苯二氮平受器促進劑誤用行為與成癮性之盛行率及相關因子研究

目的：過去認為苯二氮平受器促進劑(benzodiazepine receptor agonists; BzRAs, or Z-drugs)短期治療失眠的效果良好，副作用及成癮性也比傳統苯二氮平類藥物來得低，但陸續有研究發現長期使用對身心與認知功能仍有不良副作用且可能導致依賴或成癮。國人BzRAs濫用比例逐年增加，為及早偵測並減少國人持續濫用和副作用所帶來的問題，本研究欲調查哪些特質或行為模式的BzRAs使用者易有藥物誤用和成癮傾向，供臨床觀察和治療參考。方法：本研究於高雄醫學大學附設醫院精神科門診收案，共172位20歲至55歲、接受BzRAs治療達三個月以上的個案，經同意後進行問卷訪談；採描述性統計和邏輯迴歸方法分析資料。結果：服用超過BzRAs處方箋藥量者以習慣飲酒者的風險最高(OR=17.857) ，其餘相關因子為有無固定伴侶、慣用止痛藥、長期服用BzRAs；在醫囑以外時間服用BzRAs則以習慣飲酒者具最大風險(OR=37.598)，其它相關因素為慣用止痛藥、BzRAs單日高劑量。BzRAs高成癮者佔39.5%，包括抽菸、用藥信念上認為接受BzRAs治療之必要性愈大、對可能後果愈擔心者。結論：酒精、止痛藥、香煙等物質慣用者是對BzRAs產生誤用行為和依賴性的高危險群。另外，用藥信念也是BzRAs成癮的關鍵影響因子。

關鍵字

苯二氮平受器促進劑；誤用；依賴；用藥信念

並列摘要

Aims: Benzodiazepine receptor agonists (BzRAs, or Z-drugs) were considered effective for short-term treatment of insomnia with less adverse effects and lower risk of dependence than traditional benzodiazepines. However, many studies have found that long-term use of BzARs still causes undesirable effects physically, mentally and cognitively, even results dependence or addiction. Since the proportion of BzRAs (especially zolpidem) abuse in Taiwan have kept rising over the past years, this study aimed to determine what characteristics or patterns associate with BzRAs misuse and dependence in order to early detect in clinical practice and decline the abuse as well as to reduce the subsequent problems to the side effects of BzRAs. Methods: Psychiatric outpatients aged 20 to 55 and medicated with BzRAs for at least 3 months were interviewed through questionnaires at Kaohsiung Medical University Chung-Ho Memorial Hospital. A total of 172 subjects were included and analyzed by descriptive statistics and logistic regression statistics. Results: The behavior of taking BzRAs more than the prescribed dose was related to regular companion, habitual analgesics taking, long-term use of BzRAs, and habitual alcohol drinking which hazarded the highest (OR=17.857). The behavior of taking BzRAs at non-prescribed time was associated with habitual analgesics taking, high daily BzRAs dose, and habitual alcohol drinking which hazarded the highest (OR=37.598). There were 39.5% subjects who have BzRAs dependence tendency, while the correlates of dependence were smoking, stronger beliefs about necessity and concerns of BzRAs treatment. Conclusions: Habitual use of substance such as alcohol, analgesics, tobacco, is at high risk of BzRAs misuse and dependence; furthermore, the beliefs about medicines also significantly affect BzRAs addiction.

並列關鍵字

Benzodiazepine receptor agonists (BzRAs or Z-drugs) ； misuse ； addiction ； the beliefs about medicine

參考文獻

Tsai, J. H., Yang, P., Chen, C. C., Chung, W., Tang, T. C., Wang, S. Y., & Liu, J. K. (2009). Zolpidem-induced amnesia and somnambulism: rare occurrences? Eur Neuropsychopharmacol, 19(1), 74-76. doi: 10.1016/j.euroneuro.2008.08.007

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