Benzodiazepine Consumption Research Articles

Implementation of music in the perioperative standard care of colorectal surgery (IMPROVE study).

Patients undergoing surgery experience perioperative anxiety and pain. Music has been shown to reduce perioperative anxiety, pain and medication requirement. This study assessed the feasibility and effectiveness of implementing a perioperative music intervention. A prospective pre- and post-implementation pilot study was conducted to assess adherence to the intervention and the initial effect of music on postoperative pain scores (Numerical Rating Scale, 0-10) compared to a control group. Secondary outcomes encompassed pain scores throughout hospital admission, anxiety levels, medication usage, complications and hospital stay length. Adherence to the music intervention was preoperative 95.2%, intraoperative 95.7%, postoperative 31.9% and overall 29.7%. The intervention did influence postoperative pain. Patient's willingness to receive music was high (73%), they appreciated the intervention (median 8.0, interquartile range 7.0-9.0) and healthcare professionals were willing to apply the intervention. Music significantly reduced postoperative anxiety (2.0 vs. 3.0, p = 0.02) and the consumption of benzodiazepines on the first postoperative day (number of patients: zero [0%] vs. five [10%], p = 0.04). Implementation of music resulted in reduced postoperative anxiety and decreased consumption of benzodiazepines, and the strategy was feasible, but adjustments are needed to improve postoperative adherence. Both patients and healthcare professionals had a positive attitude towards the intervention.

Benzodiazepine use and incident risk of sudden cardiac arrest in patients with cardiovascular diseases.

Benzodiazepines (BZDs) are commonly prescribed as adjunctive drugs for patients with cardiovascular diseases (CVDs), particularly those who experience anxiety or insomnia. However, the relationship between the use of BZDs and incident risk of sudden cardiac arrest (SCA) has not been well investigated. In this study, we aimed to examine the association between the use of BZDs and the incident risk of SCA among patients with CVD. In this retrospective cohort study, a total of 74,715 eligible patients with new-onset CVD as a primary cause of hospitalization between July 2016 and August 2022 were included from the health information platform in Shenzhen, China. Among them, 61,761 BZD non-initiators were identified and matched to 12,954 BZD initiators by propensity score at a maximum ratio of 5:1. Propensity score-matched Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs). Over a 12-month follow-up period, 29 (2.24 per 1000 person-years) and 137 (2.22 per 1000 person-years) SCA cases occurred among propensity score-matched BZD initiators and non-initiators, respectively. Patients who initiated BZD treatment were associated with a 101% increased risk of SCA incidence compared with patients without BZD treatment (adjusted HR: 2.01, 95% CI: 1.42, 2.83). Furthermore, compared with the non-use (0 defined daily dose, DDD), the adjusted HR was 1.43 (95% CI: 1.32, 1.56) for the BZD consumption of ≤1 DDD and 2.58 (95% CI: 2.37, 2.81) for the BZD consumption of >1 DDD (P for trend < 0.001) within a 12-month follow-up period. This study provides evidence that BZD initiation may be associated with an increased incident risk of SCA in patients with CVD. Our finding highlights the importance of cautious prescribing BZDs in the health management of patients with CVD.

Suicide deaths and substance use in Spain between 2010 and 2022.

Suicide is a serious public health problem that affects our entire country. The aim of this research was to study the variation in completed suicide rates between 2010 and 2022 in Spain and their relationship with the consumption of addictive substances. Completed suicide data from the Spanish Statistical Office (INE) were analyzed with a joinpoint regression model to determine time trends. The relationship between the variation in completed suicide rates with sociodemographic variables, including depression rates, obtained from the Spanish Statistical Office and variables related to the consumption of substances obtained from the survey on alcohol and other drugs in Spain (EDADES) of the Government Delegation for the National Plan on Drugs (DGPNSD) was also studied using an exploratory analysis and also performing a Generalized Additive Model. The joinpoint regression model did reveal a point of significant change in the period studied for Spain showing a trend of increased suicide death rates for the studied period. The following variables correlated positively with the variation in completed suicide rates in the Generalized Additive Model: alcohol use in the past 12 months, alcohol use in the last 30 days, daily alcohol use in the last 30 days, binge drinking in the last 12 months, binge drinking in the last month, positive Alcohol Use Disorder Test for risky alcohol use, benzodiazepine use in the last 12 months, benzodiazepine use in the last month, daily benzodiazepine use in the last month, use of illegal substances in the last 12 months, use of illegal substances in the last month, mean age and depression rates. Applying preventive strategies on the risky consumption of alcohol, benzodiazepines and illegal substances would help reduce the rates of completed suicide in Spain.

Influence of daily life and health profile in subtle cognitive decline of women residing in Spanish religious communities: DeCo religious orders study.

Prior to the onset of dementia, individuals commonly undergo a phase marked by subtle cognitive changes, known as subtle cognitive decline. Recognizing these early cognitive alterations is crucial, as they can serve as indicators of an impending decline in cognitive function, warranting timely intervention and support. To determine the incidence of subtle cognitive decline in a population of Spanish women and establish the relationship with possible protective and/or risk factors such as cognitive reserve, cardiovascular risk factors, medication consumption and psychosocial factors. This is a cross-sectional observational study with women from the general population and a more homogeneous population composed of nuns from the Valencian region (Spain). A validated questionnaire was used including lifestyle variables, chronic illnesses, level of education and pharmacological treatments. Three validated subtle cognitive decline screening tests with varying levels of sensitivity and specificity were used: Memory Impairment Screening, Pfeiffer's Short Portable Mental State Questionnaire, and Semantic Verbal Fluency. Our results suggest that nuns may have a significantly reduced risk of cognitive decline compared to the general population (20.67% in nuns vs. 36.63% in the general population). This lower risk for subtle cognitive decline in nuns may be partly attributed to their higher cognitive reserve and long-time engagement in intellectually stimulating activities. Additionally, nuns tend to adopt healthy lifestyles, they are not isolated because they live in community and obtained lower scores for risk factors such as depression, anticholinergic burden, and benzodiazepine consumption. A healthy lifestyle combined with intellectually stimulating activities is related with preserved cognitive function.

Onset of Prolonged High-Potency Benzodiazepine Use Among ICU Survivors: A Nationwide Cohort Study.

Exposure to critical illness and intensive care may lead to long-term psychologic and physical impairments. To what extent ICU survivors become prolonged users of benzodiazepines after exposure to critical care is not fully explored. This study aimed to describe the extent of onset of prolonged high-potency benzodiazepine use among ICU survivors not using these drugs before admission, identify factors associated with this use, and analyze whether such usage is associated with increased mortality. Retrospective cohort study. Sweden, including all registered ICU admissions between 2010 and 2017. ICU patients surviving for at least 3 months, not using high-potency benzodiazepine before admission, were eligible for inclusion. Admission to intensive care. A total of 237,904 patients were screened and 137,647 were included. Of these 5338 (3.9%) became prolonged users of high-potency benzodiazepines after ICU discharge. A peak in high-potency benzodiazepine prescriptions was observed during the first 3 months, followed by sustained usage throughout the follow-up period of 18 months. Prolonged usage was associated with older age, female sex, and a history of both somatic and psychiatric comorbidities, including substance abuse. Additionally, a longer ICU stay, a high estimated mortality rate, and prior consumption of low-potency benzodiazepines were associated with prolonged use. The risk of death between 6 and 18 months post-ICU admission was significantly higher among high-potency benzodiazepine users, with an adjusted hazard ratio of 1.8 (95% CI, 1.7-2.0; p < 0.001). No differences were noted in causes of death between users and nonusers. Despite the lack of evidence supporting long-term treatment, prolonged usage of high-potency benzodiazepines 18 months following ICU care was notable and associated with an increased risk of death. Considering the substantial number of ICU admissions, prevention of benzodiazepine misuse may improve long-term outcomes following critical care.

Outcomes of Combined Opioids and Benzodiazepines Consumption in Elderly Trauma: A Retrospective Cohort Study.

Acute substance intoxication is associated with traumatic injury and worse hospital outcomes. The objective of this study was to evaluate the association between simultaneous opioids and benzodiazepines (OB) use and hospital outcomes in elderly trauma patients. We performed a retrospective analysis using the American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) 2017 database. We included trauma patients (age ≥ 65years) examined by urine toxicology within 24hours of presentation. The primary outcome was in-hospital mortality. Secondary outcomes included hospital and ICU lengths of stay (HLOS AND ICULOS), in-hospital complications (eg, ventilator-associated pneumonia), unplanned intubation, and duration of mechanical ventilation. Patients were stratified being both positive for opioids and benzodiazepines (OB+) or not (OB-) based on having positive or negative drug screen for both drugs, respectively. A 1:1 propensity score matching was performed controlling for demographics (eg, age and sex), comorbidities (eg, alcoholism), and injury characteristics. Of 77,311 tested patients, 849 OB+ were matched to OB- patients. Compared to OB- group, OB+ patients were more likely to have unplanned intubation (26 [3.1%] vs 8 [0.9%], P = 0.002) and had prolonged HLOS (≥2days: 683 [84.0%] vs 625 [77.8%], P = 0.002). There were no differences in all other outcomes (P > 0.05). The OB intake is associated with higher incidence of unplanned intubation and longer HLOS in elderly trauma patients. Early identification of elderly trauma patient with OB+ can help provide necessary pharmacologic and behavioral interventions to treat their substance use and potentially improve outcomes.

Intoxications involving methoxyacetylfentanyl and U-47700: a study of 3 polydrug fatalities

Novel synthetic opioids (NSOs) represent an emerging group of novel psychoactive substances, acting as agonists at the opioid receptors. NSOs include fentanyl-related compounds, e.g. methoxyacetylfentanyl (MeACF), and non-fentanyl analogs, e.g. “U compounds” including U-47700. Here we present three cases of death involving MeACF and U-47700, with particular reference to preliminary data on pharmacokinetics and tissue distribution.After a complete post-mortem examination, general unknown screenings and analysis of drugs of abuse were performed on postmortem samples by immunoassays, gas chromatography–mass spectrometry and liquid chromatography–mass spectrometry. To quantify the analytes of interest in post-mortem blood and tissues, the standard addition method was used. A toxicological significance score (TSS), weighing the role of the NSO in each death case, was assigned.Case 1 died at the hospital after consumption of U-47700, methadone (serum levels: 2,600 ng/ml and 37 ng/ml), tilidine and benzodiazepines. In case 2, U-47700 (204 ng/ml) together with methadone (290 ng/ml), flubromazepam (480 ng/ml) and diazepam (300 ng/ml) were detected in peripheral blood. In case 3, methoxyacetylfentanyl (266 ng/ml), furanylfentanyl (4.3 ng/ml) 4-ANPP (15 ng/ml) and alprazolam (69 ng/ml) were quantified in femoral blood. In all cases, the NSO likely contributed to the death (TSS = 3).NSOs appear to be often consumed in the setting of polydrug intoxications, especially in combination with other opioids and benzodiazepines, which often exert synergistic effects. The standard addition method remains the most reliable in post-mortem analysis and toxicological results should always be evaluated together with circumstantial and autopsy data.

Consumption of illicit drugs and benzodiazepines in six Spanish cities during different periods of the COVID-19 pandemic

Wastewater-based epidemiology (WBE) can provide objective and real time information about the use of addictive substances. A national study was conducted by measuring the most consumed illicit drugs, other drugs whose consumption is not so widespread but has increased significantly in recent years, and benzodiazepines in untreated wastewater from seven wastewater treatment plants (WWTPs) in six Spanish cities. Raw composite wastewater samples were collected from December 2020 to December 2021, a period in which the Spanish and regional governments adopted different restriction measures to contain the spread of the COVID-19 pandemic. Samples were analyzed using a validated analytical methodology for the simultaneous determination of 18 substances, based on solid-phase extraction and liquid-chromatography tandem mass spectrometry. Except for heroin, fentanyl, 6-acetylmorphine and alprazolam, all the compounds were found in at least one city and 9 out of 18 compounds were found in all the samples. In general, the consumption of illicit drugs was particularly high in one of the cities monitored in December 2020, when the restrictions were more severe, especially for cannabis and cocaine with values up to 46 and 6.9 g/day/1000 inhabitants (g/day/1000 inh), respectively. The consumption of MDMA, methamphetamine and mephedrone was notably higher in June 2021, after the end of the state of alarm, in the biggest population investigated in this study. Regarding the use of benzodiazepines, the highest mass loads corresponded to lorazepam. This study demonstrates that WBE is suitable for complementing epidemiological studies about the prevalence of illicit drugs and benzodiazepines during the COVID-19 pandemic restrictions.

Benzodiazepines and risk of dementia – Is there a reason for alarm?

IntroductionThe population ageing is a reality associated with an increase in prevalence of Dementia. The use of benzodiazepines is often postulated as a risk factor in these syndromes.Contrary to recommendations for its short-time use, long-term and chronic use are common, with an estimated 8,7% of elderly people in the US taking benzodiazepines.ObjectivesTo clarify the most recent evidence on the use of benzodiazepines and the risk of developing dementia.MethodsNon-systematic review of literature, using PubMed as database and filtering the results for meta-analysis.ResultsFour articles were included in this review.Zhong G et al. concluded that risk of dementia increased in consumers of benzodiazepines and it was associated with higher doses.In turn, AlDawasari A et al., when trying to clarify the use of different sedative-hypnotic drugs, found and increased risk with the consumption of benzodiazepines. After exclusion of articles with confounders and adjustment for protopathic bias, the risk was not maintained.Lucchetta RC et al. concluded that the risk exists but without inferring differences between doses or duration of action.Finally, Penninkilampi R e Eslick GD investigated this association, after controlling for the protopathic bias, concluding, contrary to AlDawasari et al., that the association benzodiazepines consumption and dementia do not result from this bias.ConclusionsWe cannot draw robust and concrete conclusions between benzodiazepines consumption and the pathogenesis of dementia because not only is the literature limited, but results are also heterogeneous. However, these prescriptions must be carried out cautiously, especially in the elderly, due to the known adverse effects associated with them.Disclosure of InterestNone Declared

Diminished Anthropometric Measures and Other Associated Variables in a Sample of Violent Offenders: A Case-Control Study.

Background Predicting criminal behavior is a complex task due to its multidimensional nature. Nevertheless, health professionals and criminologists must consider individual criminogenic risk factors to provide reliable expert opinions. Physical traits have been a subject of scrutiny since the inception of biological positivism. Aim The main objective of this study is to analyze differences in individual characteristics between violent offenders and healthy volunteers to potentially identify predictors of criminal behavior. Methods We conducted a case-control study with a sample of inmates convicted of violent offenses and compared them to healthy volunteers. Anthropometrics, sociodemographic data, drug consumption, characteristics of the family nucleus, clinical background, and basic laboratory test results were collected. Quantitative data were tested for normality and homogeneity before applying the Mann-Whitney or T-Student tests, respectively. For categorical data, Pearson's chi-square test was used for associations, and the odds ratio was determined for the associated risk in drug abuse profiles. Results Among the male participants (N = 72), the inmate group (n = 41) showed significantly lower stature (mean height [m]: 1.7454 ± 0.0694 vs 1.6643 ± 0.0659, p < 0.001), a reduced left D2:D4 finger length ratio (mean ratio [cm]: 0.9638 ± 0.0572 vs 0.9380 ± 0.068cm, p < 0.05), and smaller anthropometric measurements, including armful (mean length [m]: 1.8080 ± 0.7690 vs 1.6582 ± 0.7250, p < 0.001), wrist (mean [cm]: 17.39 ± 1.10 vs 16.57 ± 1.84, p < 0.05), mid-upper arm (mean [cm]: 31.75 ± 3.79 vs 29.97 ± 3.79, p < 0.05), and head circumferences (mean [cm]: 58.43 ± 1.92 vs 55.39 ± 1.51, p < 0.001). Additionally, the inmate group exhibited shorter lower segments (mean [cm]: 102.67 ± 4.97 vs. 97.85 ± 5.04, p < 0.001) and plantar lengths (mean [cm]: 27.45 ± 1.25 vs. 26.78 ± 1.00, p < 0.05). Furthermore, this group displayed a higher risk of alcohol (OR = 4.4, p < 0.01), cocaine (OR = 3.36, p < 0.05), and benzodiazepine consumption (OR = 3.36, p < 0.05). Parental alcohol consumption (χ² = 12.66, p < 0.01) and the practice of Protestantism (χ² = 20.087, p < 0.001) were also associated with the inmate group. Conclusion Physical traits may be considered potential criminogenic risk factors, but larger studies are necessary to validate these findings. Future research should take into account physiological and psychological correlates to gain a comprehensive understanding of the complex relationship between physical traits and criminal behavior.

Consumption of Benzodiazepines in the university population of Rio de Janeiro

Consumption of Benzodiazepines in the university population of Rio de Janeiro

Consumption Patterns of Benzodiazepines and Opioids Drawn from an Online Survey in the Early COVID-19 Pandemic

Abstract: Aims: Investigation of altered consumption patterns of benzodiazepines and opioids during the early COVID-19 pandemic. Methods: The study sample was extracted from an international web-based survey provided from April to August 2021 in 5 languages; completed by 5049 participants. A retrospective exploration of sociodemographic features, frequencies and dosages of benzodiazepine and opioid use and psychopathology was executed. Quantities of the respective substance use and consumers’ motivations for consumption pre-pandemic versus during the pandemic were compared. Associations between quantities, psychopathology, and positive effects of the substances, negative sequelae and concerns related to COVID-19 were examined. Results: A significant reduction of the consumption quantity was solely found for heroin users. Higher benzodiazepine consumption rates during the pandemic were marginally associated with a greater general psychopathology. Concerns related to the COVID-19 crisis were significantly positively correlated with the symptomatologies of the opioid and benzodiazepine users who presented a higher perception of life restriction. A significant reduction of reported motivations consumption was found for the motive partying. Conclusions: During the early COVID-19 pandemic the quantities and motives of consumption of sedatives and opioids remained mostly stable. The psychopathology of consumers was associated with specific concerns related to the pandemic.

Benzodiazepine Consumption, Functionality, Cognition, and Somnolence in Older Adults at a Tertiary Care Psychiatric Hospital in Mexico City.

The aging population in Mexico, particularly those aged 60 and above, faces challenges in healthcare, including potentially inappropriate prescriptions of benzodiazepines. Physiological changes in older adults make precise drug prescriptions crucial. This study aims to evaluate and compare functionality, cognition, and daytime somnolence in older adults using benzodiazepines versus non-users. Additionally, it outlines the demographic and clinical characteristics of both groups. A cross-sectional study enrolled 162 participants aged 60 and above, categorized as benzodiazepine consumers or non-consumers. Assessment tools included Lawton's Index, Montreal Cognitive Assessment, Epworth Sleepiness Scale, and Benzodiazepine Dependence Questionnaire. Statistical analysis employed t-tests and chi-square tests. Benzodiazepine users (n=81) exhibited lower cognitive scores, increased sleepiness, and reduced daily living activities compared to non-users (n=81). Demographically, BZD users had lower education levels. Benzodiazepine use in older adults is associated with cognitive decline, daytime somnolence, and functional limitations, emphasizing the need for cautious prescription practices and continual monitoring. This study contributes insights into the impact of benzodiazepines on the cognitive health of older adults in Mexico.

Effects of Opioid-Limiting Legislation in the State of Ohio on Opioid Prescriptions After Shoulder Arthroscopy.

Recent studies have shown that legislation regulating opioid prescriptions in the United States has been successful in reducing the morphine milligram equivalent (MME) prescribed after certain orthopaedic procedures. To (1) determine the effect of Ohio's legislation limiting opioid prescriptions after shoulder arthroscopy and (2) identify risk factors associated with prolonged opioid use and increased postoperative opioid dosing. Cohort study; Level of evidence, 3. We reviewed the data of patients who underwent shoulder arthroscopy between January 1, 2016, and March 31, 2020. Patients were classified according to the date of legislation passage (August 31, 2017) as before legislation (PRE) or on/after legislation (POST). Patients were also classified based on the number of opioid prescriptions filled within 30 days of surgery as opioid-tolerant (at least 1 prescription) or opioid-naïve (zero prescriptions). We recorded patient characteristics, medical comorbidities, and surgical details, as well as the number of opioid prescriptions, MME per prescription from 30 days preoperatively to 90 days postoperatively, and the number of gamma-aminobutyric acid (GABA) analogues and benzodiazepine prescriptions from 30 days preoperatively to the date of surgery. Differences between cohorts were compared with the Fisher exact test and Wilcoxon test. A covariate-adjusted regression analysis was used to evaluate risk factors associated with increased postoperative opioid dosing. Overall, 279 patients (n = 97 PRE; n = 182 POST; n = 42 opioid-tolerant; n = 237 opioid-naïve) were included in the final analysis. There was a significant reduction in the cumulative MME prescribed in the immediate (0-7 days) postoperative period (PRE, 450 MME vs POST, 315 MME), the first 30 postoperative days (PRE, 590 MME vs POST, 375 MME), and the first 90 postoperative days (PRE, 600 MME vs POST, 420 MME) (P < .001 for all). The opioid-tolerant cohort had higher MME at every time point in the postoperative period (P < .001). Consumption of preoperative opioid (β = 1682.5; P < .001), benzodiazepine (β = 468.09; P < .001), and GABA analogue (β = 251.37; P = .04) was associated with an increase in the cumulative MME prescribed. Opioid prescription-limiting legislation in Ohio significantly reduced the cumulative MME prescribed in the first 30 days postoperatively for both opioid-naïve and opioid-tolerant patients after shoulder arthroscopy. Consumption of opioids, benzodiazepines, and GABA analogues preoperatively was associated with increased postoperative opioid dosage.

Benzodiazepine Dependence After Cardiothoracic Intensive Care: A Nationwide Cohort Study

BackgroundThis study aimed to describe benzodiazepine use after cardiothoracic intensive care unit (ICU) care, including factors associated with new long-term high-potency benzodiazepine use after critical care, and to determine whether benzodiazepine use is associated with an increased risk of death. MethodsA nationwide retrospective cohort study was conducted of all cardiothoracic ICU patients in Sweden between 2010 and 2018. All patients older than 18 years who survived the first 3 months after admission to a cardiothoracic ICU were eligible for inclusion. A total of 36,135 patients were screened, and 4163 were ineligible. ResultsIn the final study cohort of 31,972 benzodiazepine-naive patients admitted to critical care, 578 patients had persistent high-potency benzodiazepine use. The proportion of new persistent benzodiazepine users was 5% in the first 3 months after ICU care, followed by a decline to a consistent level of 2% at 2 years of follow-up. Factors associated with persistent benzodiazepine use included higher age, female sex, psychiatric and somatic comorbidities, substance abuse, and preadmission opioid and low-potency benzodiazepine use. Adjusted hazard ratio for death 6 to 18 months after admission for new persistent benzodiazepine users was 2.2 (95% CI, 1.5-3.1; P < .001). ConclusionsHigh-potency benzodiazepine consumption is increased 2 years after admission to cardiothoracic ICU care despite lack of support for long-term use of benzodiazepines. Being older and female, prior opioid use, and comorbid conditions were among risk factors for persistent benzodiazepine use. Persistent benzodiazepine users had an increased risk of death.

La prevención cuaternaria en el uso de benzodiacepinas y cómo deprescribirlas

The consumption of benzodiazepines in our environment has increased in recent years due to the increase in Mental Health disorders caused by the COVID-19 pandemic. However, the data already showed a previous increase not only in Spain but worldwide. The causes detected are the lack of time, the inertia of the doctor and the patient or the lack of knowledge in the management of its withdrawal. Most prescriptions are made in the Primary Care context. For this reason, it should also be the space in which the deprescriptions should be carried out. This article analyzes the causes of the increase, the moment in which they should be withdrawn, the strategies to be able to carry out a correct withdrawal and community strategies carried out in Spain that have contributed to reducing their consumption.

Exploration of the barriers and enablers of benzodiazepines deprescribing in prisons: A qualitative study among health and social care professionals.

The prison environment is a place of high consumption of benzodiazepines (BZDs) due to the anxiety and sleep disturbances, mental disorders, detoxification and trafficking. The study aims to explore experiences of health and social care professionals on the use of BZDs in prisons, as well as the barriers and enablers to their deprescribing. Semistructured individual interviews with professionals working in a prison setting were performed between March and April 2022, based on an interview guide. They were recorded and transcribed using the NVivo software. A qualitative analysis using an inductive approach based on a thematic analysis was performed. Sixteen health professionals were interviewed, including psychiatrists, general practitioners, nurses, pharmacists, psychologists, musicologists and pharmacy technicians. The identified barriers to deprescribing BZDs were problems of coordination between prescribers, lack of time and alternatives. Concerning the enablers, therapeutic education groups, staff's awareness of the irrelevance of some medication and multi-professional advice were identified. This study highlights the similarities in deprescribing difficulties between prison and other settings. Some of the levers identified in our study have shown their effectiveness in different settings. Deprescribing is done most of the time in good conditions but requires an additional delay compared to the outside environment.

Global trends in the consumption of benzodiazepines and Z-drugs in 67 countries and regions from 2008-2018: a sales data analysis.

To investigate the trends in the consumption of benzodiazepines (BZDs) and Z-drugs at global, regional, and national levels from 2008 to 2018, across 67 countries and regions. This cross-sectional descriptive study investigated the consumption of BZDs and Z-drugs analysed by global pharmaceutical sales data from the IQVIA-Multinational Integrated Data Analysis System database between 2008 and 2018. Consumption was measured in defined daily dose per 1,000 inhabitants per day (DDD/TID). The global, regional, and national trends were estimated using linear mixed models. Additional analyses were conducted by grouping countries by income levels. The association between consumption and Gross Domestic Product (GDP) and the prevalence of different medical conditions was explored in univariable linear models. BZD consumption decreased annually by -1.88% (95% CI: -2.27%, -1.48%), and Z-drugs increased by +3.28% (+2.55%, +4.01%). In 2008, the top ten countries for BZD and Z-drug consumption were all European, ranging from 63.69 to 128.24 DDD/TID. Very low levels were found in Russia, Kuwait, United Arab Emirates, Saudi Arabia, French West Africa, and the Philippines, with DDD/TID <1. The consumption in high-income countries was much higher than in middle-income countries. The results showed that increased consumption of BZDs and Z-drugs was statistically associated (P<0.05) with higher GDP and increased prevalence of anxiety, self-harm, neurological disorders, chronic respiratory diseases, cardiovascular diseases and cancers. Distinct differences in consumption and trends of BZDs and Z-drugs were found across different countries and regions. Further exploration is needed to understand the association and safety of the use of BZDs and Z-drugs in patients with comorbidities.

Prescrição de Benzodiazepinas e outros Sedativos na Administração Regional de Saúde de Lisboa e Vale do Tejo de 2013 a 2020: Um Estudo Retrospetivo

Among the Organization for Economic Co-operation and Development members, Portugal has the highest reported consumption of anxiolytics, hypnotics, and sedatives, of which a large proportion are benzodiazepines or related drugs. These are known to cause tolerance and dependence. Other drugs with hypnotic effect, such as antidepressants, antihistamines, antipsychotics, or anticonvulsants have been identified by some reports as alternatives to benzodiazepines for the treatment of insomnia. In this regard, the aim of this study was to characterize the consumption of benzodiazepines, non-benzodiazepine anxiolytic, hypnotic or sedative effect drugs and other drugs with the potential to be used off-label to treat insomnia, and the results concerning benzodiazepine consumption related indicators in the primary health care setting in the Lisbon and Tagus Valley region. From 2013 to 2020, a census, descriptive and retrospective study was conducted. The evolution of the variables total defined daily doses, defined daily doses per 1000 inhabitants per day (DHD) and relevant indicators were characterized. Data were extracted from the SIARS platform used in the Lisbon and Tagus Valley regional Health Administration. There was a decrease in the consumption of benzodiazepines (from 57.44 to 63.11 DHD) and an increase of non-benzodiazepines and of drugs with potential off-label use (from 6.56 to 8.56 DHD and from 14.70 to 25.95 DHD, respectively). Among non-benzodiazepines, zolpidem was the most consumed drug, also showing an increasing trend (from 4.86 to 6.96 DHD). For the group of drugs with off-label use potential, there was an increased consumption of trazodone (from 3.81 to 7.92 DHD), mirtazapine (from 3.52 to 6.48 DHD), pregabalin (from 3.15 to 4.87 DHD), quetiapine (from 2.68 to 4.59 DHD) and gabapentin (from 1.32 to 1.90 DHD), which was only the case (or, at least, more significantly) for the lower dose formulations. The median of results of the Primary Health Care setting indicator "proportion of elderly patients without prescription of sedatives, anxiolytics, and hypnotics", was 81.0 in 2015 and increased to 84.9 in 2020. For the indicator "proportion of patients without prolonged prescription of sedatives, anxiolytics, and hypnotics", the median was 93.6 in 2019 and 94.3 in 2020. There was, overall, a decreasing trend in the dispensing of benzodiazepines in the Lisbon and Tagus Valley Region. Even though this data suggests a change in the therapeutic pattern for insomnia, more robust studies are needed to confirm this observation.

Fighting benzodiazepine misuse in Lithuania: detoxification treatment results in the single-centre toxicology department

Gabija Valauskaitė1, Gabrielė Repšytė2, Deimantė Andriuškevičiūtė3, Deima Eitmontaitė4, Robertas Badaras5,6 1Lithuanian University of Health Science, Department of Intensive Care, Kaunas, Lithuania 2Lithuanian University of Health Science, Department of Psychiatry, Kaunas, Lithuania 3Lithuanian University of Health Sciences, Faculty of Medicine, Kaunas, Lithuania 4Vilnius University, Faculty of Medicine, Clinic of Emergency Medicine, Vilnius, Lithuania 5Vilnius University, Faculty of Medicine, Clinic of Anaesthesiology and Intensive Care, Centre of Toxicology, Vilnius, Lithuania 6Republican Vilnius University Hospital, Vilnius, Lithuania Abstract Background. Chronic use of benzodiazepines frequently leads to physical dependence. In Lithuania, detoxification services are provided to individuals suffering from benzodiazepine addiction. Aim. The purpose of our study was to find out the existing links and differences between patient gender, age, characteristics of benzodiazepine consumption, and the course of treatment. Materials and methods. This retrospective study was conducted at Toxicology Centre of Republican Vilnius University Hospital. 48 patients who had been treated from 2011 January to 2018 March with the principal diagnosis of sedative, hypnotic or anxiolytic-related dependence (ICD-10 F13.2) were included in the final analysis. MS Excel and IBM SPSS 23.0 were used for data analysis, statistical significance was assumed when p<0.05. Results. An indirect intermediate correlation between benzodiazepine dose-at-arrival for treatment and age was found (rPhi=-0.16, p=0.029), as well as a direct weak link between dose-at-arrival and dose-at-discharge from the hospital (rPhi=0.420, p=0.005). Male patients used higher doses of benzodiazepines (p=0.012). Alcohol-consuming patients spent less time hospitalized (p=0.02). Women were hospitalized longer than men (p=0,02). Link between durations of inpatient treatment and benzodiazepine consumption was intermediate and direct (Spearman‘s r=0.310, p=0.032). An intermediate direct relationship between the duration of benzodiazepine consumption and number of additionally administered medicines was found (Spearman’s r=0.420, p=0.005). Conclusions. Men and younger patients had used higher doses of benzodiazepines. Patients, who had used higher doses, were prescribed a higher dose of benzodiazepines and a higher number of additional medicines at discharge. Inpatient treatment time was longer for women and for the patients, who had used benzodiazepines longer. Detoxification from benzodiazepines was shorter for alcohol-consuming patients. Keywords: benzodiazepines; withdrawal; addiction; detoxification. Full article https://doi.org/10.53453/ms.2023.2.14