Volume 7 • 2020 • Issue 2

B enzodiazepines are not dangerous on their own, but, in combination with an opioid, they can be lethal—indeed, the US Food and Drug Administration has issued black-box warnings (its most severe level) against mixing the two drugs. Is there a looming crisis? How should dental professionals, who often prescribe benzodiazepines for dental anxiety, protect their patients from possible harm? Dr. Mark Donaldson, a pharmacologist with a focus on dentistry, says that there are safe and effective clinical applications for benzodiazepines. “There are specific uses for these drugs, both benzodiazepines and opioids, in dentistry,” he says. “But not together.”  What benzodiazepines do Dr. Donaldson cites research by Drs. Daniel Haas, David Locker, and Brian Chanpong at the University of Toronto that found that about 15% of the general population classified themselves as being terrified or highly fearful of dental treatment. About half of those people had avoided or skipped dental visits due to fear. “The race has been on to introduce a treatment that would relax patients enough to perform dentistry on them,” says Dr. Donaldson. He says the best known and safest treatment for dental anxiety is nitrous oxide. “But in those offices that don’t have nitrous oxide for inhalational sedation, there is a need for a tablet; that’s where benzodiazepines have found their niche.” Common benzodiazepines include diazepam (Valium), lorazepam (Ativan), and triazolam (Halcion), among others. Benzodiazepines are central nervous system depressants. “They help us relax,” says Dr. Donaldson. The class of drugs enhance the effect of gamma-aminobutyric acid, the major inhibitory neurotransmitter in the central nervous system, at the GABA A receptor. They have sedative, sleep-inducing, antianxiety, anticonvulsant, and muscle relaxant properties. In the last year, news stories in Canada and the US warned that benzodiazepines may become “the next opioids.” In the US, benzodiazepine prescriptions increased 67% between 1996 and 2013, rising from 8 million to nearly 14 million. 1 American overdose deaths involving benzodiazepines rose from 1,135 in 1999 to more than 11,535 in 2017. In many Canadian provinces, benzodiazepines are involved in more than half of overdose deaths. 2 Dr. Mark Donaldson is the associate principal of clinical pharmacy for Vizient’s Advisory Solutions in Whitefish, Montana. He is a clinical professor in the Department of Pharmacy at the University of Montana inMissoula, clinical associate professor in the School of Dentistry at the Oregon Health & Sciences University in Portland, Oregon, and affiliate faculty in the School of Dentistry at the University of British Columbia. Dental Uses and Hazards of BENZODIAZEPINES The views expressed are those of the author and do not necessarily reflect the opinions or official policies of the Canadian Dental Association. S upporting Y our P ractice 37 Issue 2 | 2020 | Versah Digital Guided Surgery Hands-On Course Saturday, June 13, 2020 Dr. Isaac Tawil Versah Guided Surgery System Preserve the Bone • Enhance the Host ™ Surgical C-Guide printed by a Certified Lab 3mm 5mm 8mm 10mm 11.5mm 13mm 15mm PatentPending The G-Stop ™ key is available in 4 sizes S , M , L , XL , and 7 di‰erent lengths: Powered by G3 Densah ® Bur Technology Scan Here To Watch Animation: G-Stop™ Vertical Gauge Snaps on to any G3 Densah Bur and transforms it to a guided bur C-Guide™ Sleeve G-Stop ™ Key • Locks onto the G-Stop™ Vertical Gauge • Can be used with a C-Guide or as a standalone Vertical Stop. Compatible with multiple Digital Planning Platforms: versahodacademy.com Dr. Richard Martin ©2019Huwais IPHoldingsLLC. Allrightsreserved. VersahandDensahareregisteredtrademarksofHuwais IPHoldingsLLC. P052 REV01