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Fatal Poisonings Attributed to Benzodiazepines in Britain during the 1980s

Published online by Cambridge University Press:  02 January 2018

Marc Serfaty  and
George Masterton
Marc Serfaty
Affiliation:
Department of Psychiatry, Royal Victoria Infirmary, Newcastle upon Tyne NEI 4LP
George Masterton*
Affiliation:
Department of Psychological Medicine, Royal Infirmary of Edinburgh, 4 Lauriston Place, Edinburgh EH3 9 YW
*
∗Correspondence
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Abstract

The fatal toxicity indices of benzodiazepines during the 1980s were calculated from national prescribing data and mortality statistics. The overall rate was 5.9 deaths per million prescriptions for benzodiazepines taken alone or with alcohol only, anxiolytics being less toxic than hypnotics. Diazepam appeared more toxic than average among anxiolytics (P<0.05), and flurazepam and temazepam more toxic than average among hypnotics (both P<0.001). It was shown that the finding for diazepam was probably explained by concurrent use of alcohol, which implies that other anxiolytics may be safer in cases where there is alcohol misuse; but the greater toxicity of flurazepam and temazepam remained unexplained. Benzodiazepines are indeed much less toxic than the barbiturates they superseded, but they are not innocuous and temazepam in particular requires further evaluation.

Type
Papers
Information
The British Journal of Psychiatry , Volume 163 , Issue 3 , September 1993 , pp. 386 - 393
Copyright
Copyright © Royal College of Psychiatrists, 1993 

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References

Bailey, D. N. (1984) Blood concentrations and clinical findings following overdose with chlordiazepoxide alone and chlordiazepoxide plus ethanol. Clinical Toxicology, 22, 433–446.Google ScholarPubMed
Barraclough, B. M. & Pallis, D. J. (1975) Depression followed by suicide: a comparison of depressed suicides with living depressives. Psychological Medicine, 5, 55–61.Google Scholar
Brunt, P. (1992) Management of ethanol withdrawal. Prescriber's Journal, 32, 2–8.Google Scholar
Busto, U., Kaplan, H. L. & Sellers, E. M. (1980) Benzodiazepine-associated emergencies in Toronto. American Journal of Psychiatry, 137, 224–227.Google ScholarPubMed
Cassidy, S. & Henry, J. (1987) Fatal toxicity of antidepressant drugs in overdose. British Medical Journal, 295, 1021–1024.Google Scholar
Charnov, J. H. & Sturner, W. Q. (1985) Psychotropic drug-related suicides. Amrican Journal of Forensic Medicine and Pathology, 6, 312–318.CrossRefGoogle ScholarPubMed
Dinovo, E. C., Gottschalk, L. A., McGuire, F. L., et al (1976) Analysis of results of toxicological examinations performed by coroners' or medical examiners' laboratories in 2000 drug-involved deaths in nine major US cities. Clinical Chemistry, 22, 847–850.Google Scholar
Divoll, M., Greenblatt, D. J., Lacasse, Y., et al (1981) Benzodiazepine overdosage: plasma concentrations and clinical outcome. Psychopharmacology, 73, 381–383.CrossRefGoogle ScholarPubMed
Dunbar, G. C., Perera, M. H. & Jenner, F. A. (1989) Patterns of benzodiazepine use in Great Britain as measured by a general population survey. British Journal of Psychiatry, 155, 836–841.CrossRefGoogle ScholarPubMed
Dwyer, P. S. & Jones, I. F. (1984) Fatal self-poisoning in the UK and the paracetamol/dextropropoxyphene combination. Human Toxicology, 3, 145S–174S.CrossRefGoogle ScholarPubMed
Edwards, J. G. (1989) Drug related depression: clinical and epidemiological aspects. In Depression -An Integrative Approach (eds Paykel, E. S. & Hirbst, K.), pp. 81–108. London: Heinemann.Google Scholar
Farrell, M. & Strang, J. (1988) Misuse of temazepam. British Medical Journal, 297, 1402.Google Scholar
Finkle, B. S., McCloskey, K. L. & Goodman, L. S. (1979) Diazepam and drug associated deaths. Journal of the American Medical Association, 242, 429–434.Google Scholar
Forrest, A. R. W., Marsh, I., Bradshaw, C., et al (1986) Fatal temazepam overdoses. Lancet, ii, 226.CrossRefGoogle Scholar
Gorman, J. M. & Davis, J. M. (1989) Benzodiazepines. In A Comprehensive Textbook of Psychiatry (5th edn) (eds Kaplan, H. I. & Sadock, B. J.), pp. 1580–1583. Baltimore: Williams and Wilkins.Google Scholar
Hammersley, R., Lavelle, T. & Forsyth, A. (1990) Buprenorphine and temazepam abuse. British Journal of Addiction, 84, 301–303.Google Scholar
Hojer, J., Baehrendtz, S. & Gustafsson, L. (1989) Benzodiazepine poisoning: experience of 702 admissions to an intensive care unit during a 14-year period. Journal of Internal Medicine, 226, 117–122.Google Scholar
Johns, M. W. (1977) Self-poisoning with barbiturates in England and Wales during 1959–74. British Medical Journal, i, 1128–1130.CrossRefGoogle Scholar
Klee, H., Faugier, J., Hayes, C., et al (1990) AIDS-related behaviour, polydrug use and temazepam. British Journal of Addiction, 85, 1125–1132.Google Scholar
Lader, M. (1978) Benzodiazepines - the opium of the masses? Neuroscience, 3, 159–165.Google Scholar
Marks, J. (1985) The Benzodiazepines: Use, Overuse, Misuse, Abuse (2nd edn). Lancaster: MTP Press.Google Scholar
Martin, C. D. & Chan, S. C. (1986) Distribution of temazepam in body fluids and tissues in lethal overdose. Journal of Analytical Toxicology, 10, 77–78.Google Scholar
Mellinger, G. D., Balter, M. B. & Uhlenhuth, E. H. (1984) Prevalence and correlates of long-term regular use of anxiolytics. Journal of the American Medical Association, 251, 375–379.Google Scholar
Morgan, K., Dallosso, H., Ebrahim, S., et al (1988) Prevalence, frequency and duration of hypnotic use among the elderly living at home. British Medical Journal, 296, 601–602.CrossRefGoogle ScholarPubMed
Morris, J. A. & Gardner, M. J. (1988) Calculating confidence intervals for relative risks (odds ratios) and standardised ratios and rates. British Medical Journal, 296, 1313–1316.Google Scholar
Naranjo, C. A. & Sellers, E. M. (1986) Clinical assessment and pharmacotherapy of the alcohol withdrawal syndrome. In Recent Developments in Alcoholism, Vol 4 (ed. Galanter, M.), pp. 265–281. New York: Plenum Press.Google Scholar
Office of Population Censuses And Surveys (1980–1989a) Mortality Statistics - Accidents and Violence (England and Wales). Series DH4. London: HMSO.Google Scholar
Office of Population Censuses And Surveys (1980–1989b) National Populations (England and Wales). Series DH1. London: HMSO.Google Scholar
Olson, K. R., Yin, L., Osterloh, J., et al (1985) Coma caused by trivial triazolam overdose. American Journal of Emergency Medicine, 3, 210–211.Google Scholar
Perera, K. M. H., Tulley, M. & Jenner, F. A. (1987) The use of benzodiazepines among drug addicts. British Journal of Addiction, 82, 511–515.CrossRefGoogle ScholarPubMed
Petursson, H. & Lader, M. (1981) Withdrawal from long-term benzodiazepine treatment. British Medical Journal, 283, 643–645.Google Scholar
Proudfoot, A. T. & Park, J. (1978) Changing pattern of drugs used for self-poisoning. British Medical Journal, i, 90–93.Google Scholar
Registrar General for Scotland (1980–1989) Annual Report: Mortality Statistics. Scotland: General Registrar Office.Google Scholar
Reidenberg, M. M., Levy, M., Warner, H., et al (1978) Relationship between diazepam dose, plasma level, age and central nervous depression. Clinical Pharmacology and Therapeutics, 23, 371–374.Google Scholar
Rickels, K., Case, W. G., Schweizer, E. E., et al (1986) Low-dose dependence in chronic benzodiazepine users: a preliminary report on 119 patients. Psychopharmacology Bulletin, 22, 407–415.Google Scholar
Rickels, K., Case, W. G., Schweizer, E. E., & Schweizer, E. (1987) Psychiatric indications for benzodiazepines. In The Benzodiazepines in Current Clinical Practice (eds Freeman, H. & Rue, Y.), pp. 35–41. Royal Society of Medicine International Congress and Symposium Series, No. 114. London: Royal Society of Medicine.Google Scholar
Rickels, K., Case, W. G., Schweizer, E. E., & Schweizer, E., Case, W. G., et al (1990) Long-term therapeutic use of benzodiazepines - 1. Effects of abrupt discontinuation. Archives of General Psychiatry, 47, 899–907.CrossRefGoogle ScholarPubMed
Rodrigo, E. K., King, M. B. & Williams, P. (1988) Health of long-term benzodiazepine users. British Medical Journal, 296, 603–606.Google Scholar
Royal College Of Psychiatrists (1988) Benzodiazepines and dependence: a college statement. Psychiatric Bulletin, 12, 107–108.Google Scholar
Ryan, H. F., Merrill, B. F., Scott, G. E., et al (1968) Increased suicidal thoughts and tendencies: association with diazepam therapy. Journal of the American Medical Association, 203, 1137–1139.Google Scholar
Sakol, M. S., Stark, C. & Sykes, R. (1989) Buprenorphine and temazepam abuse by drug takers in Glasgow - an increase. British Journal of Addiction, 84, 439–441.CrossRefGoogle ScholarPubMed
Skegg, D. C. G., Richards, S. M. & Doll, R. (1979) Minor tranquillizers and road accidents. British Medical Journal, i, 917–919.CrossRefGoogle Scholar
Stark, C., Sykes, R. & Mullin, P. (1987) Temazepam abuse. Lancet, ii, 802–803.Google Scholar
Taylor, D. (1987) Current usage of benzodiazepines in Britain. In The Benzodiazepines in Current Clinical Practice (eds Freeman, H. & Rue, Y.), pp. 13–17. Royal Society of Medicine International Congress and Symposium Series, No. 114. London: Royal Society of Medicine.Google Scholar
Taylor, D. (1989a) Guidelines for withdrawing benzodiazepines. British Journal of Pharmaceutical Practice, 11, 106–110.Google Scholar
Taylor, F. K. (1989b) The damnation of benzodiazepines. British Journal of Psychiatry, 154, 697–704.Google Scholar
Turner, P. (1987) Benzodiazepines and the general physician. In The Benzodiazepines in Current Clinical Practice (eds Freeman, H. & Rue, Y.), pp. 47–50. Royal Society of Medicine International Congress and Symposium Series, No. 114. London: Royal Society of Medicine.Google Scholar
Tyrer, P. (1987) Benefits and risks of benzodiazepines. In The Benzodiazepines in Current Clinical Practice (eds Freeman, H. & Rue, Y.), pp. 3–11. Royal Society of Medicine International Congress and Symposium Series, No. 114. London: Royal Society of Medicine.Google Scholar
Tyrer, P. & Murphy, S. (1987) The place of benzodiazepines in psychiatric practice. British Journal of Psychiatry, 151, 719–723.Google Scholar
Vale, J. A., Buckley, B. M. & Meredith, T. J. (1984) Deaths from paracetamol and dextropropoxyphene (Distalgesic) in England and Wales in 1979. Human Toxicology, 3, 135S–143S.Google Scholar
Whitman, J. G. (1991) Flumazenil. Prescribers' Journal, 31, 57–60.Google Scholar
Williams, P. (1978) Physical ill-health and psychotropic drug prescription: a review. Psychological Medicine, 8, 683–693.CrossRefGoogle ScholarPubMed
Williams, P. (1987) Long-term benzodiazepine use in general practice. In The Benzodiazepines in Current Clinical Practice (eds Freeman, H. & Rue, Y.), pp. 19–31. Royal Society of Medicine International Congress and Symposium Series, No. 114. London: Royal Society of Medicine.Google Scholar
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