Benzodiazepine Receptor Agonist Use Disorder Among Older Adults

Patient Guideline Summary

Publication Date: January 1, 2020

Objective
 

Objective
 

This patient summary means to discuss key recommendations from the Canadian Coalition for Seniors Mental Health (CCSMH) for benzodiazepine receptor agonist use disorder among older adults. It is limited to adults 18 years of age and older and should not be used as a reference for children.

Overview

Overview

  • Benzodiazepine Use Disorder describes excess intake of sedative-hypnotic medicines like Valium, Librium, and Edluar leading to adverse consequences.
  • We will use the abbreviation BRZA throughout this summary to refer to these drugs.
  • The Diagnostic and Statistical Manual of Mental Disorders (DSM–5) lists 11 criteria relevant to the diagnosis of Benzodiazepine Use Disorder. The more criteria that are met, the more serious the condition.
  • Symptoms include cognitive impairment, delirium, falls, fractures, hospitalizations, and motor vehicle crashes.
  • This patient summary focuses on managing and reducing Benzodiazepine Use Disorder in the elderly.

Diagnosis

Diagnosis

  • Diagnosis is based on the number of DSM-5 criteria that are met.
  • The risk of abuse should be assessed before prescribing BZRAs, and patients should be advised of the risks and benefits.

Treatment

Treatment

  • Advancing age increases sensitivity to BZRAs. Therefore, treatment should generally be limited to 4 weeks or less.
  • Cognitive behavior therapies (CBTs), rather than BZRAs, are the preferred option for anxiety and insomnia.
  • BZRA treatment should be monitored.
  • Long-acting BZRAs should generally be avoided.
  • Neither opioids nor alcohol should be taken together with BZRAs.
  • Stopping the drug may require tapering to avoid withdrawal symptoms.
  • Serious cases of Benzodiazepine Use Disorder that have failed prior withdrawal efforts should be considered for referral to a specialty addiction or mental health service.
  • Healthcare professionals should prioritize facility-wide attention to BZRAs abuse and methods to curtail it.

Abbreviations

  • BZRAs: Benzodiazepine Receptors Agonists
  • CBTs: Cognitive Behavior Therapies
  • CCSMH: Canadian Coalition For Seniors Mental Health
  • DSM–5: Diagnostic And Statistical Manual Of Mental Disorders

Source Citation

Conn DK, Hogan DB, Amdam L, Cassidy KL, Cordell P, Frank C, Gardner D, Goldhar M, Ho JM, Kitamura C, Vasil N. Canadian Guidelines on Benzodiazepine Receptor Agonist Use Disorder Among Older Adults Title. Can Geriatr J. 2020 Mar 30;23(1):116-122. doi: 10.5770/cgj.23.419. PMID: 32226570; PMCID: PMC7067147.

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.