BENZODIAZEPINES ANDBUPRENORPHINE

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Disclosure of Relevant Financial Relationships  Content ofActivity:
PCSS-O Buprenorphine/BenzodiazepinePresentation


Name
Stephen A.Wyatt,DO

 Com  merc  ial  Inter  ests

 Relevant  Financial  Relationships:  What Was  Received

 Relevant  Financial  Relationships:  For WhatRole

 No Relevant  Financial  Relationships  with Any  Commercial  Interests

 
None

 X

 

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WHY ARE WE TALKING ABOUTTHEM?


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"BLUELIGHT"

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TREATMENTADMISSIONS


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EPIDEMIOLOGY OFBENZODIAZEPINES


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EPIDEMIOLOGY

XANAX

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EPIDEMIOLOGY

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EPIDEMIOLOGY OFBENZODIAZEPINES

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SEDATIVEHYPNOTICS

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MECHANISM OF ACTION -GABAARECEPTOR


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MECHANISM OF ACTION -GABAARECEPTOR

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GABAA receptor is the binding site forGABA

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Differentallostericbinding sites modulate theactivity.
Directagonists

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Enhanced GABAbinding

 


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The allosteric sites are the targets of variousdrugs,

 

 

 

 


ethanol
neuroactivesteroids,  inhaledanaesthetics

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PHARMACOKINETICSBENZODIAZEPINES

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COGNITION

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MOST ABUSEDBENZODIAZEPINES

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ONBLINE DOECTORRNEVIEWZODIAZEPINEUSE PATTERNS

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Recreational abuse of BZs alone isuncommon


�Commonly taken as part of polysubstanceabuse
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Motivations.
Euphoria

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Augment euphoriant effect of other drugs, especiallyopiates

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Up to 80% of opiate abusers have takenBZs

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To ease the "crash" fromcocaine

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29%-33% of alcohol abusers takeBZs

 

 

BenzodiazepineDependence,Toxicity,andAbuse:ATaskForceReportoftheAmerican  PsychiatricAssociation.Washington,DC,APA,1990


BENZODIAZEPINEABUSE


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STREETMARKET

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HOW REINFORCING AREBENZODIAZEPINES?

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PHARMACOKINETICSBENZODIAZEPINES

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Addiction (1998) 93(9),1385�1392

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PHARMACODYNAMICS -ANIMALMODEL

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PHARMACODYNAMICS -ANIMALMODEL

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EPIDEOMNLINE DIOOCTORLREOVIEWGYOF:

Buprenorphine andBenzodiazepines

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EPIDEMIOLOGYOF:
BUPRENORPHINE ANDBENZODIAZEPINES

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PHARMACODYNAMICS

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PHARMACODYNAMICS

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BENZODIAZAPINE PLUS:  BUPRENORPHINE VS.METHADONE

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BENZODIAZAPINEPLUS:

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ONCLINE DOOCTORRMEVIEW   BINEDBENZODIAZEPINESANDBEST ONLINE DOCTORREVIEW

Buprenorphine
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Cohort study of 325 buprenorphine with past year  benzodiazepine use andmisuse.

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Not associated with treatment retention or illicit opioid use  (urine toxicologyscreens)

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No greater overdoserate.

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Greater accidental injury related ED visits(>females)


ZSchuman-Olivier,et.al.,DrugandAlcoholDependence,October2013


WITHDRAWAL

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BENZODIAZEPINE -WITHDRAWALTREATMENT

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PROLONGEDWITHDRAWAL

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ANTIDEPRESSANTS FORGAD

Kapczinski F, et al. Cochrane Database Syst Rev.2003;(2):CD003592.

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TCAS FORANXIETY

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AN APPROACH TO TALKING TO PATIENTS ABOUT  ANXIETY.

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AN APPROACH TO TALKING TO PATIENTS ABOUT  PANIC.

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Usemuch of the same approach as in the anxiouspatient.

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Talk to them about the importance of notpanicking!

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Explain the experience of of panic and the physiology  hyperventilation..
SOB

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Numbness and tingling of mouth andfingers

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Upsetstomach

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Chest heaviness

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Visualabnormalities

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Fainting

 

 

 

SUMMARY

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Addiction Psychiatrist

By newz

Addiction Psychiatrist

Diazepam and clonazepam ≈ $2.00-$4.00/pill  Many who seek these drugs for a "high" quickly move on to other agents  High risk for continued misuse of BZs: Heroin dependent / methadone or buprenorphinemaintenance 75%+ admitted taking BZs to enhance intoxication or treatwithdrawal

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