The epidemiology of benzodiazepine misuse: A systematic review

• Published in: Drug and alcohol dependence Vol. 200; pp. 95 - 114
• Main Authors: Votaw, Victoria R., Geyer, Rachel, Rieselbach, Maya M., McHugh, R. Kathryn
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.07.2019; Elsevier Science Ltd
• Subjects: Benzodiazepines; Benzodiazepines - adverse effects; Benzodiazepines - therapeutic use; Criminality; Critical point; Documents; Drug Overdose - diagnosis; Drug Overdose - epidemiology; Drug Overdose - prevention & control; Emergency medical care; Emergency medical services; Epidemiology; Evidence-based medicine; Extraction; Health problems; Hepatitis C; HIV; Human immunodeficiency virus; Humans; Medical treatment; Nonmedical prescription drug use; Overdose; Prescription drug misuse; Prescription Drug Misuse - psychology; Prescription Drug Misuse - trends; Prescription drugs; Prescription Drugs - adverse effects; Prevalence; Psychiatric symptoms; Public health; Public Health - trends; Quality of Life; Risk behavior; Risk taking; Sedatives; Signs and symptoms; Subgroups; Substance use; Substance-Related Disorders - diagnosis; Substance-Related Disorders - epidemiology; Substance-Related Disorders - therapy; Systematic review; Tranquilizers; Tranquillizers; United States > US; Sedatives; Prescription drug misuse; Nonmedical prescription drug use; Tranquilizers; Benzodiazepines
• ISSN: 0376-8716; 1879-0046; 1879-0046
• DOI: 10.1016/j.drugalcdep.2019.02.033

•We reviewed epidemiological studies on benzodiazepine misuse.•Polysubstance use and psychiatric distress increase risk of misuse.•Benzodiazepines are commonly co-ingested with other substances.•Coping with negative affect and sleep are the most common motives for misuse.•Misuse is associated with poor outcomes, including morbidity and mortality. Benzodiazepine misuse is a growing public health problem, with increases in benzodiazepine-related overdose deaths and emergency room visits in recent years. However, relatively little attention has been paid to this emergent problem. We systematically reviewed epidemiological studies on benzodiazepine misuse to identify key findings, limitations, and future directions for research. PubMed and PsychINFO databases were searched through February 2019 for peer-reviewed publications on benzodiazepine misuse (e.g., use without a prescription; at a higher frequency or dose than prescribed). Eligibility criteria included human studies that focused on the prevalence, trends, correlates, motives, patterns, sources, and consequences of benzodiazepine misuse. The search identified 1970 publications, and 351 articles were eligible for data extraction and inclusion. In 2017, benzodiazepines and other tranquilizers were the third most commonly misused illicit or prescription drug in the U.S. (approximately 2.2% of the population). Worldwide rates of misuse appear to be similar to those reported in the U.S. Factors associated with misuse include other substance use, receipt of a benzodiazepine prescription, and psychiatric symptoms and disorders. Benzodiazepine misuse encompasses heterogeneous presentations of motives, patterns, and sources. Moreover, misuse is associated with myriad poor outcomes, including mortality, HIV/HCV risk behaviors, poor self-reported quality of life, criminality, and continued substance use during treatment. Benzodiazepine misuse is a worldwide public health concern that is associated with a number of concerning consequences. Findings from the present review have implications for identifying subgroups who could benefit from prevention and treatment efforts, critical points for intervention, and treatment targets.