Another limitation of the current research base on benzodiazepine-related morbidity and mortality is that the different pharmacologic properties of sedative/hypnotics –such as half-life and potency— have seldom been explored.(18) This is an important clinical and scientific gap given that benzodiazepines with shorter onset such as alprazolam are thought to have higher addictive potential than longer-acting medications such as clonazepam. (6, 19) In fact, previous work in non-OUD populations have shown significant intra-benzodiazepine variation in health outcomes; for instance, certain benzodiazepines appear to be associated with greater injury risk in the elderly than others.(18) Furthermore, very little research has investigated drug-related poisoning associated with selective benzodiazepine receptor modulators (Z drugs: zolpidem, zaleplon, eszopiclone); these medications have increasingly been found to have a spectrum of adverse effects similar to benzodiazepines, with similar dose response effects on all-cause mortality in the general population.(20, 21) Since studies to date have relied on relatively small numbers of benzodiazepine users, they have precluded examination of how drug subclasses (e.g., short- vs. long-acting; Z drugs) or dosage regimens impact OUD outcomes.
