Managing Sedative Dependency: A Challenging Problem

Sedatives have long been known to be a difficult class of drugs to manage because most patients become dependent on them. A Sunday session, “Updates in Treating Sedative Dependency in Addiction and Chronic Pain,” will address how to tackle this challenge.

“The reason for this workshop has to do with the fact that making patients free from sedatives—and I mean discontinuing them—is very, very difficult,” said Herbert L. Malinoff, MD, FACP, FASAM, session organizer. “Once initiated, they produce dependency in virtually all people who take them regularly. It is a tenacious problem, and most doctors don’t know how to do this, including doctors who prescribe them.”

Presented from 8 to 9:30 am Sunday in Governor’s Ballroom A, Fourth Floor, the session will feature Dr. Malinoff and two other speakers discussing how sedatives work, how people react to them, the mechanism of withdrawing from sedative use, and how best to manage the problem that led to sedatives being prescribed.

“I will present a recital of what sedatives are, what they do to the brain, why they cause dependency, what are the prescribed sedatives on the market, what happens to people who take these sedatives, and why they are bad,” said Dr. Malinoff, Clinical Assistant Professor in the Department of Anesthesiology, University of Michigan, Ann Arbor.

Three common problems will be reviewed: cognitive impairment, visuospatial discoordination, and how all benzodiazepines are central nervous system depressants.

“Patients become clumsy, they fall and spill, and they become depressed,” Dr. Malinoff said. “This has been described as a downward spiral of worsening function and decreasing pain perception in people with chronic pain problems. If you put people who have chronic pain problems on sedatives, almost universally they do poorly.”

Mark A. Weiner, MD, Medical Director at Pain Recovery Solutions, Ypsilanti, Michigan, will discuss the challenge of stopping the use of sedatives.

“You have to be adept at using medications that can take the place of sedatives, which in themselves are not sedating, and that prevents anyone from emerging without a sedative withdrawal syndrome,” Dr. Malinoff said. “Sedative withdrawal syndrome occurs because these drugs produce dependency, and the withdrawal syndrome is the opposite of sedation, which is excitation.”

Melvin Pohl, MD, FASAM, Medical Director at the Las Vegas Recovery Center, will discuss how to handle the management of the initial problem that led to sedatives being prescribed for the patient, Dr. Malinoff said, adding, “Dr. Pohl is an expert at non-pharmacologic coping mechanisms.”

“Sedative use is very common,” he said. “There are multiple problems with this class of drugs, and in most patients they are not indicated. Sadly, in patients who have used them for any period of time, it is very difficult to subtly discontinue these medications. One has to be adept in using adjunctive medications and procedures to discontinue these medications.”