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I propose this article be merged into the overdose section in the main Benzodiazepine article because I believe it does not warrant a separate article. They share a substantial amount of text, so additional information would not make the section too large. I've looked at several other major drug articles, and I could not find any drugs that had a separate article on overdose. I first found this article because it was linked from the main benzodiazepine article, and I found it too repetitious to be useful. Lastly, I simply can't foresee an article specifically on benzo overdose growing into a long article. Unless I'm missing something, this article is just a glorified stub that won't go anywhere. Letsgoridebikes (talk) 06:13, 5 February 2009 (UTC)
Hmmm, this section was created because the benzodiazepine article was getting too big, so the article was split. The benzo article is already approaching again too big status and may need to be split further some time in the near future. I didn't create this page, Jmh649 did, so I have let him know of your suggestion but I would be opposed to merging this content back into the benzodiazepine article due to its current size. Otherwise I might have agreed.--Literaturegeek | T@1k? 11:05, 5 February 2009 (UTC)
- Toxicology is an entire subfield of medicine. There is lots of literature to expand this topic. The reference books are specific to toxicology see Nelson, Lewis H.; Flomenbaum, Neal; Goldfrank, Lewis R.; Hoffman, Robert Louis; Howland, Mary Deems; Neal A. Lewin (2006). Goldfrank's toxicologic emergencies. New York: McGraw-Hill, Medical Pub. Division. ISBN 0-07-143763-0.. Both uptodate and emedicine have separate pages on this topic.http://emedicine.medscape.com/article/813255-overview http://www.uptodate.com/online/content/topic.do?topicKey=subabuse/9619&selectedTitle=1~8&source=search_result Well Tricyclic antidepressant overdose and Paracetamol toxicity are examples of other pages on overdoses. I have been working on organizing the articles on toxicology. Medicine article are however poor and there is lots of work that needs to be done. What we really need is more medical editors to help. This article needs a section on epidemiology. History of abuse. General decontamination measures. etc. It is more difficult to edit a large page as it is slower. Hope this explains everything. Removed the tags.--Doc James (talk · contribs · email) 17:22, 5 February 2009 (UTC)
Oxazepam was listed as the least toxic benzodiazepine, but there were three listed as the most toxic: flunitrazepam, temazepam, and alprazolam. There was no reference attached to it. I did a little research and found that the original study had listed oxazepam as the least toxic and temazepam the most toxic. I couldn't find any literature stating flunitrazepam was the most toxic. The only thing on alprazolam that I was able to find was the review which is referenced in the article. The review doesn't talk of deaths caused by alprazolam, but it basis its assertion that alprazolam is the most toxic based solely on length of stay (LOS) at the hospital, intensive care (ICU) admission, coma (GCS < 9), flumazenil administration and requirement for mechanical ventilation. It compared alprazolam to diazepam and "other" unnamed benzodiazepines. Given that alprazolam is the most widely prescribed benzodiazepine in the United States by a significant margin, this review is not at all a surprise. According to the "Trends in the Abuse of Prescription Drugs" by Jane Carlisle Maxwell, Ph.D., which can be found here, alprazolam, clonazepam, diazepam, and lorazepam make up almost the entire line-up of the misused benzodiazepines in the United States. The above link on the trends of prescription drug abuse in the U.S. lists benzodiazepine emergency department (ED) visits at 144,385 in 2004. There were 49,842 alprazolam ED visits in 2004 (so alprazolam alone made up 34.5% of all benzodiazepine ED visits). Clonazepam, the third most scripted benzodiazepine, had ED visits that numbered 26,238 (18.2%). Alprazolam and clonazepam alone made up 76,080 (53%) of all benzodiazepine ED visits. Now factor in the diazepam and lorazepam ED visits and you'll get a clear picture of why the review on alprazolam that is referenced in the article (which happens to be a 2004 review; the same year for which we have the raw numbers listed right here in this message) is simply not good enough. It certainly says nothing about alprazolam's toxicity relative to other benzodiazepines. The most commonly prescribed benzodiazepines in the United States are (in descending order): alprazolam, diazepam, clonazepam, lorazepam, oxazepam, and chlordiazepoxide. Bastian (talk) 22:19, 14 October 2011 (UTC)
The oxazepam and temazepam was from Buckley, but not cited correctly. The alprazolam was from US ER statistics. The Flunitrazepam/Nitrazepam was from swedish suicides. They missed Flurazepam from Buckley/Serfaty.
Please, you inserted various misrepresentations of sources and also original research into that article. Please take the time to thoroughly read the references before editing. It is also not the place to insert your opinion about the weak methodology of studies. (wrt. Alprazolam toxicity) The studies have certainly not claimed this themselves, so you cannot cite this your own criticism to them, but it is OR. Serfaty found Flurazepam most toxic, followed by Temazepam. Buckley et al. compared Temazepam and Oxazepam and focused on them to corroborate Serfati et al. findings. But Buckley also cites Serfati in that Flurazepam has the highest toxicity index. When citing primary sources, please cite it as "A 1980 Nepalese study found...XXX and YYY", not "It IS XXX and YYY". The study which found Alprazolam most toxic (the one with the weak methodology) is an Australian study, they merely cite to the US study of ER admissions for comparison with their own data. The timeline is not unimportant. It is obvious that sedatives, sold as "sleeping pills" are most often used for suicide attempts and then result in massive overdoses and mixed overdoses with whatever the medicine chest gave and with alcohol. What at some time is most prescibed as a sleeping pill depends on kind of fashion among the MDs. Now the Z-drugs are taking this place. Others found Flunitrazepam most toxic earlier, it really depends on availability, and also on available package size limits, as mentioned by the alprazolam toxicity study. They do not sell temazepam in large packs any more in Australia. Now alprazolam is taking the place in suicides, as 100-packs are still available, says the Alprazolam study.
Regarding the toxicity. Toxicity as by ER statistics as well as toxicity by death statistics means almost the frequency of somebody willing to take several boxes of it. This just varies by intent. If the people try to get intoxicated they mix it with whatever they think and chose a benzo with a reputation of giving a good "buzz". If the people try to commit suicide they take what says "sleeping pill" on it together with what has a reputation of making you "dead". What has a reputation of giving a "buzz" as well as what is prescibed as a tranquilizer as well as what is prescibed as a sleeping pill varies over time, is almost a matter of fashion. If many people go dead using a particular sleeping pill the doctors prescribe something else which is presumed less toxic. Also if many people go dead by some pill it becomes a fashion among suicidalists because they heard that others have easily sprouted little wings. The same for the "buzz", it also becomes a fashion because people have prescribed to them or buy or sell what they heard from other addicts. The ER room admissions with severe symptoms as well as the death statistics from the coroner/morgue mix both above motifs and are equally valid for analysis of the public health threat, so to say the death cases are the elite of the ER admissions. Regarding the refs, as I said above, you just have to read them and then cite precisely. Just open them and you see what I said above. Open Buckley and search for flurazepam. Buckley also did not say most toxic and least toxic, but more/less toxic than most and focused on temazepam/oxazepam in response to Serfaty. All, see above. The swedish suicide statistics mentioned nitrazepam/flunitrazepam for 80% of the suicides at a different time, just open the ref. The reason was simply that these both were prescibed as "sleeping pills", not that they were particularly toxic. The same is true for temazepam in contrast to oxazepam. Temazepam prescibed as an allegedly "strong" sleeping pill got fans among suicidalists and junkies, oxazepam with a reputation of a boring anxiolytic didn't make the list of pills somebody would take several boxes full. From a toxicology standpoint these statistics say little, they are statistics of realistic public health threat.
I guess the most likely factual connection between the statistics and the toxicological profile of the substances is that in the classical benzodiazepines a methylation in 1-position gives a more sedating substance, if you compare (oxazepam-temazepam) (lorazepam-lormetazepam) (nitrazepam-nimetazepam) (nordazepam-diazepam) etc. consequently the methylated ones are prescibed as sedatives/sleeping pills, the non-methylated ones as day tranquilizers. Then the methylated ones show up more in suicide statistics and are more used by addicts who value the sedative effect or find them subjectively "stronger" and show up in the ER/morgue with a mixed intoxication or massive overdose. It does not say that their ratio of effective dose to LD50 is worse or much worse, it is just a matter of the expectations on the side of abusers/addicts and suicidalists I guess. 220.127.116.11 (talk) 05:41, 20 October 2011 (UTC)