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Benzodiazepines and other psychotropic drugs.

Part 1 - Effects and Hazards

Drugs from the group of benzodiazepines are psychotropic drugs with different pharmacodynamic active components. However, because of their considerable addictive potential, long-term use should be avoided. For this reason, numerous current media reports are again warning against abuse.

In the first part of this series of articles, the properties as well as the dangers and risks are discussed. Then, in three sequels, the dazzling history of their discovery and development is reported.

Properties of the benzodiazepines

Since it was discovered Leo H. Sternbach (1908 - 2005) in the 1960s Benzodiazepines one of the most prescribed drugs worldwide. They have in their spectrum of activity anxiolytic (anti-anxiety), sedating (calming), hypnotic (sleep-inducing, sleep-promoting), anticonvulsant (antispasmodic) and central muscle relaxing (relaxing) components.

The dazzling Discovery story The benzodiazepines will be described in a later section of this article and is an impressive pharmaceutical and medical historical document. First, however, the most important pharmacological properties of this class of substances should be discussed:

Compared to many other psychiatric drugs, the Benzodiazepines the benefit of an unusually large therapeutic Width. This means that the difference between a desired blood level and toxic or even life-threatening concentrations is extremely large. Lethal MonoIntoxications with classic benzodiazepines are therefore rarely observed.

Benzodiazepines are feared as Interaction partner mixed intoxication, for example with alcohol or other centrally active foreign substances, which can often be fatal. The effects can still be numerous relevant to traffic medicine Failure symptoms are assigned. For example, the Anxiolysis (anti-anxiety effect) go hand in hand with disinhibition and increased willingness to take risks, while the sedative and hypnotic Effects often lead to a reduced attention and a restricted ability to react. After all, he can muscle relaxing effect have negative effects on motor skills (risk of falling, weak knee when braking). Especially after prolonged (improper) use, the Personality changes reported.

In addition to acute cases of poisoning, chemical-analytical evidence also plays an important role in monitoring people who are dependent on foreign substances. Certain benzodiazepines are called Substitute and alternative drugs on the scene abused (so-called "downers"). First of all, flunitrazepam (e.g. Rohypnol®) should be mentioned here. After tolerance development (habituation), however, extreme overdoses are often tolerated, which do not necessarily have to be accompanied by externally recognizable symptoms of failure.

Important: Zaleplon (Sonata®), zolpidem (Bicalm®, Stilnox®) and zopiclone (Optidorm®, Somnosan®, Ximovan®), the so-called Z-substances, are non-benzodiazepines, but they have a similar effect to benzodiazepines. The difference in the action profile compared to the benzodiazepines is small. They are said to have a lower potential for dependence, which is rather questionable due to the numerous case reports.

An important tip: The 4-K rule

In order to avoid unnecessary risks when taking medication, the German Central Office for Addiction Issues (DHS) developed the "4-K rule". It is intended to prevent drug abuse.

The "4-K" stand for:

  • KClear indication: Prescription only if there is a clear medical need and only if the patient has been informed about the existing risk of dependence.
     

  • KLowest dose required: prescription of the smallest pack sizes, dosage appropriate to the indication.
     

  • KShort application: agree on the duration of therapy with the patient, re-appointments at short notice, careful review of further treatment.
     

  • KAbrupt discontinuation: To avoid withdrawal symptoms and rebound phenomena, taper off the therapy by reducing the dose.

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Bottom line: Sleeping pills, sedatives and other medications can be useful in an acute crisis, but usually do not solve the cause of the problem. According to experts, only the patients themselves can do this by consciously changing their lives within the scope of their possibilities. Marriage and debt counseling, family relief and the conscious setting of boundaries at work help, as do stress management and relaxation techniques. Psychotherapy can also help to track down the causes of complaints.

Current Supplement: Opioids Plus Benzodiazepines: A Deadly Combination.

Taking an opioid pain reliever at the same time as a benzodiazepine has doubled the risk of emergency admissions and hospital stays for policyholders in the United States. Benzodiazepines could be responsible for some of the opiate overdoses, according to the results of a study published in the British Medical Journal. The number of opioid prescriptions in the United States has nearly tripled in the past 15 years. The result was not just an increase in opiate addiction. The number of deaths from opiate overdoses has also increased significantly. A possible cause could be the simultaneous prescription of benzodiazepines, which are prescribed as a sleep aid or to treat anxiety.

Previous studies had shown that patients had benzodiazepines in their blood in 30 percent of all fatal opiate overdoses.

In parts 2, 3 and 4, the dazzling history of the discovery of benzodiazepines is described alongside warning case reports on abuse and criminal use.