Download Benzodiazepines and risk behaviour

Benzodiazepines and risk
behaviour
Graham Mackintosh
Critical Incidents Training Officer
Scottish Drugs Forum
Overdose: Definition
“Use of any drug(s) in such quantities
that acute adverse physical or mental
effects occur. It can be deliberate or
accidental; lethal or non lethal”.
Drug-related deaths, Scotland 1996 - 2005 Source: GRO
450
382
400
356
332
350
291
Deaths
300
250
244
336
317
292
249
224
Deaths
200
150
100
50
0
1996
1997
1998
1999
2000
2001
Year
2002
2003
2004
2005
Drugs detected at post-mortem drug related
deaths 2003
Positive cases
Drug
Number
(%)
BZDs (total) 2
202
(68.5)
Diazepam
171
(58.0)
Temazepam
85
(28.8)
Oxazepam
47
(15.9)
Other BZD
10
(3.4)
Heroin/morphine
178
(60.3)
Alcohol
167
(56.6)
Codeine 3
134
(45.4)
Methadone
83
(28.1)
Dihydrocodeine
51
(17.3)
Cannabis 4
31
(10.5)
31
(10.5)
Antidepressants
5
DRD involving Benzodiazepines
2002 -2005 Scotland
250
200
150
benzodiazepines
100
50
0
2002
2003
2004
2005
Linking benzodiazepines and
overdose
• Reducing drug related deaths, ACMD, 2000
• National Investigation into Drug Related Deaths
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in Scotland, 2003.
Benzodiazepines and cocaine as risk factors in
fatal opiod overdose,NTA 2007.
Clinical Guidelines Drug Misuse and
Dependence, draft 2007
Know the score campaign materials.
What are the links?
Benzodiazepine
Risk Factors
Physical effects
Behavioural effects
Characteristics
Of users
Physical effects
• CNS depressant
• Potential to increase respiratory
depressant effects of heroin, other
opiates.
• Low doses > reduce anxiety
Higher doses > sedative effects increase.
• Decrease level of consciousness
Behavioural Effects
• Perception of risk
• Recklessness/ risk taking behaviour
• Amnesia
• Reduction of fear
• Invisible
• Invincible
• Increased suggestibility
User characteristics?
• Higher levels of depression
• Higher levels of anxiety
• Traumatic life events
• Poorer social functioning
• Poorer coping strategies
Maybe seeking oblivion
Para-suicidal behaviour
National Investigation 2003
• Of 171 benzo positive at post mortem only
31% were in receipt of prescription.
• This suggests illicit manufacture and/or
diversion of prescribed drugs.
• Issue for policy makers, service providers,
police.
Diazepam or is it?
Police seizures
• Legal diazepam accounts for vast majority
of seizures.
• Diversion from legitimate markets.
• Unlicensed versions illicitly made or
legitimately made abroad but quality does
not meet UK standards.
• Fakes- many originate from India,
Pakistan, Thailand.
“Street valium”?
• Nitrazepam, alprazolam
• Strong antihistamines – Piriton, Promethazine.
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Sedative action, side effects drowsiness,
dizziness, confusion.
Methenamine – antiseptic/antibacterial can
cause irritation of stomach or bladder
Warfarin – blood thinning medication
Amitriptylene - seizures, heart rate,sedation
Unusual reactions
• Paradoxical reactions
• Increased excitement
• Increased anxiety
• Hyperactivity
• Sexual disinhibition
• Hostility
• Rage
Who is at risk?
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Under 18
Over 65
Neurological disorders
Antisocial personality disorder
Learning disabilities
Impulse control problems
Mood – history of aggression
Environment
High doses – high potency
Alcohol
Why?
• Anxiolytic / amnesic effects leads to loss of restraint of
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social behaviour
Reduces ability to concentrate on external social cues
Impaired ability to identify angry facial expression > fail
to modify behaviour
Aggressive response to mild provocation more likely
Dissociation between feelings and behaviour – felt more
tolerant and friendly but in fact more aggresive
Finally……………
• Hepatitis C
• Injecting behaviours
• Stimulant users
• Dependence
• Withdrawal
• Seizures
• Internet