinical Guidelines on Drug Misuse and Dependence Update, 2017. Drug Misuse and Dependence: UK Guidelines on Clinical Management. Department of Health, 2017.Google Scholar
Kuryshev, Y. A., Bruening-Wright, A., Brown, A. M., Kirsch, G. E. Increased cardiac risk in concomitant methadone and diazepam treatment: Pharmacodynamic interactions in cardiac ion channels. Journal of Cardiovascular Pharmacology. 2010; 56 (4): 420–30.Google Scholar
Ashton, C. H. Benzodiazepines: How They Work and How to Withdraw. Newcastle University Institute of Neuroscience, 2002.Google Scholar
Busto, U. E., Sykora, K., Sellers, E. M. A clinical scale to assess benzodiazepine withdrawal. Journal of Clinical Psychopharmacology. 1989 9 (6): 412–16.Google Scholar
Wilson, S., Anderson, K., Baldwin, D., Dijk, D.-J., Espie, A., Espie, C. et al. British Association for Psychopharmacology consensus statement on evidence-based treatment of insomnia, parasomnias and circadian rhythm disorders: An update. Journal of Psychopharmacology. 2019; 33 (8): 923–47.Google Scholar
Evoy, K. E., Morrison, M. D., Saklad, S. R. Abuse and misuse of pregabalin and gabapentin. Drugs. 2017; 77 (4): 403–26.Google Scholar
Gahr, M., Freudenmann, R., Kölle, M., Schönfeldt-Lecuona, C. Pregabalin and addiction: Lessons from published cases. Journal of Substance Use. 2013; 19 (6): 448–9.Google Scholar
National Institute for Health and Care Excellence. Neuropathic Pain – Drug Treatment. 2020. [Available from: https://cks.nice.org.uk/topics/neuropathic-pain-drug-treatment/#!scenario.]Google Scholar
Baldwin, D. S., den Boer, J. A., Lyndon, G., Emir, B., Schweizer, E., Haswell, H. Efficacy and safety of pregabalin in generalised anxiety disorder: A critical review of the literature. Journal of Psychopharmacology. 2015; 29 (10): 1047–60.Google Scholar
Schifano, F., D’Offizi, S., Piccione, M., Corazza, O., Deluca, P., Davey, Z. et al. Is there a recreational misuse potential for pregabalin? Analysis of anecdotal online reports in comparison with related gabapentin and clonazepam data. Psychotherapy and Psychosomatics. 2011; 80 (2): 118–22.CrossRefGoogle Scholar
Smith, R. V., Havens, J. R., Walsh, S. L. Gabapentin misuse, abuse and diversion: A systematic review. Addiction. 2016; 111 (7): 1160–74.Google Scholar
Bockbrader, H. N., Wesche, D., Miller, R., Chapel, S., Janiczek, N., Burger, P. A comparison of the pharmacokinetics and pharmacodynamics of pregabalin and gabapentin. Clinical Pharmacokinetics. 2010; 49 (10): 661–9.Google Scholar
Lyndon, A., Audrey, S., Wells, C., Burnell, E. S., Ingle, S., Hill, R., Hickman, M., Henderson, G. Risk to heroin users of polydrug use of pregabalin or gabapentin. Addiction. 2017; 112 (9): 1580–9.Google Scholar
Freynhagen, R., Backonja, M., Schug, S., Lyndon, G., Parsons, B., Watt, S. et al. Pregabalin for the treatment of drug and alcohol withdrawal symptoms: A comprehensive review. CNS Drugs. 2016; 30 (12): 1191–200.Google Scholar
Olive, M. F., Cleva, R. M., Kalivas, P. W., Malcolm, R. J. Glutamatergic medications for the treatment of drug and behavioral addictions. Pharmacology Biochemistry and Behavior. 2012; 100 (4): 801–10.Google Scholar
Tyrer, P, Murphy, S, Riley, P. The Benzodiazepine Withdrawal Symptom Questionnaire. Journal of Affective Disorders 1990; 19 (1): 53–61.Google Scholar
de las Cuevas, C, Sanz, E. J., de la Fuente, J.A., Padilla, J., Berenguer, J.C. The Severity of Dependence Scale (SDS) as screening test for benzodiazepine dependence: SDS validation study. Addiction. 2000; 95 (2): 245–50.Google Scholar
Kobayashi, M., Okajima, I., Narisawa, H., Kikuchi, T., Matsui, K., Inada, K., et al. Development of a new benzodiazepine hypnotics withdrawal symptom scale. Sleep and Biological Rhythms 2018; 16: 263–71.Google Scholar
Narisawa, H., Inoue, Y., Kobayashi, M., Okajima, I., Kikuchi, T., Kagimura, T., et al. Development and validation of the Benzodiazepine Hypnotics Withdrawal Symptom Scale (BHWSS) based on item response theory. Psychiatry Research 2021; 300: 113900.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×