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The Effects of Tranquillization:
Benzodiazepine Use in Canada

Health Canada Publication: 1982


  1. Canadian Medical Association Journal, 1978, 118 (1533).

  2. ibid.

  3. United States Department of Health, Education, and Welfare, "Prescribed and Nonprescribed Medicines: Type and Use of Medicines, United States, July 1964 - June 1965, Vital and Health Statistics, 1967, Series 10, Number 39, p. 2.

  4. Fejer, D. and Smart, R.,"The Use of Psychoactive Drugs by Adults", Canadian Psychiatric Association Journal, 1973, 18 (4): 313-320.

  5. Smart, R. G. and Goodstadt, M. S., "Alcohol and Drug Use among Ontario Adults: Report of a Household Survey, 1976, Toronto: Addiction Research Foundation, Substudy No. 798, 1976.

  6. Provisional Results of Gallup Survey, 1977, Commissioned by Non-Medical Use of Drugs Directorate, Department of National Health and Wclfare, 0ttawa.

  7. Schuster, C. R., Bergman, J. and Hartel. C. R., Assessing the Impact on Public Health, Individual Deficit, and Organ System Damage Associated with Psychoactive Substance Use, Rockville, Maryland: National Institute on Drug Abuse, International Activities Program, August 1980, p. 76.

  8. (8a.) Saskatchewan Joint Committee on Drug Utilization, Report No. 3, 3475 Albert St., Regina, Canada, October 1979.

    (8b.) Personal communication from Mr. George Peters, Saskatchewan Prcscription Drug Plan, Saskatchewan Department of Health, Regina, Saskatchewan.

  9. Ontario Ministry of Health, Annual Ontario Prescription Survey, "Distribution of Psychotropic Prescriptions in Ontario, 1970-1978".

  10. Schuster et al., 1980, op. cit.

  11. Anderson, R. M., "The Use of Repeatedly Prescribed Medicines", (Prescribing in General Practice 3), Journal of the College of General Practitioners, 1980, 30: 609-613.

  12. Saskatchewan Joint Committee on Drug Utilization, 1979, op. cit.

  13. ibid.

  14. Charlton, A., Spitzer, W. O., Roberts, R. S., and Deltmore, T., "Patterns of Medical Drug Use - A Comtnunity Focus", Canadian Medical Association Journal, 1976, 114 (1): 33-37.

  15. Guse, L., Morier, G., and Ludwig, J., "Winnipeg Survey of Prescription (Mood Altering) Drug Use among Women", Technical Report, NMUDD, Manitoba Alcoholism Foundation, October 1976.

  16. Archer, C. and Benner, M. "Women's Use of Psychotropic Medication: A Community Survey", Canadian Family Physician, 1980, 26: 867-871.

  17. Cooperstock, R., "Psychotropic Drug Use among Women", Canadian Medical Association Journal, 1976, 115: 760-763.

  18. Gallup Survey, 1977, op. cit.

  19. Bass, M. and Paul, D., "The Influence of Sex on Tranquillizer Prescribing", Paper presented at the North American Primary Care Research Group Meeting, March 1977, Williamsburg, Virginia.

  20. Cooperstock, 1976, op. cit.

  21. ibid.

  22. Pflanz, M., Basler, H., and Schwoon, D., "Use of Tranquillizing Drugs by a Middle-Aged Population in a Western German City", Journal of Health and Social Behavior, 1977,18 (2): 194-205.

  23. Chambers, C. D., Inciardi, J. A., and Siegal, H. A., Chemical Coping: The Extent of Non-Addicting Drug Use in the United States, New York: Spectrum Publications, 1974.

  24. Guse et al, 1976, op. cit.

  25. ibid.

  26. ibid.

  27. Archer and Benner, 1980, op. cit.

  28. Greenblatt, D. J., Shader, R. I., and Koch-Weser, J., "Psychotropic Drug Use in the Boston Area", Archives of General Psychiatry, 1975, 32 (4): 518-521.

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  30. Bass and Paul, 1977, op. cit.

  31. Horwitz, A., "The Pathways into Psychiatric Treatment: Some Differences between Men and Women", Journal of Health and Social Behavior, 1977, 18 (2): 169-178.

  32. ibid.

  33. Phillips, D. L., and Segal, B. E., "Sexual Status and Psychiatric Symptoms", American Sociological Review, 1969, 34 (1) : 58-72.

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  35. Ontario Counril of Health, Health Care for the Aged, Toronto, 1978.

  36. Saskatchewan Joint Committee on Drug Utilization, 1979, op. cit.

  37. Mitenko, P. A., "Drug Use in the Elderly", Drug Merchandising, June 1978 59: 37-42.

  38. Mitenko, P. A., Hildahl, V. K., Large, G. W., Aoki, F. Y., and Sitar, D. S., "Drug Use in the Elderly (Manitoba - 1978)", Clinical Research, 1980, 28: 665A.

  39. Dennis, P. J., "Monitoring of Psychotropic Drug Prescribing in General Practice", British Medical Journal, 1979, 2 (6198): 1115-1116.

  40. Krogh, C., McLean, W. M., and La Pierre, Y. D., "Minor Tranquillizers in Somatic Disorders", Canadian Medical Association Journal, May 6, 1978, 118 (9): 1097-1108.

  41. Achong, M. R., Bayne, J. R. D., Gerurn, L. W., and Golshani, S., "Prescribing of Psychoactive Drugs for Chronically Ill Elderly Patients", Canadian Medical Association Journal, June 24, 1978, 118: 1503-1508.

  42. Blackwell, B., "Psychotropic Drugs in Use Today: The role of Diazepam in Medical Practice", Journal of the American Medical Association, 1973, 225 (13): 1637-1641.

  43. Parish, P. A., "The Prescribing of Psychotropic Drugs in General Practice". Journal of the Royal College of General Practitioners, Supplement No. 4, 1971, 21 (92): 1-77.

  44. Hemminki, E., "General Practitioners' lndications for Psychotropic Drugs", Scandinavian Journal of Social Medicine, 1974, 2: 79-85.

  45. (45a.) Krogh et al., 1978, op. cit.

    (45b.) Hemminki, 1974, op. cit.

  46. Subcommittee on Long-Term Care of the Special Committee on Aging, United States Senate, Nursing Home Care in the United States: Failure in Public Policy, Supporting Paper No. 2: "Drugs in Nursing Homes: Misuse, High Costs, and Kick-backs", January 1975, 95th Congress, 1st Session, Washington, D.C.: U. S. Government Printing House.

  47. Tu, J.-D., "A Survey of Psychotropic Medication in Mental Retardation Facilities", Journal of Clinical Psychiatry, 1979, 40: 125-128.

  48. Workman, D. G., and Cunningham, D. G., "Effect of Psychotropic Drugs on Aggression in a Prison Setting", Canadian Family Physician, 1975, 2 (11): 63-66.

  49. Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Washington, D.C.: American Psychiatric Association, 1980.

  50. Greenblatt, D. J., and Shader, R.I., "Benzodiazepines", The New England Journal of Medicine, 1974, 291 (19, 23): 1011-1015,1239-1243.

  51. Bellantuono, C., Reggi. V., Tognoni, G., and Garattini, S., Benzodiazepines: Clinical Pharmacology and Therapeutic Use", Drugs, 1980, (3); 195-219.

  52. Sellers, E. M. and Kalant, H.,"Alcohol Intoxication and Withdrawal", New England Journal of Medicine, 1976, 294: 757-762.

  53. Sellers, 1978, op. cit.

  54. Greenblatt and Shader, 1974, op. cit.

  55. Bellantuono et al. 1980, op. cit.

  56. Lasagna, L., "The Role of Benzodiazepines in Nonpsychiatric Medical Practice", American Journal of Psychiatry, 1977, 134(6):656-658.

  57. Bellantuono et al., 1980, op. cit.

  58. Schuster, 1980, op. cit.

  59. Workman and Cunningham, 1975, op. cit.

  60. Brown, C. R., "The Effect of Benzodiazepines in Prison Populations", Journal of Clinical Psychiatry,1978, 39(3): 219-222.

  61. Schuster et al. 1980, op. cit.

  62. United States Senate, Use and Abuse of Benzodiazepines, Transcript of a hearing before the Subcommittee on Health and Scientific Research of the Committee on Labor and Human Resources, Washington, D.C.: U. S. Government Printing Office, 1980.

  63. Sellers, 1978, op. cit.

  64. Greenblatt, D. J. and Shader, R. I., "Effects of Age and Other Drugs on Benzodiazepine Kinetics", Paper presented at symposium, New Perspectives in Benzodiazepine Therapy, Heidelberg University, Heidelberg, Germany, 1980.

  65. Sellers, 1978, op. cit.

  66. Bellantuono et al., 1980, op. cit.

  67. Allen, M. D. and Greenblatt, D. J., "Hypnotics and Sedatives", in Dukes, M. N. G.(ed), Side Effects of Drugs Annual 3, Amsterdam: Excerpta Medica, 1979.

  68. Graham, P., "Management in Child Psychiatry: Recent Trends", British Journal of Psychiatry, 1976, 129: 97-108.

  69. Boston Collaborative Drug Surveillance Program,"Clinical Depression of the Central Nervous System Due to Diazepam and Chlordiazepoxide in Relation to Cigarette Smoking and Age", New England Journal of Medicine, 1973, 288: 277-280.

  70. Committee on the Review on Medicines, Systematic Review of Benzodiazepines", British Medical Journal, 1980, 280 (6218):910-912.

  71. Preskorn, S. H. and Denner, L. J., "Benzodiazepines and Withdrawal Psychosis", Journal of the American Medical Association, 1977, 237(1): 36-38.

  72. Covi, L., Lipman, R. S., Pattison, J. H., Derogatis, L. R., and Uhlenluth, E. H., "Length of Treatment with Anxiolytic Sedatives and Response to Their Sudden Withdrawal", Acta Psychiatrica Scandinavia, 1973,49:51-64.

  73. Pevnick, J. S., Jasinski, D. R., and Haertzen, C. A., "Abrupt Withdrawal from Therapeutically Administered Diazepam", Archives of General Psychiatry,1978, 35: 995-998.

  74. Greenblatt, D. J. and Shader, R. I., "Dependence, Tolerance, and Addiction to Benzodiazepines: Clinical and Pharmacokinetic Considerations", Drug Metabolism Reviews, 1978, 8 (1): 13-28.

  75. Tyrer, P., Rutherford, D., and Huggett, T., "Benzodiazepine Withdrawal Symptoms and Propranolol," The Lancet, March 7, 1981, 520-522.

  76. "Benzodiazepine Withdrawal", The Lancet, January 27, 1979, 1 (8109): 196.

  77. ibid.

  78. Sellers, 1978, op. cit.

  79. Gotestam, K. G. and Andersson, B. E., "Subjective Effects and Vigilance after Diazepam and Oxazepam in Normal Subjects", Acta Psychiatrica Scandinavica, 1978, S274: 117-121.

  80. Gottschalk, L. A., "Effects of Certain Benzodiazepine Derivatives on Disorganization of thought as Manifested in Speech", Current Therapeutic Research, 1977, 21 (2): 192-206.

  81. Wittenborn, J. R. "Effects of Benzodiazepines on Psychomotor Performance", British Journal of Clinical Pharmacology, Supplement, 1979, 7: 61-67.

  82. ibid.

  83. Kleinknecht, R. A., and Donaldson, D., "A Review of the Effects of Diazepam on Cognitive and Psychomotor Performance", The Journal of Nervous and Mental Disease, 1975, 161 (6): 399-411.

  84. Liljequist, R., and Mattila, M. J., "Acute Effects of Temazepam and Nitrazepam on Psychomotor Skills and Memory", Acta Pharmacologica Toxicologica, 1979, 44 (5): 364-369.

  85. Skegg, D. C. G., Richards, S. M., and Doll, R., "Minor Tranquillizers and Road Accidents", British Medical Journal, 1979, 1(6168): 917-919.

  86. Solomon, F., White, C. C., Parron, D. L., and Mendelson, W. B., "Sleeping Pills, Insomnia and Medical Practice", New England Journal of Medicine, 1979, 300 (14): 803-808.

  87. Roth, T., Zorick, F., Sicklesteel, J., and Stepanski, E., "Effects of Benzodiazepines on Sleep and Wakefulness", British Journal of Clinical Pharmacology, 1981, 11 (1S): 31S-35S.

  88. Abelson, H., Cohen. R., Schrayer, D., and Rappeport, M., Drug Experience, Attitudes, and Related Behavior among Adolescents and Adults, Part 1, Main Findings, Princeton: Response Analysis Corporation, 1973.

  89. Fejer and Smart, 1973. op. cit.

  90. Gallup, 1977. op. cit.

  91. CODAP: Data from the Client Oriented Data Acquisition Process (CODAP), Annual Summary Report, 1978, National Institute on Drug Abuse, Statistical Series E, No. 11, 1978.

  92. Woody, G. E., O'Brien, C. P., and Greenstein, R., "Misuse and Abuse of Diazepam: An Increasingly Common Medical Problem", The International Journal of the Addictiions, 1975, 10 (5):843-848.

  93. Kapur, B. M., Everson, A., Segal, R., and LeBlanc, A. E., "Benzodiazepine Analysis as a Monitoring Tool", Paper presented at the Ninth International Congress of Clinical Chemistry, Toronto, July 14-18, 1975.

  94. Cimbura, G., Warren, R. A., Bennett, R. C., Lucas, D. M., and Simpson, H. M., Drugs Detected in Fatally Injured Drivers and Pedestrians in the Province of Ontario, Ottawa: Traffic Injury Research Foundation of Canada, March 1980.

  95. Seppala,T., Linnoila, M., and Mattila, M. J., "Drugs, Alcohol and Driving", Drugs, 1979, 17: 389-408.

  96. Ruedy, J., "Acute Drug Poisoning in the Adult", Canadian Medical Association Journal, 1973, 109 (9): 603-608.

  97. Johnson, F. G., Frankel. B. G., Ferrence, R. G. Jarvis, G. K., and Whitehead, P. C., "Self-In-jury in London, Canada: A Prospective Study", Canadian Journal of Public Health, 1975, 66 (4): 307-316.

  98. Proudfoot, A. T., and Park, J., "Changing Pattern of Drugs Used for Self-Poisoning", British Medical Journal, 1978. 1: 90-93.

  99. Finkle, B. S., McCloskey. K. L., and Goodman, L. S., "Diazepam and Drug-Associated Deaths", Journal of the American Medical Association, 1979, 242: 429-434.

  100. DAWN: Project Dawn, Annual Report - 1978, Drug Enforcement Agency and National Institute on Drug Abuse, Washington, D.C., 1980.

  101. Ruedy, 1973, op cit.

  102. Rangno, R. E., "Epidemiology and Therapy of Suicidal Drug Intoxication", in Sellers, E. M. (ed), Clinical Pharmacologv of Psychoactive Drugs, Toronto: Addiction Research Foundation, 1975, pp. 43-54.

  103. Busto, U., Kaplan, H. L., and Sellers, E. M., "Benzodiazepine Associated Emergencies in Toronto", American Journal of Psychiatry, 1980, 137: 224-227.

  104. Sims, M., Purdy, M., and Devenyi, P., "Drug Overdoses in a Canadian City", American Journal of Public Health, 1973, 63 (3): 215-226.

  105. Busto et al., 1980, op. cit.

  106. Smith, A., "Doctor in Need of a Cure", Times Higher Education Supplement, 3.4.81.

  107. Engel, G. L., "The Need for a New Medical Model: A challenge for Biomedicine", Science, April 8, 1977, 196 (4286): 129-136.

  108. Kennedy, I., Unmasking Medicine, Reith Lecture, 1980, London: British Broadcasting Corporation.

  109. Castonguay, I. G., Expenditures of the Health Care System in Ontario 1970/71 to 1977/78, 0ntario Ministry of Treasury and Economics, Central Statistical Services, Toronto, May 1981.

  110. Mechanic, D., "Correlates of Frustration among British General Practitioners", Journal of Health and Social Behavior, 1970, 11:87-104.

  111. Cartwright, A., Patients and Their Doctors, London: Routledge and Kegan Paul, 1967.

  112. Birmingham Research Unit of the Royal College of General Practitioners, "Practice Activity Analysis, 4. Psychotropic Drugs", Journal of the Royal College of General Practitioners, 28 (187): 122-124.

  113. Renaud, M., Beauchemin, J., Lalonde, C., Poirier, H., and Berthiaume, S., "Practice Settings and Prescribing Profiles: The Simulation of Tension Headaches to General Practitioners Working in Different Practice Settings in the Montreal Area", American Journal of Public Health, 1980, 70 (10): 1068-1073.

  114. Stolley, P. D., Becker, M. H., Lasagna, L., McEvilla, J. D., and Sloane, L. M., "The Relationship between Physician Characteristics and Prescribing Appropriateness", Medical Care, 1972, 10 (1):17-18.

  115. Baron, S. H., and Fisher, S., "Use of Psychotropic Drug Prescriptions in a Prepaid Group Practice Plan", Public Health Reports, 1962, 77: 871-881.

  116. Rabin, D. L., Personal Communication, 1977.

  117. Chaiton et al., 1976, op. cit.

  118. Dixon, A. S., "Drug Use in Family Practice: A Personal Study", Canadian Family Physician, 1978, 24: 345-353.

  119. Reilly, P. M., and Patten, M. P., "An Audit of Prescribing by Peer Review", Prescribing in General Practice 1, Journal of the Royal College of General Practitioners, 1978, 28 (194): 525-530.

  120. Blackburn, J. L., Laxdal, 0. E., and Dempsey. M. J., "Saskatchewan Dial-Access Drug lnformation Service", Canadian Medical Association Journal, 1976, 115: 869-871.

  121. Greenlick, M. R. and Darsky, B. J., "A Comparison of General Drug Utilization in a Metropolitan Community with Utilization under a Drug Prepayment Plan", American Journal of Public Health, 1968, 58: 2121-2135.

  122. Stolley et al., 1972, op. cit.

  123. Vayda, E., "A Comparison of Surgical Rates in Canada and in England and Wales", The New England Journal of Medicine, 1973, 289 (23): 1224-1229.

  124. Smith, M. C., and Garner, D. D., "Effects of a Medicaid Program on Prescription Drug Availability and Acquisition", Medical Care, 1974, 12 (7): 571-581.

  125. Office of Health Economics, Effects of Prescription Charges, London, December 1980.

  126. Pharmaceutical Manufacturers Association of Canada, The Pharmaceutical Industry and Ontario, Ottawa, 1978, pp. 34-35.

  127. Murray, R., Ghodse, H., Harris, C., Williams, D., Williarns, P. (eds), The Misuse of Psychotropic Drugs, London: Gaskell (The Royal College of Psychiatrists), Special Publication 1, 1981.

  128. Brooke, P., "Promotional Parameters: A Preliminary Examination of Promotional Expenditures", Journal of Drug Issues, 1976, 6 (1): 21-27.

  129. Sellers, E. M., "Clinical Pharmacology in Canada", Clinical Pharmacology and Therapeutics, 1974, 16 (3, Part 2): 543-624.

  130. Reekie, W. D., The Economics of the Pharmaceutical Industry, London: The Macmillan Press Ltd., 1975.

  131. Walker, H.D., Market Power and Price Levels in the Ethical Drug Industry, Bloomington: Indiana University Press, 1971.

  132. Linn, L. S., and Davis, M. S., "Physicians' Orientation toward the Legitimacy of Drug Use and Their Preferred Source of New Drug Information", Social Science and Medicine,1972, 6: 199.

  133. Heinminki, E., "Review of Literature on the Factors Affecting Drug Prescribing", Social Science and Medicine, 1975, 9: 111-115.

  134. Hemminki, E. and Pesonen, T., "The Function of Drug Company Representatives", Scandinavian Journal of Social Medicine, 177, 5: 105-114.

  135. ibid.

  136. Morgan, H. A., Jeffers, T. A., Petrie. J. C., and Walker, W., "Drug Advertising in Medical Journals", British Journal of Clinical Pharmacology, 1976, 3: 1057-1060.

  137. Smith, M. C., "Appeals Used in Advertisements for Psychotropic Drugs: An exploratory Study", American Journal of Public Health, 1977, 67 (2): 171-173.

  138. Stimson. G. V., "'The Message of Psychotropic Drug Ads", Journal of Communication, 1975, 25 (3): 153-160.

  139. King, E., "Sex Bias in Psychoactive Drug Advertisements", Psychiatry, 1980, 43: 129-137.

  140. Smith, M. C., "Portrayal of the Elderly in Prescription Drug Advertising", The Gerontologist, 1976, 16 (4): 329-334.

  141. Mosher, E. H., "Portrayal of Women in Drug Advertising: A Medical Betrayal", Journal of Drug Issues, 1976, 6 (1): 72-78.

  142. Cooperstock, R., and Lennard, H., "Some Social Meanings of ‘Tranquilliser Use", Sociology of Health and Illness, 1979, 1 (3): 331-347.

  143. Subcommittee on Long-Term Care of the Special Committee on Aging, United States Senate, 1975, op. cit.

  144. Butler, R. N., "Public Interest Report No. 19 - The Overuse of Tranquillizers in Older Patients", International Journal of Aging and Human Development, 1976, 7 (2): 185-187.


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