College of Community Health Sciences, University of Alabama, Tuscaloosa, AL, USA.
Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
J Addict Dis. 2024 Jan-Mar;42(1):75-79. doi: 10.1080/10550887.2022.2117510. Epub 2022 Sep 16.
Novel psychoactive substances, such as designer benzodiazepines (DBZD), are a growing public health concern. There are about 30 different DZBDs reported, which can vary widely in their effect and potential for harmful outcomes, ranging from agitation to confusion to coma. Despite the scope of this widespread phenomena, little information on the management of DBZD dependence is available in the literature.
In this case report, we present a patient with DBZD dependence requesting assistance tapering off the DBZD, clonazolam. He began self-medicating with clonazolam seven years prior for panic attacks to the point he was using 40 drops per day and having significant withdrawal during the day. He was prescribed gabapentin for his underlying anxiety while he tapered his clonazolam dose. Once he achieved a 75% reduction in his use of clonazolam, he had trouble managing withdrawal and anxiety symptoms and could not taper further.
We discuss the challenges of treating patients with DBZD use disorder in an outpatient setting. Switching a patient from a DZBD to a prescription benzodiazepine for the purposes of a taper can be dangerous as an outpatient due to the inability to monitor at-home DBZD usage and the resulting risk of overdose. DBZDs can also be highly potent and make it difficult to achieve success using current withdrawal guidelines.
新型精神活性物质，如设计苯二氮䓬类药物（DBZD），是一个日益严重的公共卫生问题。据报道，大约有 30 种不同的 DZBD，其影响和潜在的有害后果差异很大，从激动到混乱到昏迷。尽管这种广泛存在的现象范围很广，但文献中几乎没有关于 DBZD 依赖管理的信息。
在本病例报告中，我们介绍了一位 DBZD 依赖患者，要求协助逐渐减少 DBZD，氯硝西泮的用量。他在七年前开始自行服用氯硝西泮治疗惊恐发作，每天服用 40 滴，白天有明显的戒断症状。他因潜在的焦虑症而服用加巴喷丁，同时逐渐减少氯硝西泮的剂量。当他的氯硝西泮用量减少 75%时，他难以控制戒断和焦虑症状，无法进一步减少剂量。
我们讨论了在门诊环境下治疗 DBZD 使用障碍患者的挑战。由于无法在家中监测 DBZD 的使用情况，以及由此导致的过量风险，因此，将患者从 DZBD 转换为处方苯二氮䓬类药物进行减量治疗可能非常危险。DBZDs 也可能非常有效，这使得使用当前的戒断指南很难取得成功。
