By Anthony McDaniel, M.D.
A sedative or tranquilizer is a substance that induces sedation by reducing irritability or excitement. At higher doses it may result in slurred speech, staggering gait, poor judgment, and slow, uncertain reflexes. Doses of sedatives such as benzodiazepines when used as a hypnotic to induce sleep tend to be higher than those used to relieve anxiety whereas only low doses are needed to provide calming sedative effects. Sedatives can be abused to produce an overly-calming effect (alcohol being the classic and most common sedating drug). At high doses or when they are abused, many of these drugs can cause unconsciousness and even death.
All sedatives can be misused, but barbiturates and benzodiazepines are responsible for most of the problems with sedative use due to their widespread recreational or non-medical use. People who have difficulty dealing with stress, anxiety or sleeplessness may overuse or become dependent on sedatives. Heroin users take them either to supplement their drug or to substitute for it. Stimulant users frequently take sedatives to calm excessive jitteriness. Others take sedatives recreationally to relax and forget their worries. Barbiturate overdose is a factor in nearly one-third of all reported drug-related deaths. These include suicides and accidental drug poisonings. Accidental deaths sometimes occur when a drowsy, confused user repeats doses, or when sedatives are taken with alcohol. In the U.S., in 1998, a total of 70,982 sedative exposures were reported to U.S. poison control centers, of which 2310 (3.2%) resulted in major toxicity and 89 (0.1%) resulted in death. About half of all the people admitted to emergency rooms in the U.S. as a result of nonmedical use of sedatives have a legitimate prescription for the drug, but have taken an excessive dose or combined it with alcohol or other drugs.
There are also serious paradoxical complications that may occur in conjunction with the use of sedatives that lead to unexpected results in some individuals. Malcolm Lader at the Institute of Psychiatry in London estimates the incidence of these adverse reactions at about 5%, even in short-term use of the drugs. The paradoxical reactions may consist of depression, with or without suicidal tendencies, phobias, aggressiveness, violent behavior and symptoms sometimes misdiagnosed as psychosis. Sedatives and alcohol are sometimes combined recreationally or carelessly. Since alcohol is a strong depressant that slows brain function and depresses respiration, the two substances compound each other's actions and this combination can prove fatal. Sedation can sometimes leave the patient with long-term or short-term amnesia. Lorazepam is one such pharmacological agent that can cause anterograde amnesia. Intensive care unit patients who receive higher doses over longer periods of time, typically via IV drip, are more likely to experience such side effects.
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