自20 世纪 50 年代初次研发以来,苯二氮卓类药物被广泛用于多种疾病的治疗,是一种被滥用的药物。苯二氮卓类药物是除酒精之外最常用于娱乐的催眠或镇静药物。
关于苯二氮䓬类药物使用情况的流行病学研究结果会根据不同的抽样人群而存在差异。法国的 EVA 研究表明老年人使用苯二氮卓类药物的发生率是 4.7/1000 人-月。[3]Lechevallier-Michel N, Berr C, Fourrier-Reglat A. Incidence and characteristics of benzodiazepine use in an elderly cohort: the EVA study. Therapie. 2005;60:561-566.http://www.ncbi.nlm.nih.gov/pubmed/16555493?tool=bestpractice.com美国约 10% 的老年人定期服用苯二氮卓类药物,多用于镇静和抗焦虑。[4]Gleason PP, Schulz R, Smith NL, et al. Correlates and prevalence of benzodiazepine use in community-dwelling elderly. J Gen Intern Med. 1998;13:243-250.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1496936/http://www.ncbi.nlm.nih.gov/pubmed/9565387?tool=bestpractice.com精神卫生机构中接受抗抑郁治疗的成年人服用苯二氮卓类药物的比例高达 36%。[5]Valenstein M, Khanujua Taylor K, Austin K, et al. Benzodiazepine use among depressed patients treated in mental health settings. Am J Psychiatry. 2004;161:654-661.http://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.161.4.654http://www.ncbi.nlm.nih.gov/pubmed/15056511?tool=bestpractice.com尽管研究显示苯二氮䓬类药物对创伤后应激障碍 (post-traumatic stress disorder, PTSD) 的预防和治疗无效,但 30%-74% 的 PTSD 患者得到了苯二氮䓬类药物的处方。[6]Guina J, Rossetter SR, DeRhodes BJ, et al. Benzodiazepines for PTSD: a systematic review and meta-analysis. J Psychiatr Pract. 2015;21:281-303.http://www.ncbi.nlm.nih.gov/pubmed/26164054?tool=bestpractice.com
白种人中苯二氮卓类药物使用率高于其他种族人群。女性苯二氮卓类药物使用率是男性的两倍。镇静药、抗焦虑药和催眠药的处方常用于 50-70 岁的人群。报告显示苯二氮䓬类药物使用广泛,在巴西中年至年龄较长的成年人群的使用率为 3.9%,而在加拿大 65 岁及以上人群的使用率则为 35.9%。[7]Brunoni AR, Nunes MA, Figueiredo R, et al. Patterns of benzodiazepine and antidepressant use among middle-aged adults: the Brazilian longitudinal study of adult health (ELSA-Brasil). J Affect Disord. 2013;151:71-77.http://www.ncbi.nlm.nih.gov/pubmed/23769607?tool=bestpractice.com[8]Préville M, Vasiliadis HM, Bossé C, et al. Pattern of psychotropic drug use among older adults having a depression or an anxiety disorder: results from the longitudinal ESA study. Can J Psychiatry. 2011;56:348-357.http://journals.sagepub.com/doi/abs/10.1177/070674371105600606?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmedhttp://www.ncbi.nlm.nih.gov/pubmed/21756449?tool=bestpractice.com有证据表明,无论老年人群是否患有阿尔茨海默病,使用苯二氮䓬类药物都可能会增加卒中和髋部骨折的风险。[9]Saarelainen L, Tolppanen AM, Koponen M, et al. Risk of hip fracture in benzodiazepine users with and without Alzheimer disease. J Am Med Dir Assoc. 2017;18:87;e15-e87;e21.http://www.jamda.com/article/S1525-8610(16)30435-2/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/27847263?tool=bestpractice.com[10]Taipale H, Koponen M, Tanskanen A, et al. Use of benzodiazepines and related drugs is associated with a risk of stroke among persons with Alzheimer's disease. Int Clin Psychopharmacol. 2017;32:135-141.http://www.ncbi.nlm.nih.gov/pubmed/28072593?tool=bestpractice.com[11]Huang WS, Muo CH, Chang SN, et al. Benzodiazepine use and risk of stroke: a retrospective population-based cohort study. Psychiatry Clin Neurosci. 2014;68:255-262.http://www.ncbi.nlm.nih.gov/pubmed/24829937?tool=bestpractice.com
苯二氮䓬类药物在 18 岁至 25 岁的人群中非医疗用途的使用率最高,为 0.7%-1.9%。[12]Buckley NA, Dawson AH, Whyte IM, et al. Relative toxicity of benzodiazepines in overdose. BMJ. 1995;310:219-221.http://www.bmj.com/cgi/content/full/310/6974/219http://www.ncbi.nlm.nih.gov/pubmed/7866122?tool=bestpractice.com苯二氮䓬类药物的使用在酒精滥用者中尤为常见,高达 40% 酒精滥用者报告在喝酒中途或喝酒时自行服用苯二氮䓬类药物。
关于非法使用药物,苯二氮卓类药物在镇静、抗焦虑和催眠方面很大程度上取代了巴比妥类药物、安眠酮和格鲁米特。苯二氮卓类药物在医疗及娱乐用途方面均优于较老的药物,因为它更安全,药物过量导致严重中毒的风险更低。[12]Buckley NA, Dawson AH, Whyte IM, et al. Relative toxicity of benzodiazepines in overdose. BMJ. 1995;310:219-221.http://www.bmj.com/cgi/content/full/310/6974/219http://www.ncbi.nlm.nih.gov/pubmed/7866122?tool=bestpractice.com
尽管药物具有安全性,但苯二氮䓬类药物过量现在十分常见,尤其常见于自杀行为和联合阿片类药物滥用的人群。[13]Warner M, Trinidad JP, Bastian BA, et al. Drugs most frequently involved in drug overdose deaths: United States, 2010-2014. Natl Vital Stat Rep. 2016;65:1-15.https://www.cdc.gov/nchs/data/nvsr/nvsr65/nvsr65_10.pdfhttp://www.ncbi.nlm.nih.gov/pubmed/27996932?tool=bestpractice.com在美国处方药物的致命过量服用的案例中,苯二氮䓬类药物约占 31%,此类致命过量服用案例中,75% 还涉及阿片类药物。[14]Bachhuber MA, Hennessy S, Cunningham CO, et al. Increasing benzodiazepine prescriptions and overdose mortality in the United States, 1996-2013. Am J Public Health. 2016;106:686-688.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4816010/http://www.ncbi.nlm.nih.gov/pubmed/26890165?tool=bestpractice.com在英国,苯二氮卓类药物最常见于老年人蓄意自伤。[15]Hawton K, Bergen H, Casey D, et al. Self-harm in England: a tale of three cities. Multicentre study of self-harm. Soc Psychiatry Psychiatr Epidemiol. 2007;42:513-521.http://www.ncbi.nlm.nih.gov/pubmed/17516016?tool=bestpractice.com澳大利亚同样存在这一趋势,报告显示老年人群中苯二氮䓬类药物的开处和蓄意服毒相关。[16]Ticehurst S, Carter GL, Clover KA, et al. Elderly patients with deliberate self-poisoning treated in an Australian general hospital. Int Psychogeriatr. 2002;14:97-105.http://www.ncbi.nlm.nih.gov/pubmed/12094912?tool=bestpractice.com