Rates of misuse

Little attention has focused on the degree that benzodiazepines are abused as a primary drug of
choice, but they are frequently abused alongside other drugs of abuse especially alcohol,
stimulants and opiates.[15] The benzodiazepine most commonly abused can vary from country to
country and depends on factors including local popularity as well as which benzodiazepines are
available. Nitrazepam for example is commonly abused in Nepal and the United Kingdom,[16][17]
whereas in the United States of America where nitrazepam is not available on prescription other
benzodiazepines are more commonly abused.[6] In the United Kingdom and Australia there have
been epidemics of temazepam abuse. Particular problems with abuse of temazepam are often
related to gel capsules being melted and injected and drug related deaths.[18][19][20] Injecting most
benzodiazepines is dangerous because of their relative insolubility in water (with the exception
of midazolam), leading to potentially serious adverse health consequences for users.[21][22]
Benzodiazepines are a commonly misused class of drug. A study in Sweden found that
benzodiazepines are the most common drug class of forged prescriptions in Sweden.[23] Very
high rates of benzodiazepines detected in motor vehicle drivers often exceeding therapeutic
doses have been reported in Sweden and in Northern Ireland.[24][25] One of the hallmarks of
problematic benzodiazepine drug misuse is escalation of dose. Most licit prescribed users of
benzodiazepines do not escalate their dose of benzodiazepines.[26]
A 2004 US government study of nationwide ED visits conducted by SAMHSA found that
sedative-hypnotics in the USA are the most frequently misused pharmaceutical drug with 35% of
drug related visits to the Emergency Department involving sedative hypnotics. Benzodiazepines
accounted for the majority of these. Benzodiazepines are more commonly misused than opiate
pharmaceuticals which accounted for 32% of visits to the emergency department. Males and
females misuse benzodiazepines equally. Of drugs used in attempted suicide, benzodiazepines
are the most commonly used pharmaceutical drug with 26% of attempted suicides involving
benzodiazepines. Alprazolam is the most commonly misused benzodiazepine, followed by
clonazepam, lorazepam and diazepam as the 4th in the USA.[27]
Motivations for drug misuse
Benzodiazepines have demonstrated reward seeking behaviour in animal studies.[28] Humans are
motivated to misuse benzodiazepines to achieve a sedative-hypnotic high which often produces
effects including feeling energetic, relaxed, drunken, talkative, pleasure and euphoria. In India up
to 50-60% of heroin addicts use benzodiazepines and 20% of injecting substance misusers also
inject benzodiazepines.[29] Benzodiazepines can be used counter effects of other drugs eg to
"come down" from stimulants or enhance the effects of other CNS depressant drugs eg alcohol
or heroin.[30][31][32][33] Compulsive benzodiazepine use is believed to be due to adaptational changes
in the GABAA receptor and possibly also its effects on the opioid system. The abuse potential of
sedative-hypnotics are governed mainly by their effects on the alpha1 containing GABAA
receptors