Agonist substitution for high-dose benzodiazepine-dependent patients: let us not forget the importance of flumazenil.

Benzodiazepines (BZD), typically used to treat insomnia and anxiety disorders, are largely prescribed in all medical fields. This widespread use has led to misuse a frequent and often inappropriate consumption and iatrogenic overdosing. Although BZD intentional abusers have very often other substance abuse problems, the arise of addiction from legitimate prescription however is largely underestimated. Our opinion origins from the increasing number of patients seeking an inpatient detoxification treatment in our Addiction Unit (up to approximately 50% of clinical admissions). Our target patients are BZD chronic abusers, and applied treatment is based on rapid stopping of BZD under slow flumazenil infusion (FLU-I). During the last 8 years, our group treated with FLU-I 294. We can confirm that symptoms were reported as mild. Even if our goal is generally a the total abstinence from BZDs, we suggest FLU-I represents a very effective tool in order to obtain major success also when an agonist-substitution with slow onset of action BZD can be the final objective. The receptor resensibilization obtained with 4-6 days of FLU-I let patients experience a full welfare with very small doses of low power BZD; nevertheless, we must precise that in major patients being treated with FLU-I, the real aim is