Murphy Yoko, Wilson Emily, Goldner Elliot M, Fischer Benedikt
Social and Epidemiological Research, Centre for Addiction and Mental Health (CAMH), 33 Russell St., Toronto, ON, M5S 2S1, Canada.
Faculty of Health Sciences, Centre for Applied Research in Mental Health and Addictions (CARMHA), Simon Fraser University, Vancouver, BC, V6B 5K3, Canada.
Clin Drug Investig. 2016 Jul;36(7):519-30. doi: 10.1007/s40261-016-0397-8.
Benzodiazepines are commonly prescribed psycho-pharmaceuticals (e.g., for anxiety, tension, and insomnia); they are generally considered safe but have potential adverse effects. Benzodiazepine use in Canada versus internationally is comparably high, yet no recent comprehensive review of use, misuse, or related (e.g., morbidity, mortality) harm at the population level exists; the present review aimed to fill this gap. We searched four key scientific literature databases (Medline, CINAHL, EBM Reviews, and Web of Science) with relevant search terms, and collected relevant "gray literature" (e.g., survey, monitoring, government reports) data published in 1995-2015. Two reviewers conducted data screening and extraction; results were categorized and narratively summarized by key sub-topics. Levels of benzodiazepine use in the general population have been relatively stable in recent years; medical use is generally highest among older adults. Rates of non-medical use are fairly low in general but higher in marginalized (e.g., street drug use) populations; high and/or inappropriate prescribing appears common in older adults. Benzodiazepines are associated with various morbidity outcomes (e.g., accidents/injuries, cognitive decline, sleep disturbances, or psychiatric issues), again commonly observed in older adults; moreover, benzodiazepines are identified as a contributing factor in suicides and poisoning deaths. Overall there is a substantial benzodiazepine-related health problem burden-although lower than that for other psycho-medications (e.g., opioids)-in Canada, mainly as a result of overuse and/or morbidity. National benzodiazepine prescription guidelines are lacking, and few evaluated interventions to reduce benzodiazepine-related problems exist. There is a clear need for reducing inappropriate benzodiazepine use and related harm in Canada through improved evidence-based practice as well as monitoring and control.
苯二氮䓬类药物是常用的精神药物（如用于治疗焦虑、紧张和失眠）；它们通常被认为是安全的，但有潜在的不良反应。加拿大与国际上苯二氮䓬类药物的使用量相对较高，但目前尚无关于人群层面使用、滥用或相关危害（如发病率、死亡率）的近期全面综述；本综述旨在填补这一空白。我们使用相关检索词搜索了四个关键科学文献数据库（医学文献数据库、护理学与健康领域数据库、循证医学评论数据库和科学引文索引数据库），并收集了1995年至2015年期间发表的相关“灰色文献”（如调查、监测、政府报告）数据。两名评审员进行数据筛选和提取；结果按关键子主题进行分类和叙述性总结。近年来，普通人群中苯二氮䓬类药物的使用水平相对稳定；老年人的医疗用途通常最高。非医疗用途的发生率总体较低，但在边缘化人群（如街头毒品使用）中较高；老年人中高剂量和/或不适当的处方似乎很常见。苯二氮䓬类药物与各种发病结果相关（如事故/伤害、认知能力下降、睡眠障碍或精神问题），这些在老年人中也很常见；此外，苯二氮䓬类药物被确定为自杀和中毒死亡的一个促成因素。总体而言，在加拿大，与苯二氮䓬类药物相关的健康问题负担相当大——尽管低于其他精神药物（如阿片类药物）——主要是由于过度使用和/或发病。加拿大缺乏全国性的苯二氮䓬类药物处方指南，且几乎没有经过评估的减少与苯二氮䓬类药物相关问题的干预措施。显然有必要通过改进循证实践以及监测和控制来减少加拿大不适当的苯二氮䓬类药物使用及相关危害。
