1 Benzodiazepines Use, Misuse, Abuse and Poisoning Karen E. Simone, PharmD, DABAT Northern New...

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BenzodiazepinesUse, Misuse, Abuse and Poisoning

Karen E. Simone, PharmD, DABATNorthern New England Poison Center

[email protected]

mailto:[email protected]

http://www.1-800-222-1222.info/

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Contents

•Poison Center Overview

•Types of Hotline Calls

•Benzodiazepine Perspective

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Northern New England Poison Center

• Certified by the American Association of Poison

Control Centers (AAPCC) in November 2004

– Staff

– Hotline

– Outreach

– Surveillance

– Research

Funding: Maine Medical Center/MaineHealth; Fletcher Allen Health Care; States of Maine, New Hampshire and Vermont; Health Resources and Services Administration; United Ways of Greater Portland, York, Kennebec Valley; Denver Health (surveillance projects)

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Types of Calls – Poisoning Reasons

• Unintentional– General, environmental, misuse, therapeutic error, occupational,

good poisoning, bite/sting

• Intentional– Abuse, misuse, suicide attempt

• Other– Malicious, tampering/contamination, withdrawal

• Adverse effect– Drug, chemical, other

• Unknown– Drug, chemical, other

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Types of Calls – Question Types

• Substance Abuse– Identification, effects, drug screens, withdrawal

• Medication– Pharmacology, adverse effects, interactions, withdrawal

• Toxicology– General, environmental, food poisoning, pregnancy/lactation

• Prevention/safety– Plants, lectures/health fairs, printed materials

• Occupation– Safety, monitoring

• Medical/legal/other– Drug, chemical, other

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Benzodiazepines Poisoning Victims

Age and Gender

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Poisonings by Age(N=29,249)

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

< 6 6 - 12 13 - 19 20s 30s 40s 50s > 60

Age in Years

Nu

mb

er o

f P

ois

on

ing

s

All Poisonings (cases)

Benzodiazepine Poisonings (citings)

Human poisonings, known ages

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BenzodiazepinesAs a Percentage of Poisonings by Age

(N=29,249)

0

2

4

6

8

10

12

14

< 6 6 - 12 13 - 19 20s 30s 40s 50s > 60

Age in Years

Per

cen

tag

e o

f P

ois

on

ing

s

Human poisonings, known ages, known reasons

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Benzodiazepine Poisoning - Age and Gender(N = 1,044)

0

20

40

60

80

100

120

140

160

180

200

< 6 6 - 12 13 - 19 20s 30s 40s 50s > 60

Age in Years

Nu

mb

er o

f P

ois

on

ing

s

Males

Females


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Benzodiazepine Poisonings - Age and GenderIntentional - Substance Abuse

(N = 101)

0

2

4

6

8

10

12

14

16

18

20

< 6 6 - 12 13 - 19 20s 30s 40s 50s > 60

Age in Years

Nu

mb

er o

f P

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on

ing

s

Males

Females


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Benzodiazepine Poisonings - Age and GenderIntentional - Suicide Attempt

(N = 616)

0

20

40

60

80

100

120

140

< 6 6 - 12 13 - 19 20s 30s 40s 50s > 60

Age in Years

Nu

mb

er o

f P

ois

on

ing

s

Males

Females


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Benzodiazepines Poisoning Victims

Reason by Age

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Reason for Poisoning by Age (cases)(N = 28,971)

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

< 6 6 - 12 13 - 19 20s 30s 40s 50s > 60

Age in Years

Nu

mb

er o

f P

ois

on

ing

s

Unintentional

Intentional


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Reason for Benzodiazepine Poisoning by Age (citings)

0

50

100

150

200

250

< 6 6 - 12 13 - 19 20s 30s 40s 50s > 60

Age in Years

Nu

mb

er o

f P

ois

on

ing

s

Unintentional

Intentional

(N = 1,026)


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Reason for Unintentional Benzodiazepine Animal Poisoning

Accessed medicine from:• Floor• Trash container• Medicine bottle (chewed)

– Mom’s or Dad’s– Grandma’s– Sitter’s

Effects: vomiting, wobbly legs, unsteady on paws

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Reason for Unintentional Benzodiazepine Child Poisoning

Similar to pet, also note:• Therapeutic error (parent’s anti-anxiety instead

of child’s attention deficit medication)• Accessed from drug-dealing situation• Accessed from pill reminder• Other medications sometimes involved

Effects: ataxia, lethargy, slurred speech, dizziness, vomiting, (respiratory depression if other medications involved)

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Reason for Unintentional Benzodiazepine Poisoning by Age (citings)

0

20

40

60

80

100

120

< 6 6 - 12 13 - 19 20s 30s 40s 50s > 60

Age in Years

Nu

mb

er o

f P

ois

on

ing

s

General

Therapeutic Error

(N = 269)

Adverse Effect


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Reason for Intentional Benzodiazepine Poisoning by Age (citings)

0

20

40

60

80

100

120

140

160

180

200

< 6 6 - 12 13 - 19 20s 30s 40s 50s > 60

Age in Years

Nu

mb

er o

f P

ois

on

ing

s

Suicide Attempt

Abuse

(N = 757)

MisuseWithdrawal


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Benzodiazepines

How frequent?

Which ones?

22Human poisonings, known ages, known reasons

Poisonings - Suicide (citings)Northern New England Poison Center

Top 10 Substance Categories(SASRS Database)

0

200

400

600

800

1000

1200

1400

Quarter3

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2004 2005 2006 2007

Antidepressants

Benzodiazepines/Benzodiazepine-like

Non-Opioid Analgesics without sedatives (aspirin, Tylenol®)

Antipsychotics (atypical)

Alcohol/Alcohol-containing (mouthwash, hair spray)

Opioids

Anticonvulsants/Mood Stabilizers

Non-Opioid Analgesics with Sedatives (Fiorinal®, Fioricet®,Midrin, Tylenol PM®)Cardiovascular (Heart)

Antihistamines (sedating)

County All County

Count

Year Quarter

Group Name


Exposures - Suicide (citings)Northern New England Poison Center

Top 10 Benzodiazepines(SASRS Database)

0

50

100

150

200

250

Quarter3

Quarter4

Quarter1

Quarter2

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Quarter1

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2004 2005 2006 2007

Benzodiazepines/Benzodiazepine-like - Clonazepam (Klonopin®)

Benzodiazepines/Benzodiazepine-like - Other/unknownbenzodiazepine

Benzodiazepines/Benzodiazepine-like - Lorazepam (Ativan®)

Benzodiazepines/Benzodiazepine-like - Zolpidem (Ambien®)

Benzodiazepines/Benzodiazepine-like - Alprazolam (Xanax®)

Benzodiazepines/Benzodiazepine-like - Diazepam (Valium®)

Benzodiazepines/Benzodiazepine-like - Eszopiclone/Zopiclone(Lunesta®, Imovane®)

Benzodiazepines/Benzodiazepine-like - Temazepam (Restoril®)

Benzodiazepines/Benzodiazepine-like - Chlordiazepoxide(Librium®)

Benzodiazepines/Benzodiazepine-like - Zaleplon (Sonata®)

County All County

Count

Year Quarter

Group Name

Sub Group Name


Poisonings - Abuse (citings)Northern New England Poison Center


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350

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2004 2005 2006 2007

Stimulants and Street DrugsOpioidsAlcohol/Alcohol-containing (mouthwash, hair spray)Asthma, Cold and Cough, Eye, Ear, Nose and ThroatBenzodiazepines/Benzodiazepine-likeAntidepressantsPotential Inhalant (Likely to be Abused)Antihistamines (sedating)Antipsychotics (atypical)Non-Opioid Analgesics without sedatives (aspirin, Tylenol®)

County All County

Count

Year Quarter

Group Name


Poisonings - Abuse (citings)Northern New England Poison Center


0

5

10

15

20

25

30

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45

50

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2004 2005 2006 2007


Benzodiazepines/Benzodiazepine-like - Other/unknownbenzodiazepineBenzodiazepines/Benzodiazepine-like - Alprazolam (Xanax®)




Benzodiazepines/Benzodiazepine-like - Eszopiclone/Zopiclone(Lunesta®, Imovane®)Benzodiazepines/Benzodiazepine-like - Temazepam (Restoril®)

Benzodiazepines/Benzodiazepine-like - Oxazepam (Serax®)


County All County

Count

Year Quarter

Group Name

Sub Group Name

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Benzodiazepines

Substance Abuse

Questions

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Substance Abuse-Related Questions (Citings)Northern New England Poison Center

Top 10 Substance Categories (SASRS Database)

0

2000

4000

6000

8000

10000

12000

14000

Quarter3

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Quarter1

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Quarter3

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Quarter1

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Quarter1

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2004 2005 2006 2007

Opioids

Benzodiazepines/Benzodiazepine-like

Unknown Drug

Non-Opioid Analgesics without sedatives (aspirin, Tylenol®)

Antidepressants

Cardiovascular (Heart)

Skeletal Muscle Relaxants

Stimulants and Street Drugs

Antibiotics and Other Anti-infectives, Vaccines

Other Drug (Chemotherapy, Radiopharmaceuticals, Diagnostic,Hormones, Antidiabetic, Antithyroid)

County All County

Count

Year Quarter

Group Name

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Substance Abuse-Related Questions (citings)Northern New England Poison Center

Top 10 Benzodiazepines (SASRS Database)

0

200

400

600

800

1000

1200

1400

1600

1800

Quarter3

Quarter4

Quarter1

Quarter2

Quarter3

Quarter4

Quarter1

Quarter2

Quarter3

Quarter4

Quarter1

Quarter2

2004 2005 2006 2007






Benzodiazepines/Benzodiazepine-like - Eszopiclone/Zopiclone(Lunesta®, Imovane®)Benzodiazepines/Benzodiazepine-like - Oxazepam (Serax®)

Benzodiazepines/Benzodiazepine-like - Clorazepate (Tranxene®)



County All County

Count

Year Quarter

Group Name

Sub Group Name

29

Law Enforcement Questions (citings)Northern New England Poison Center


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1400

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2004 2005 2006 2007

OpioidsBenzodiazepines/Benzodiazepine-likeNon-Opioid Analgesics without sedatives (aspirin, Tylenol®)AntidepressantsUnknown DrugSkeletal Muscle RelaxantsAntibiotics and Other Anti-infectives, VaccinesCardiovascular (Heart)Stimulants and Street DrugsStomach and Bladder (other than opioid or anticholinergics)

County All County

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Year Quarter

Group Name

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Law Enforcement Questions (citings)Northern New England Poison Center


0

50

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250

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Quarter1

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2004 2005 2006 2007







Benzodiazepines/Benzodiazepine-like - Chlordiazepoxide(Librium®)Benzodiazepines/Benzodiazepine-like - Eszopiclone/Zopiclone(Lunesta®, Imovane®)Benzodiazepines/Benzodiazepine-like - Other/unknownbenzodiazepineBenzodiazepines/Benzodiazepine-like - Oxazepam (Serax®)

County All County

Count

Year Quarter

Group Name

Sub Group Name

1 Benzodiazepines Use, Misuse, Abuse and Poisoning Karen E. Simone, PharmD, DABAT Northern New...

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