Abuse of benzodiazepines: the problems and the solutions. A report of a Committee of the Institute for Behavior and Health, Inc.

Benzodiazepines are medications used to treat many of the most frequent and disturbing symptoms seen in medical practice, including anxiety, insomnia, muscle spasms, some forms of epilepsy, and other illnesses. The World Health Organization (WHO) has determined benzodiazepines to be "essential drugs" that should be available in all countries for medical purposes. As benzodiazepines were recognized as generally safe and effective drugs, their medical use increased but so did problems of abuse outside medical practice. This report focuses specifically on the nonmedical use, or abuse, of benzodiazepines for purposes, durations, or at dosage levels not intended by the prescribing physician or in ways outside medical guidelines. The principal contribution of this report to the resolution of the controversy about the use of benzodiazepines is to draw a sharp distinction between the medical use of these drugs and their nonmedical use, which this report labels "abuse." Problems which exist with the medical use of benzodiazepines, such as their use by patients who are better treated with other medications (or without medication) and the problems of withdrawal symptoms on discontinuation of medically prescribed benzodiazepines, are not addressed because these are problems of routine, legitimate medical practice. On the other hand, aspects of medical practice which affect nonmedical use of benzodiazepines are extensively dealt with in this report including the diversion of legitimately prescribed benzodiazepines into the illicit drug market and the prescribing of benzodiazepines for drug abusers. Extensive animal and human research has shown that benzodiazepines are "reinforcing" drugs in the sense that animals and humans will maintain behavior on which delivery of the drug is dependent. Animal studies of self-administration of potentially abused drugs show that benzodiazepines are less powerful reinforcers than intermediate half-life barbiturates (such as secobarbital) and psychomotor stimulants (such as amphetamine and cocaine). A substantial body of human research has shown that benzodiazepines are moderately "liked" for their reinforcing effects by drug abusers and alcoholic subjects but that both anxious people and normal (non-drug abusing, non-anxious) human subjects prefer placebo to benzodiazepines, demonstrating that these substances are usually not liked by people who are not drug abusers or alcoholics. Among drug abusers, benzodiazepines are preferred less than either intermediate half-life barbiturates or stimulants. This difference between the response of substance abusers and normal and anxious research subjects supports the fundamental distinction