| Sumario: | Benzodiazepines are drugs used in treatment of anxiety and insomnia, in addition to muscle pain and seizures. Benzodiazepines are widely used by the general population and the sales figures correspond to a daily consumption of therapeutic doses of benzodiazepines in 4-5% of the population. Benzodiazepines are effective drugs with low toxicity. Benzodiazepines are also popular as drugs of abuse and its consumption may contribute to exacerbate an existing drug abuse problem. The cost benefit considerations are therefore especially interesting when these drugs are prescribed to subjects with pre-existing problems of drug abuse. Methods The systematic review was performed according to general principles of HTA. The work was carried out together with a review team of professionals from the drug abuse field. Systematic searches were performed after published systematic reviews and randomised controlled trials in international databases. Results The report includes 38 studies; one systematic review, 33 randomised controlled trials and four observational studies. There were only two randomised controlled trials involving drug-dependent subjects. The other studies involve long-term users of therapeutic doses of benzodiazepines (14 studies), non-dependent subjects with a history of drug abuse (12 studies) and subjects with alcohol-dependence (6 studies). The focus of the report is therefore concentrated on subjects with general drug abuse problems or with long-term users of therapeutic doses of benzodiazepines. No studies were found on the therapeutic effects of benzodiazepines for the usual indications (anxiety, insomnia, epilepsy) in subjects with drug abuse problems. The studies showed that benzodiazepines have abuse liability in this population and may lead to dependence problems. In addition, benzodiazepines impaired psychomotor skills and cognitive functions in drug abusers as well as in long-term users of benzodiazepines. The report showed that even though benzodiazepines reduce symptoms related to alcohol withdrawal, this could as well be achieved with other drugs without abuse potential. Conclusion The systematic review did not found any studies on the therapeutic effect of benzodiazepines in drug-dependent subjects. Our report documents evidence of negative effects in subjects with drug problems. Benzodiazepines have abuse liability and may lead to dependence problems. The studies showed that benzodiazepines impaired psychomotor skills and cognitive functions in drug abusers as well as in long-term users of benzodiazepines. The magnitude of the effects on psychomotor and cognitive functions is less apparent for oxazepam and roughly equivalent for other benzodiazepines.
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