Benzodiazepines: reconsidered.

The benzodiazepines were first introduced in 1960. Chlordiazepoxide (Librium) was the first of the class of drugs called benzodiazepines, in a deliberate attempt to synthesize a tranquilizer without the sedative properties and abuse, addiction, tolerance, and dependence potential of the barbiturates, and other sedative/hypnotic drugs. The popularity of the benzodiazepines rose steadily to a peak period in the mid 1970s when diazepam (Valium) was the most commonly prescribed drug of any kind, including antihypertensive, analgesic and other psychotropic medications. The current evaluations of benzodiazepines use and abuse demonstrate clearly that they produce tolerance and dependence in short and long-term administration. The development of abuse and addiction is also strongly substantiated although they are not as easily appreciated and identified because of confusion in diagnosis and treatment of abuse and addiction. Significant problems in definitions, diagnosis, interpretations and conclusions exist in general practice regarding abuse and addiction, and their relationship to use of and symptoms produced by benzodiazepines. The lack of clarity in defining abuse and addiction and tolerance and dependence in clinical practice leads to institution and perpetuation of the toxicity and untoward effects of the benzodiazepines.