INTERNATIONAL STUDY OF EXPERT JUDGMENT ON THERAPEUTIC USE OF BENZODIAZEPINES AND OTHER PSYCHOTHERAPEUTIC MEDICATIONS .1. CURRENT CONCERNS

Although clinical experience influences psychotropic drug treatment wo rld-wide, it has been underutilized because it has not been systematic ally gathered and widely disseminated. An international survey was con ducted to help remedy this situation. One of the major objectives was to develop a representative body of expert judgment and opinion on the clinical use of benzodiazepines in relation to other psychotherapeuti c medications that might be used for the same purposes. A select inter national panel of psychiatric experts on the pharmacotherapy of the an xiety and depressive disorders (N = 73) was constituted on the basis o f progressive peer nominations. The peer selection process began with primary nominators from 44 countries. Judgments and opinions about psy chotherapeutic medications were elicited from the Expert Panel via a s elf-administered questionnaire. Completion rate: 90 per cent (66/73). Outcomes bear directly on current therapeutic and regulatory concerns. Topics addressed include: special indications for use, abuse liabilit y, dependence potential, duration of treatment, high-risk treatments, and adverse effects. Although sometimes divided, agreement was general ly high and indicative of a good benefit to risk ratio for the benzodi azepines. Expert judgments were more positive than would have been ant icipated from media reports, public concern, and recent regulatory pos tures. The following inferences can be drawn from this body of expert judgment and opinion: (1) qualitative differences in abuse liability a mong the benzodiazepines are minimal; (2) physical dependence at thera peutic doses is not a major clinical problem; (3) when physical depend ence occurs, it can be readily managed clinically by the treating phys ician; (4) the relative abuse liability of the benzodiazepines as a cl ass is low. These expert evaluations do not support or justify the imp osition of stronger or differential restrictions on the benzodiazepine s. The data help define the reasonable limits within which clinical gu idelines and regulatory mandates can be meaningfully promulgated.