Challenges of Diagnosing and Managing Designer Benzodiazepine Dependence and Withdrawal: A Case Report

Linda Peng, David Lawrence, Ximena A. Levander

Research output: Contribution to journalArticlepeer-review

Abstract

Background:Over the last 10 years, an increasing number of unregulated novel psychoactive substances, including "designer benzodiazepines" (DBZDs), have emerged on the recreational drug market. Despite the rapidly increasing usage of DBZDs, there is a significant lack of information regarding clinical management. Here we present a case illustrating the difficulties of diagnosing and managing DBZD related sedative-hypnotic use disorder.Case Presentation:Our patient is a 30-year-old man with severe opioid and sedative-hypnotic use disorders. He had a 10-year history of using heroin, clonazolam, and alprazolam. He stopped using heroin when on methadone maintenance therapy but continued using clonazolam and nonprescribed alprazolam. His opioid treatment program discontinued methadone due to benzodiazepine intoxication, and he returned to heroin use. He then presented for residential withdrawal management where he underwent successful buprenorphine induction and benzodiazepine withdrawal management. During a 3-month period of benzodiazepine abstinence, he struggled with ongoing cravings and post-acute withdrawal syndrome, ultimately leading to return to DBZD use.Discussion:Despite the increasing prevalence of DBZD use, the usage of DBZDs is likely under-recognized because these compounds are generally not included on standard in-office urine drug immunoassay tests. Initial studies suggest that DBZDs have high potencies, shorter half-lives, are more addictive, and can result in more severe withdrawal symptoms compared to known benzodiazepines. However, there remains a lack of information about the pharmacokinetics and pharmacodynamics of DBZDs, making clinical management for DBZD related sedative-hypnotic use disorders challenging to treat.

Original languageEnglish (US)
Pages (from-to)249-251
Number of pages3
JournalJournal of addiction medicine
Volume16
Issue number2
DOIs
StatePublished - Mar 1 2022
Externally publishedYes

Keywords

  • benzodiazepines
  • designer drugs
  • hypnotics and sedatives
  • substance withdrawal syndrome

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Pharmacology (medical)

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