Benzodiazepines and the Z drugs, zolpidem and zopiclone, act on the benzodiazepine binding site of the GABAA receptor: they are collectively called benzodiazepine receptor agonists. While most of these drugs are prescribed restricted substances (Schedule 4, as defined by the Therapeutic Goods Administration [TGA] alprazolam and flunitrazepam are controlled drugs (Schedule 8).
Potential harms of benzodiazepines, zolpidem or zopiclone use include toxicity (particularly respiratory depression, if used with other sedatives, including alcohol and opioids), falls, and impaired cognition, concentration and attention. These can lead to traffic accidents, poor self-care and impairment of work and parenting. Although early media reports described unusual behaviours with zolpidem and zopiclone use, behavioural changes following their ingestion do not differ from those seen with benzodiazepinesOlson, 2008. Newer illicit designer benzodiazepines such as etizolam are being detected in Australia through toxicovigilance screening.
The spectrum of substance use is described in these guidelines by the terms ‘hazardous use’, ‘harmful use’ and ‘substance dependence’, outlined in
Terminology describing the spectrum of substance use. Within these categories, types of use of benzodiazepines, zolpidem or zopiclone range from use as prescribed (eg if prolonged doses are prescribed for anxiety or sleep disorders) to nonmedical use. Nonmedical use does not align with the directed use, for example, use to become intoxicated or to treat a symptom other than the clinician intended
Australian Institute of Health and Welfare (AIHW)McNeely, 2014.
Patients may not be aware that continued use (even as prescribed) poses risk. With lower doses (eg less than 15 mg
oral daily diazepam equivalent), patients may be stable for some time at that dose but can still experience harms. These harms include impacts on cognition and increased falls.
Note: Patients on long-term benzodiazepines, zolpidem or zopiclone (even at stable lower doses) are at risk of harms.
A person with
substance dependence may experience a strong drive to escalate their use, despite harms occurring. Current or past disorders of alcohol or other drug use increase the likelihood of dependence on benzodiazepines, zolpidem or zopiclone. Higher-dose, high-risk use of more than one substance (polysubstance use) can sometimes be chaotic.
