2026-2027 | On-Demand Session | Sedatives-Hypnotics: Board Review | September 2026-Sedatives-Hypnotics: Board Review Recording

Video Transcription

Video Summary

This didactic lecture by Dr. Beth Howell reviewed sedative-hypnotic use disorders with a board-style emphasis on benzodiazepines, Z-drugs, barbiturates, and newer designer sedatives. She began with clinical cases illustrating key dangers: additive respiratory depression when benzodiazepines are combined with alcohol, and delayed withdrawal seizures from long-acting agents like diazepam because of long half-lives.<br /><br />The talk covered epidemiology, showing that sedative misuse is common, often polysubstance-related, and frequently involves alprazolam. Dr. Howell emphasized that routine urine drug screens may miss many sedatives, so a negative screen does not rule out use. She reviewed DSM-5 intoxication, withdrawal, and use disorder criteria, and then explained the GABA-A receptor, highlighting that benzodiazepines and Z-drugs are positive allosteric modulators that increase chloride channel opening, while barbiturates increase the duration of channel opening and have more dangerous, less selective effects.<br /><br />She discussed therapeutic uses, adverse effects, overdose risk, and special issues with older adults, pregnancy, alcohol co-use, and opioids. Withdrawal management was a major focus: assess timing using drug half-life, avoid symptom-triggered benzodiazepine withdrawal protocols, and instead use cross-tolerant agents like diazepam or phenobarbital, sometimes with adjunctive anticonvulsants such as gabapentin. She also reviewed the ASAM benzodiazepine tapering guideline and stressed that slow outpatient tapers are often difficult and can be miserable for patients with use disorders.<br /><br />Finally, she addressed protracted withdrawal and benzodiazepine-induced neurologic dysfunction, noting the need for validation, careful differential diagnosis, and individualized treatment. The lecture ended with practical strategies for severe cases involving illicit designer benzodiazepines.

Keywords

sedative-hypnotic use disorder

benzodiazepines

Z-drugs

barbiturates

designer sedatives

benzodiazepine withdrawal

diazepam

alprazolam

GABA-A receptor

respiratory depression

urine drug screen

DSM-5 criteria

phenobarbital

ASAM tapering guideline