BENZODIAZEPINS and GABAPENTINOIDS: Why they should not be taken lightly

This literature review is conducted for Scotland, because over the last decade, the use of “designer” drugs in this country may have contributed to polydrug use and an increase in substance abuse-related deaths. Thus, if Scotland constitutes a good field for studying mortality linked to substances, including drugs, the results may be valid for other rich countries. Moreover, in recent years, Scotland has experienced a disproportionately high number of substance-related deaths compared to other European countries. The causes here are opioids, cocaine and alcohol and, more recently, synthetic benzodiazepines such as etizolam and prescription drugs such as gabapentinoids, substances increasingly detected in toxicology reports. .

Etizolam and gabapentinoids, central nervous system drugs with sedative effects and high dependence risk, could both promote a culture of polyconsumption of substances and contribute to an increase in the number of deaths linked to their abuse.

The study is a systematic literature review of published data on gabapentinoids and etizolam in the Scottish population, to establish their contribution to the increase in substance abuse-related deaths in general. 18 studies were selected for this review. The analysis reveals that:

• these 2 medications are increasingly cited as contributing factors to deaths linked to substance abuse;
• (in Scotland) the number of deaths linked to gabapentinoids now represents almost 1 in 3 deaths linked to substance abuse;
• the concomitant use of opioids and other substances remains the most common factor in these adverse effects, including deaths linked to etizolam and gabapentinoids;
• prescriptions for gapapentinoids are simultaneously increasing, particularly off-label…; a prescribing trend that could be explained by efforts to limit the prescribing of opioids and benzodiazepines?
• Finally, a higher rate of gabapentinoid prescriptions noted among older women and etizolam-related deaths are

more accidental in men and more intentional in women.

The authors therefore sound the alarm, and not just for Scotland, with the analysis suggesting thatBoth substances can promote polydrug use and thus contribute more strongly to mortality.