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Chapter 4 - Addiction to Prescription Medication: Benzodiazepines, Z-Drugs and Gabapentinoids

Published online by Cambridge University Press:  02 November 2021

By
Emma Rourke  and
Fergus Law
Edited by
Ed Day
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Summary

Benzodiazepines, Z-drugs and gabapentinoids are commonly prescribed medications with multiple indications that have the potential for misuse and dependence. Benzodiazepines enhance the effect of the neurotransmitter gamma-aminobutyric acid (GABA) at the GABA-A receptor, resulting in sedative, anxiolytic, hypnotic, anticonvulsant and muscle relaxant properties. The ‘Z-drugs’ (zopiclone and zolpidem) are non-benzodiazepine hypnotics that also have an agonist effect at the GABA-A receptor. The gabapentinoids (pregabalin and gabapentin) act to decrease central neuronal excitability by binding to α2-δ protein subunits of voltage-activated calcium channels on the neuronal membrane. They were initially marketed as antiepileptic drugs, but are now licensed for use in neuropathic pain and generalised anxiety disorder. This chapter considers each class in turn, exploring the pharmacokinetics, metabolism and potential desired effects that lead to misuse. A practical method for assessing people with potential dependence is described for each substance, as well as strategies to support stabilisation, withdrawal and relapse prevention.

Keywords

benzodiazepinezopiclonezolpidempregabalingabapentindependencestabilisationdetoxificationwithdrawal
Type
Chapter
Information
Seminars in Addiction Psychiatry , pp. 68 - 96
Publisher: Cambridge University Press
Print publication year: 2021

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