Griffiths Roland R, Johnson Matthew W
Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
J Clin Psychiatry. 2005;66 Suppl 9:31-41.
Hypnotic drugs, including benzodiazepine receptor ligands, barbiturates, antihistamines, and melatonin receptor ligands, are useful in treating insomnia, but clinicians should consider the relative abuse liability of these drugs when prescribing them. Two types of problematic hypnotic self-administration are distinguished. First, recreational abuse occurs when medications are used purposefully for the subjective "high." This type of abuse usually occurs in polydrug abusers, who are most often young and male. Second, chronic quasi-therapeutic abuse is a problematic use of hypnotic drugs in which patients continue long-term use despite medical recommendations to the contrary. Relative abuse liability is defined as an interaction between the relative reinforcing effects (i.e., the capacity to maintain drug self-administration behavior, thereby increasing the likelihood of nonmedical problematic use) and the relative toxicity (i.e., adverse effects having the capacity to harm the individual and/or society). An algorithm is provided that differentiates relative likelihood of abuse and relative toxicity of 19 hypnotic compounds: pentobarbital, methaqualone, diazepam, flunitrazepam, lorazepam, GHB (gamma-hydroxybutyrate, also known as sodium oxybate), temazepam, zaleplon, eszopiclone, triazolam, zopiclone, flurazepam, zolpidem, oxazepam, estazolam, diphenhydramine, quazepam, tra-zodone, and ramelteon. Factors in the analysis include preclinical and clinical assessment of reinforcing effects, preclinical and clinical assessment of withdrawal, actual abuse, acute sedation/memory impairment, and overdose lethality. The analysis shows that both the likelihood of abuse and the toxicity vary from high to none across these compounds. The primary clinical implication of the range of differences in abuse liability is that concern about recreational abuse, inappropriate long-term use, or adverse effects should not deter physicians from prescribing hypnotics when clinically indicated.
催眠药物，包括苯二氮䓬受体配体、巴比妥类药物、抗组胺药和褪黑素受体配体，可用于治疗失眠，但临床医生在开这些药物时应考虑其相对滥用可能性。区分了两种有问题的催眠药物自我给药类型。首先，娱乐性滥用是指药物被故意用于主观的“快感”。这种滥用类型通常发生在多药滥用者身上，他们大多是年轻男性。其次，慢性准治疗性滥用是指患者不顾医疗建议而长期使用催眠药物的有问题行为。相对滥用可能性被定义为相对强化作用（即维持药物自我给药行为的能力，从而增加非医疗性问题使用的可能性）和相对毒性（即有能力伤害个体和/或社会的不良反应）之间的相互作用。提供了一种算法，可区分19种催眠化合物的相对滥用可能性和相对毒性：戊巴比妥、甲喹酮、地西泮、氟硝西泮、劳拉西泮、γ-羟基丁酸（GHB，也称为羟丁酸钠）、替马西泮、扎来普隆、艾司佐匹克隆、三唑仑、佐匹克隆、氟西泮、唑吡坦、奥沙西泮、艾司唑仑、苯海拉明、夸西泮、曲唑酮和雷美替胺。分析因素包括强化作用的临床前和临床评估、戒断的临床前和临床评估、实际滥用情况、急性镇静/记忆损害以及过量致死率。分析表明，这些化合物的滥用可能性和毒性从高到无各不相同。滥用可能性差异范围的主要临床意义在于，当有临床指征时，对娱乐性滥用、不当长期使用或不良反应的担忧不应阻止医生开具催眠药物。
