Karen E. Simone, PharmD, DABAT

Northern New England Poison Center

(207)662-7221

simonk@mmc.org

BenzodiazepinesA Common Cause of Poisoning

Extent of the Problem

Northern New England Poison Center

• Certified by the American Association of Poison Control

Centers (AAPCC) in November 2004

– Staff

– Hotline

– Outreach

– Surveillance

– Research

Funding: Maine Medical Center; Fletcher Allen Health Care; States of Maine, New Hampshire and Vermont; Health Resources and Services Administration; United Ways of Greater Portland, York, Kennebec Valley; Purdue Pharma L.P. (surveillance projects)

Learning Objectives:

• Describe the prevalence of benzodiazepines in overdoses reported to the Northern New England Poison Center (NNEPC).

• Indicate what poison data suggest regarding the contribution of benzodiazepines to the prescription drug abuse problem in the State of Maine.

• Name the most commonly abused benzodiazepines

• Discuss the prevalence of abuse of the newer hypnotics

Northern New England Poison Center Hotline Calls

2005

Northern New England Poison Center Hotline Calls

2005

Human and Animal

Reason for Poisoning (Maine calls)

0

500

1,000

1,500

2,000

2,500

3,000

Abuse/ Misuse Suicide Attempt Unknown

R eas on

Al l Other Substances

Benzodiazepines

9%

33%

14%

N = 15,543

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

Unintentional

R eas on

1%

25%

Human Human

Substance Citings

Prevalence of Benzodiazepine Poisoning by Age (Maine Calls)

0

200

400

600

800

1000

1200

1400

1600

1800

13-19 20s 30s 40s 50s > 60

Age in Years

Nu

mb

er o

f S

ub

stan

ce C

itin

gs

All Other Substances

Benzodiazepines

N = 15,857 (all ages)

3% 7%

9% 11%

5% 3%

Human

Prevalence of Benzodiazepine Information Requests by Age(Maine calls)

0

2000

4000

6000

8000

10000

12000

13-19 20s 30s 40s 50s > 60 Unknown

Age in Years

Nu

mb

er o

f S

ub

stan

ce C

itin

gs All Other Substances

Benzodiazepines

N = 25,512 (all ages)

10%

6%

4%10%

13%

13%

13%

Human and Animal

Public Medical and Other Information

0

1000

2000

3000

4000

5000

6000

7000

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

2001 2002 2003 2004 2005 2006

Opioids

Benzodiazepines/Benzodiazepine-like

Non-Opioid Analgesics without sedatives (aspirin, Tylenol®)

Unknown Drug

Antidepressants

Cardiovascular (Heart)

Skeletal Muscle Relaxants

Stimulants and Street Drugs

Antibiotics and Other Anti-infectives, Vaccines

Other Drug (Chemotherapy, Radiopharmaceuticals, Diagnostic,Hormones, Antidiabetic, Antithyroid)

County ME

Fact

Year Quarter

Group Name

Public Medical and Other Information

0

1000

2000

3000

4000

5000

6000

7000

Quar

ter

1

Quar

ter

2

Quar

ter

3

Quar

ter

4

Quar

ter

1

Quar

ter

2

Quar

ter

3

Quar

ter

4

Quar

ter

1

Quar

ter

2

Quar

ter

3

Quar

ter

4

Quar

ter

1

Quar

ter

2

Quar

ter

3

Quar

ter

4

Quar

ter

1

Quar

ter

2

Quar

ter

3

Quar

ter

4

Quar

ter

1

Quar

ter

2

Quar

ter

3

2001 2002 2003 2004 2005 2006

Opioids

Benzodiazepines/Benzodiazepine-like

Non-Opioid Analgesics without sedatives (aspirin, Tylenol®)

Unknown Drug

Antidepressants

Cardiovascular (Heart)

Skeletal Muscle Relaxants

Stimulants and Street Drugs

Antibiotics and Other Anti-infectives, Vaccines

Other Drug (Chemotherapy, Radiopharmaceuticals, Diagnostic,Hormones, Antidiabetic, Antithyroid)

County ME

Fact

Year Quarter

Group Name

Law Enforcement Information

0

200

400

600

800

1000

1200

Quar

ter

3

Quar

ter

4

Quar

ter

1

Quar

ter

2

Quar

ter

3

Quar

ter

4

Quar

ter

1

Quar

ter

2

Quar

ter

3

Quar

ter

4

Quar

ter

1

Quar

ter

2

Quar

ter

3

Quar

ter

4

Quar

ter

1

Quar

ter

2

Quar

ter

3

Quar

ter

4

Quar

ter

1

Quar

ter

2

Quar

ter

3

2001 2002 2003 2004 2005 2006

Opioids

Benzodiazepines/Benzodiazepine-likeNon-Opioid Analgesics without sedatives (aspirin, Tylenol®)Antidepressants

Unknown DrugAntibiotics and Other Anti-infectives, Vaccines

Skeletal Muscle RelaxantsCardiovascular (Heart)

Stimulants and Street DrugsStomach and Bladder (other than opioid or anticholinergics)

County ME

Fact

Year Quarter

Group Name

Public Medical and Other Information

0

100

200

300

400

500

600

700

800

900

1000

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

2001 2002 2003 2004 2005 2006

Benzodiazepines/Benzodiazepine-like - Clonazepam (Klonopin®)

Benzodiazepines/Benzodiazepine-like - Alprazolam (Xanax®)

Benzodiazepines/Benzodiazepine-like - Lorazepam (Ativan®)

Benzodiazepines/Benzodiazepine-like - Diazepam (Valium®)

Benzodiazepines/Benzodiazepine-like - Temazepam (Restoril®)

Benzodiazepines/Benzodiazepine-like - Clorazepate (Tranxene®)

Benzodiazepines/Benzodiazepine-like - Oxazepam (Serax®)

Benzodiazepines/Benzodiazepine-like - Chlordiazepoxide(Librium®)Benzodiazepines/Benzodiazepine-like - Zolpidem (Ambien®)

Benzodiazepines/Benzodiazepine-like - Eszopiclone/Zopiclone(Lunesta®, Imovane®)

County ME

Fact

Year Quarter

Group Name

Sub Group Name

Public Medical and Other Information

0

100

200

300

400

500

600

700

800

900

1000

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

2001 2002 2003 2004 2005 2006

Benzodiazepines/Benzodiazepine-like - Clonazepam (Klonopin®)

Benzodiazepines/Benzodiazepine-like - Alprazolam (Xanax®)

Benzodiazepines/Benzodiazepine-like - Lorazepam (Ativan®)

Benzodiazepines/Benzodiazepine-like - Diazepam (Valium®)

Benzodiazepines/Benzodiazepine-like - Temazepam (Restoril®)

Benzodiazepines/Benzodiazepine-like - Clorazepate (Tranxene®)

Benzodiazepines/Benzodiazepine-like - Oxazepam (Serax®)

Benzodiazepines/Benzodiazepine-like - Chlordiazepoxide(Librium®)

Benzodiazepines/Benzodiazepine-like - Zolpidem (Ambien®)

Benzodiazepines/Benzodiazepine-like - Eszopiclone/Zopiclone(Lunesta®, Imovane®)

County ME

Fact

Year Quarter

Group Name

Sub Group Name

Law Enforcement Information

0

50

100

150

200

250

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

2001 2002 2003 2004 2005 2006

Benzodiazepines/Benzodiazepine-like - Clonazepam (Klonopin®)

Benzodiazepines/Benzodiazepine-like - Alprazolam (Xanax®)

Benzodiazepines/Benzodiazepine-like - Diazepam (Valium®)

Benzodiazepines/Benzodiazepine-like - Lorazepam (Ativan®)

Benzodiazepines/Benzodiazepine-like - Zolpidem (Ambien®)

Benzodiazepines/Benzodiazepine-like - Temazepam (Restoril®)

Benzodiazepines/Benzodiazepine-like - Chlordiazepoxide(Librium®)Benzodiazepines/Benzodiazepine-like - Eszopiclone/Zopiclone(Lunesta®, Imovane®)Benzodiazepines/Benzodiazepine-like - Triazolam (Halcion®)

Benzodiazepines/Benzodiazepine-like - Clorazepate (Tranxene®)

County ME

Fact

Year Quarter

Group Name

Sub Group Name

Exposure Abuse

0

50

100

150

200

250

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

2001 2002 2003 2004 2005 2006

Stimulants and Street Drugs

Opioids

Alcohol/Alcohol-containing (mouthwash, hair spray)

Benzodiazepines/Benzodiazepine-like

Asthma, Cold and Cough, Eye, Ear, Nose and Throat

Antidepressants

Non-Opioid Analgesics without sedatives (aspirin,Tylenol®)Antipsychotics (atypical)

Antihistamines (sedating)

Anticonvulsants/Mood Stabilizers

County ME

Fact

Year Quarter

Group Name

Exposure Abuse

0

5

10

15

20

25

30

35

40

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

2001 2002 2003 2004 2005 2006

Benzodiazepines/Benzodiazepine-like - Clonazepam(Klonopin®)Benzodiazepines/Benzodiazepine-like - Alprazolam(Xanax®)Benzodiazepines/Benzodiazepine-like - Diazepam(Valium®)Benzodiazepines/Benzodiazepine-like - Lorazepam(Ativan®)Benzodiazepines/Benzodiazepine-like - Other/unknownbenzodiazepineBenzodiazepines/Benzodiazepine-like - Zolpidem(Ambien®)Benzodiazepines/Benzodiazepine-like - Temazepam(Restoril®)Benzodiazepines/Benzodiazepine-like - Oxazepam(Serax®)Benzodiazepines/Benzodiazepine-like - Chlordiazepoxide(Librium®)Benzodiazepines/Benzodiazepine-like -Eszopiclone/Zopiclone (Lunesta®, Imovane®)

County ME

Fact

Year Quarter

Group Name

Sub Group Name

Exposure Suicide

0

100

200

300

400

500

600

700

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

2001 2002 2003 2004 2005 2006

Antidepressants

Benzodiazepines/Benzodiazepine-like

Non-Opioid Analgesics without sedatives (aspirin, Tylenol®)

Antipsychotics (atypical)

Alcohol/Alcohol-containing (mouthwash, hair spray)

Anticonvulsants/Mood Stabilizers

Opioids

Cardiovascular (Heart)

Non-Opioid Analgesics with Sedatives (Fiorinal®, Fioricet®,Midrin®, Tylenol PM®)Antihistamines (sedating)

County ME

Fact

Year Quarter

Group Name

Exposure Suicide

0

20

40

60

80

100

120

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

2001 2002 2003 2004 2005 2006

Benzodiazepines/Benzodiazepine-like - Clonazepam (Klonopin®)

Benzodiazepines/Benzodiazepine-like - Alprazolam (Xanax®)

Benzodiazepines/Benzodiazepine-like - Lorazepam (Ativan®)

Benzodiazepines/Benzodiazepine-like - Zolpidem (Ambien®)

Benzodiazepines/Benzodiazepine-like - Diazepam (Valium®)

Benzodiazepines/Benzodiazepine-like - Other/unknownbenzodiazepineBenzodiazepines/Benzodiazepine-like - Zaleplon (Sonata®)

Benzodiazepines/Benzodiazepine-like - Chlordiazepoxide(Librium®)Benzodiazepines/Benzodiazepine-like - Temazepam (Restoril®)

Benzodiazepines/Benzodiazepine-like - Eszopiclone/Zopiclone(Lunesta®, Imovane®)

County ME

Fact

Year Quarter

Group Name

Sub Group Name

Public Medical and Other Information

0

500

1000

1500

2000

2500

3000

Quar

ter

1

Quar

ter

3

Quar

ter

4

Quar

ter

1

Quar

ter

2

Quar

ter

3

Quar

ter

4

Quar

ter

1

Quar

ter

2

Quar

ter

3

Quar

ter

4

Quar

ter

1

Quar

ter

2

Quar

ter

3

Quar

ter

4

Quar

ter

1

Quar

ter

2

Quar

ter

3

Quar

ter

4

Quar

ter

1

Quar

ter

2

Quar

ter

3

2001 2002 2003 2004 2005 2006

Opioids - Oxycodone (OxyContin®, Percocet®)

Opioids - Hydrocodone (Lortab®, Tussionex®, Vicodin®)

Opioids - Tramadol (Ultram®)

Opioids - Morphine (Avinza®, Kadian®, MS Contin®,Oramorph®)Opioids - Methadone (Dolophine®, Methadose®)

Opioids - Propoxyphene (Darvocet®, Darvon®)

Opioids - Codeine(Tylenol®, Fiorinal® or Soma® with codeine)

Opioids - Hydromorphone (Dilaudid®, Palladone®)

Opioids - Buprenorphine (Suboxone®)

Opioids - Meperidine (Demerol®)

County ME

Fact

Year Quarter

Group Name

Sub Group Name

Law Enforcement Information

0

50

100

150

200

250

300

350

400

Quar

ter

3

Quar

ter

4

Quar

ter

1

Quar

ter

2

Quar

ter

3

Quar

ter

4

Quar

ter

1

Quar

ter

2

Quar

ter

3

Quar

ter

4

Quar

ter

1

Quar

ter

2

Quar

ter

3

Quar

ter

4

Quar

ter

1

Quar

ter

2

Quar

ter

3

Quar

ter

4

Quar

ter

1

Quar

ter

2

Quar

ter

3

2001 2002 2003 2004 2005 2006

Opioids - Oxycodone (OxyContin®, Percocet®)

Opioids - Hydrocodone (Lortab®, Tussionex®, Vicodin®)

Opioids - Methadone (Dolophine®, Methadose®)

Opioids - Propoxyphene (Darvocet®, Darvon®)

Opioids - Morphine (Avinza®, Kadian®, MS Contin®,Oramorph®)Opioids - Tramadol (Ultram®)

Opioids - Buprenorphine (Suboxone®)

Opioids - Codeine(Tylenol®, Fiorinal® or Soma® with codeine)

Opioids - Hydromorphone (Dilaudid®, Palladone®)

Opioids - Meperidine (Demerol®)

County ME

Fact

Year Quarter

Group Name

Sub Group Name

Exposure Suicide

0

10

20

30

40

50

60

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

2001 2002 2003 2004 2005 2006

Opioids - Hydrocodone (Lortab®, Tussionex®, Vicodin®)

Opioids - Oxycodone (OxyContin®, Percocet®)

Opioids - Propoxyphene (Darvocet®, Darvon®)

Opioids - Methadone (Dolophine®, Methadose®)

Opioids - Tramadol (Ultram®)

Opioids - Codeine(Tylenol®, Fiorinal® or Soma® with codeine)

Opioids - Other/unknown opioid

Opioids - Morphine (Avinza®, Kadian®, MS Contin®,Oramorph®)Opioids - Fentanyl (Duragesic®, Sublimaze®)

Opioids - Buprenorphine (Suboxone®)

County ME

Fact

Year Quarter

Group Name

Sub Group Name

Exposure Abuse

0

5

10

15

20

25

30

35

40

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

Qua

rter

4

Qua

rter

1

Qua

rter

2

Qua

rter

3

2001 2002 2003 2004 2005 2006

Opioids - Methadone (Dolophine®, Methadose®)

Opioids - Oxycodone (OxyContin®, Percocet®)

Opioids - Hydrocodone (Lortab®, Tussionex®,Vicodin®)Opioids - Buprenorphine (Suboxone®)

Opioids - Fentanyl (Duragesic®, Sublimaze®)

Opioids - Propoxyphene (Darvocet®, Darvon®)

Opioids - Morphine (Avinza®, Kadian®, MS Contin®,Oramorph®)Opioids - Other/unknown opioid

Opioids - Tramadol (Ultram®)

Opioids - Codeine(Tylenol®, Fiorinal® or Soma® withcodeine)

County ME

Fact

Year Quarter

Group Name

Sub Group Name