Based on epidemiological data, the prevalence of benzodiazepine (BZD) abuse is generally low in the therapeutic setting. However, the incidence of BZD misuse and abuse is much higher in (people who abuse alcohol and other drugs, either currently or in their past history.
When BZDs are combined with other CNS depressants (e.g., alcohol, antidepressants, antipsychotics, opioids), patients are at risk of respiratory depression, heavy sedation, coma and death. Alcohol and BZDs can produce cross-tolerance, and regular use of both can make withdrawal more severe and/or protracted.
Patients who use two or more psychoactive drugs in combination (polydrug use) and those with a history of significant mental illness may be more vulnerable to major harms. When treating polydrug users, avoid initiating BZDs, and for patients already taking them, reduce and cease prescription of BZDs in a supervised manner.