Outpatient Treatment of Chronic Designer Benzodiazepine Use: A Case Report

We describe the difficulty in detecting these substances and the development of a use disorder including adverse outcomes such as seizures when stopped. The evidence for management is anecdotal. Case: We describe the case of a male of approximately 25 years of age with alcohol and sedative-hypnotic use disorder related to illicit “Xanax bars,” whose point of care urinalysis did not identify benzodiazepines and whose broad-spectrum urinalysis identified the presence of flualprazolam, a novel designer benzodiazepine. He suffered a subacute withdrawal seizure and responded to treatment with loading doses of diazepam and naltrexone. Discussion: Although previous literature has focused on poisoning and intoxication (including coma), there are few studies examining treatment options for chronic designer benzodiazepine use. Standard approaches, such as conversion to a longer-acting benzodiazepine with a prolonged taper, are risky with designer benzodiazepines due to the unknown level of tolerance and risk of overdosing the patient. Illicit “Xanax” is not equivalent to prescribed alprazolam and cannot be converted and tapered. To be cautious, supervised benzodiazepine tapers or anticonvulsants should be explored as treatment strategies, based on their use in pharmaceutical benzodiazepine use disorders. Inpatient acute withdrawal management should be considered, and anticonvulsants may play a role in the first 4 to 6 weeks of treatment.
Source: Journal of Addiction Medicine - Category: Addiction Tags: Case Reports Source Type: research