Benzodiazepine withdrawal in subjects on opiate substitution treatment,Sevrage aux benzodiazépines des sujets dépendants aux opiacés en traitement de substitution
La Presse Médicale. 2006-04-01; 35(4): 599-606
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Article in French
Fatséas M(1), Lavie E, Denis C, Franques-Rénéric P, Tignol J, Auriacombe M.
(1)Laboratoire de Psychiatrie et JE 2358, Université Victor Segalen Bordeaux 2,
Institut Fédératif de Recherche en Santé Publique, Inserm-IFR no 99, Département
d’Addictologie, CHU de Bordeaux, Centre Hospitalier Charles Perrens.
Presse Med. 2006 Apr;35(4 Pt 1):563-4.
INTRODUCTION: Benzodiazepines are the most widely used psychotropic agents in
the world. Abuse and dependence are reported in the general population and among
drug misusers, including those dependent on heroine. Benzodiazepine use by
heroine users increases their risk of overdose, not only from heroin but also
substitution drugs such as methadone and more recently buprenorphine. Hence,
detoxification from benzodiazepines is desirable.
OBJECTIVE: The objective of this paper was to review the literature and
determine the best benzodiazepine detoxification procedure for opiate-dependent
individuals receiving substitution treatment.
METHODS: Relevant studies were sought through systematic searches of Medline and
Toxibase (a database focusing on substance abuse).
RESULTS: There were fewer controlled studies than expected about benzodiazepine
detoxification, and all of them excluded subjects who misused opiates or were in
opiate substitution treatment. The best evidence supports a procedure where the
patient is switched to a long-lasting benzodiazepine and the dose then tapered
by 25% of the initial dose each week. Diazepam is the drug most often used in
the framework. In opiate users, diazepam may raise special problems of misuse,
as suggested by clinical and epidemiologic studies. Nonetheless, diazepam is the
only benzodiazepine found to be effective for this withdrawal in controlled
studies and some studies indicate that unprescribed diazepam use in heroin users
is sometimes motivated by the desire to alleviate withdrawal symptoms and
CONCLUSION: Although diazepam appears to have potential for abuse, the available
data does not rule out its therapeutic interest for benzodiazepine withdrawal in
patients on opiate substitution treatment in an adequate treatment setting.
Specific studies of this population are needed.