European Journal of Clinical Pharmacology

, Volume 75, Issue 1, pp 77–85 | Cite as

Presentations to the emergency department with non-medical use of benzodiazepines and Z-drugs: profiling and relation to sales data

  • C . LyphoutEmail author
  • C. Yates
  • Z. R. Margolin
  • P. I. Dargan
  • A. M. Dines
  • F. Heyerdahl
  • K. E. Hovda
  • I. Giraudon
  • B. Bucher-Bartelson
  • J. L. Green
  • Euro-DEN Research Group
  • D. M. Wood
Pharmacoepidemiology and Prescription



Non-medical use of benzodiazepines and Z-drugs is common; however, there is limited information available on the extent of harm related to this in Europe, as well as the relationship between misuse and availability.


To describe presentations to the emergency department in Europe related to the recreational use of benzodiazepines and Z-drugs and compare regional differences in these presentations with legal drug sales of benzodiazepines and Z-drugs within each country.


Emergency department presentations with recreational misuse of benzodiazepines and Z-drugs were obtained from the Euro-DEN dataset for the period from October 2013 to September 2015; data extracted included demographics, clinical features, reported coused drugs, and outcome data. Sales figures obtained by QuintilesIMS™ (Atlanta, Georgia) were used to compare regional differences in the proportion of benzodiazepines and Z-drugs in the emergency department presentations and legal drug sales across Europe.


Over the 2 years, there were 2119 presentations to the Euro-DEN project associated with recreational use of benzodiazepines and/or Z-drugs (19.3% of all Euro-DEN presentations). Presentations with 25 different benzodiazepines and Z-drugs were registered in all countries, most (1809/2340 registered benzodiazepines and Z-drugs, 77.3%) of which were prescription drugs. In 24.9%, the benzodiazepine was not specified. Where the benzodiazepine/Z-drug was known, the most frequently used benzodiazepines and Z-drugs were respectively clonazepam (29.5% of presentations), diazepam (19.9%), alprazolam (11.7%), and zopiclone (9.4%). The proportions of types of benzodiazepines/Z-drugs related to ED-presentations varied between countries. There was a moderate (Spain, UK, Switzerland) to high (France, Ireland, Norway) positive correlation between ED presentations and sales data (Spearman Row’s correlation 0.66–0.80, p < 0.005), with higher correlation in countries with higher ED presentation rates.


Presentations to the emergency department associated with the non-medical use of benzodiazepines and/or Z-drugs are common, with variation in the benzodiazepines and/or Z-drugs between countries. There was a moderate to high correlation with sales data, with higher correlation in countries with higher ED presentation rates. However, this is not the only explanation for the variation in non-medical use and in the harm associated with the non-medical use of benzodiazepines/Z-drugs.


Acute toxicity Benzodiazepine Z-drug Prescription Emergency department Euro-DEN 


Funding information

The Euro-DEN Project was funded by the DPIP/ISEC Programme of the European Union; all of the authors had funding from the European Commission through the Euro-DEN project except ML and EL, whose costs were co-funded by the Swiss Centre of Applied Human Toxicology (SCAHT), and BB, JG, ZM, and CL.

Compliance with ethical standards

Conflict of interest

PD and DW have received financial and statistical support to undertake population and web monitoring studies on the non-medical use of prescription and non-prescription medicines in the UK and Singapore and travel and honorarium costs to attend and present at the Annual RADARS International Symposium and Scientific Meeting from the RADARS System, Denver Health and Hospital Authority, Denver, US.

Supplementary material

228_2018_2550_MOESM1_ESM.docx (26 kb)
Online Supplement 1 (DOCX 26 kb)
228_2018_2550_MOESM2_ESM.docx (116 kb)
Online Supplement 2 (DOCX 115 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • C . Lyphout
    • 1
    • 2
    Email author
  • C. Yates
    • 3
  • Z. R. Margolin
    • 4
  • P. I. Dargan
    • 1
    • 5
  • A. M. Dines
    • 1
  • F. Heyerdahl
    • 6
  • K. E. Hovda
    • 6
  • I. Giraudon
    • 7
  • B. Bucher-Bartelson
    • 4
  • J. L. Green
    • 4
    • 8
  • Euro-DEN Research Group
  • D. M. Wood
    • 1
    • 5
  1. 1.Clinical ToxicologyGuy’s and St Thomas’ Hospitals NHS Foundation Trust, and King’s Health PartnersLondonUK
  2. 2.Emergency DepartmentUniversity HospitalGhentBelgium
  3. 3.Emergency Department and Clinical Toxicology UnitHospital Universitari Son EspasesMallorcaSpain
  4. 4.Denver Health Rocky Mountain Poison & Drug CenterDenverUSA
  5. 5.Faculty of Life Sciences and MedicineKing’s College LondonLondonUK
  6. 6.The National CBRNe Centre of Medicine, Department of Acute Medicine, Medical DivisionOslo University HospitalOsloNorway
  7. 7.European Monitoring Centre for Drugs and Drug Addiction (EMCDDA)LisbonPortugal
  8. 8.Inflexxion, Inc.WalthamUSA

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