Not Again: Benzodiazepines Once More Under Attack.

It seems that we are again in the midst of a new storm of concern about an epidemic of benzodiazepine (BZ) overuse, misuse, and abuse. The first concern, in the 1980s, posited BZs as an epidemic of excessive prescribing and was frequently mentioned in books, movies, and numerous lay magazine articles. There was also concern that BZs were abused or misused, caused addiction with difficult withdrawal symptoms, or taken without medical supervision by large numbers of people. Available data from that period, while acknowledging potential problems with BZs, did not support this exaggerated view of serious hazards and widespread overuse. Although it was well known that BZs, such as other sedative hypnotics, could produce physiological dependence (usually mild) and a discontinuation syndrome (usually brief), the pharmacology and safety of these anxiolytics was well known. Categorized by elimination half­life and receptor potency, BZs were widely and successfully used to treat a variety of anxiety syndromes including acute states of anxiety, panic and trauma, medically associated anxiety and stress, as well as assisting with sleep onset at night.1 Of greatest medical concern, however, was the abuse of BZs that was primarily seen in those who were already abusers of alcohol or other drugs. Benzodiazepine abuse was a genuine public health problem, but fortunately a relatively small issue when compared with the widespread appropriate medical use of BZs.2 Careful door­to­ door surveys of BZ use indicated that approximately 6% of those surveyed indicated that they took BZs on a regular basis during the previous year,1,2 and this rate of long­term use was lower than in several European countries.3 Much of BZ use in the United States was short term (3 weeks or less) and was prescribed by family practitioners Journal of Clinical Psychopharmacology: October 2015 ­ Volume 35 ­ Issue 5 ­ p 493–495 doi: 10.1097/JCP.0000000000000383 Editorial