Inappropriate benzodiazepine medical and non-medical use: a neglected problem begging for prevention

Aims: We aimed at providing an epidemiological overview on inappropriate use of benzodiazepines (BDZ) and its adverse outcomes. Methods: We performed a narrative review of recent studies focused on the epidemiology of BDZ inappropriate use. We addressed prevalence of use, incidence and possible predictors of life-threatening events, mortality risk, barriers to monitoring their use and to good prescription practice, screening and prevention of inappropriate use of BDZ. Results: Besides being good symptomatic medications, BDZ convey the risk of dependence and addiction, making their long-term use discouraged by the Food and Drugs Administration. BDZ prescription and long-term use are not systematically recorded, and therefore risky behaviors are scarcely documented. This prevents from attributing adverse events to BDZ use. While life-threatening events are well known in polysubstance intoxication, the specific effects of BZD non-medical use remain unrecognized. Ascertainment of cause of deaths often does not include BDZ, and does not distinguish between accidental or intentional overdose. Monitoring of BDZ use, preparedness of emergency departments, screening of at-risk subjects, sensitization of the general public and support for discontinuation treatments might help controlling BDZ inappropriate use. Further data are needed to characterize life-threatening events and deaths, and in turns help preventing a quote of the severe outcomes related to this medical problem. Conclusions: The inappropriate use of BDZ requires public health attention. Effective monitoring systems are needed to record and characterize BDZ use, especially when chronic. Health education programs targeting patients and providers should be promoted to recognize and control inappropriate use of BDZ.