Benzodiazepines in Psychiatric Disorder Management: The Safe Ways to Use

Benzodiazepines are one of the commonly prescribed psychotropic medications with significant abuse potential. As per the national drug use survey report, 1.08% of the Indian population are current users of sedative and hypnotic agents.^[1] Among the general population, 0.11% are using sedative agents in a dependence pattern.^[1] However, benzodiazepine dependence or abuse is high in clinical settings. Patients seeking consultations for various health issues often receive benzodiazepines and develop dependence over time. In an Indian tertiary care mental health setting, benzodiazepine abuse was higher; alprazolam and nitrazepam are the most common benzodiazepines abused.^[2] An Indian study reports that benzodiazepines are commonly prescribed to psychiatric patients, and the most common indication is to treat anxiety.^[3] In a survey on the UK population, it was found that 7.7% of participants self-reported abuse of benzodiazepines in their lifetime, and the common reasons are to deal with sleep difficulties, stress, and anxiety.^[4] This study reported that the common source of availing benzodiazepines is from healthcare professionals.^[4] It has been reported in clinical practice that patients are continuing benzodiazepines for a longer time than recommended, on higher doses of benzodiazepines than indicated or on multiple benzodiazepines, which increases the risk of development of benzodiazepine dependence. No evidence combining multiple benzodiazepines gives any additional benefit than prescribing a single benzodiazepine.^[5]

Benzodiazepine misuse is an under-recognized issue. Promoting public health and ensuring the well-being of individuals who use benzodiazepines requires preventing dependence on these medications. Benzodiazepines are prescription drugs frequently used to treat anxiety, insomnia, and specific medical conditions. Even though they can offer significant relief, their potential for addiction and dependence is a significant concern. Below are some strategies and guidelines for preventing benzodiazepine dependence:

1. Limit Duration and Dosage: It’s recommended that healthcare providers prescribe benzodiazepines for the shortest amount of time and at the lowest effective dose possible. This helps to lower the risk of developing tolerance and dependence.

2. Careful Prescribing: Healthcare providers must be careful when prescribing benzodiazepines to people with a history of substance abuse or addiction. They should explore alternative treatments and discuss the potential risks and benefits of benzodiazepine use. Though it is unethical and unfortunate to prescribe multiple benzodiazepines to a patient, it is not uncommon. It is better to avoid prescribing multiple benzodiazepines in each patient to prevent the development of benzodiazepine dependence.^[5]

3. Regular Reassessment: It is vital for healthcare providers to periodically evaluate patients who are taking benzodiazepines to determine if ongoing usage is still required. If the underlying condition being treated has improved, the healthcare provider should consider gradually reducing or stopping the medication.^{[6, 7]}

4. Alternative Treatments: When dealing with anxiety and insomnia, it’s worth considering non-pharmacological interventions such as cognitive-behavioral therapy (CBT), relaxation techniques, and lifestyle adjustments. These treatments can provide effective relief without the potential risk of dependence.^[8]

5. Combination Therapy: Sometimes, it may be beneficial to combine benzodiazepines with other treatments or medicines to achieve better results while reducing the amount and length of time that the benzodiazepines need to be taken.

6. Tapering: Individuals taking benzodiazepines for a long time must gradually discontinue their medication through a supervised tapering process by medical professionals. Abruptly stopping the use of benzodiazepines can result in severe withdrawal symptoms.^[6]

7. Monitoring: Healthcare providers need to closely monitor patients who are using benzodiazepine medication for an extended period. This involves conducting regular check-ups to evaluate the effectiveness of the medication and to detect any indications of dependence or adverse effects.^[9]

8. Patient Education: Healthcare professionals must educate patients about the potential risks associated with benzodiazepines, including the risk of developing dependence. Patients should be informed that these medications are intended for short-term use and that prolonged use may result in tolerance, withdrawal symptoms, and addiction.^[7]

9. Public Awareness Campaigns: Public health campaigns and educational initiatives can help raise awareness about the potential risks of benzodiazepine use and the importance of responsible medication management.

10. Support and Resources: Access to addiction treatment services, counseling, and support groups is crucial for individuals battling benzodiazepine dependence. These resources provide the essential assistance required to conquer dependency and recover successfully.

To avoid benzodiazepine dependence, adopting a comprehensive approach involving healthcare providers, patients, regulatory bodies, and society is essential. Responsible prescribing practices, patient education, and alternative treatments can help minimize the risks associated with benzodiazepine use. This approach can lead to better outcomes for individuals’ mental health and overall well-being. Prescription auditing is another measure that can give better insight into the prescription pattern of benzodiazepines and may help in cautious prescriptions of benzodiazepines by clinicians.