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

Abstract

Background

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.

Aim

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.

Methods

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.

Results

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.

Conclusion

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.

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Funding

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.

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Correspondence to C . Lyphout.

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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.

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Lyphout, C..., Yates, C., Margolin, Z. et al. Presentations to the emergency department with non-medical use of benzodiazepines and Z-drugs: profiling and relation to sales data. Eur J Clin Pharmacol 75, 77–85 (2019). https://doi.org/10.1007/s00228-018-2550-1

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Keywords

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