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Flunitrazepam Inclusion/Facilitation of Criminal Activity
Under society and culture > recreational use, a paragraph is dedicated to discussing flunitrazepam's potential usage in facilitating criminal activity, especially date rape and robbery; however, flunitrazepam and the issue in general is not mentioned on any other pages dedicated to specific benzodiazepines, and there's little evidence that most common benzodiazpeines see appreciable usage in the above mentioned criminal activity, likely due to the fact that unlike flunitrazepam, other benzodiazepines generally possesses relatively minor polar solubility and thus will not dissolve readily in most common beverages, making it far more difficult to administer the drug without a subject's knowledge.
In essence I feel the section is out of place and potentially confusing/misleading, but as someone not especially familiar with the dos and don'ts of wiki editing I don't feel comfortable just deleting it based purely on personal judgement, so I figured I'd at least bring it up here. 100.19.116.119 (talk) 17:57, 17 August 2019 (UTC)[reply]
Respiratory Depression
DocJames and I seem to be having multiple disputes on various pages. I am a physician-pharmacologist who has been teaching at one of the largest research medical schools in the US for 26 years, but I don't get to editing Wikipedia often. When I do, it's to correct something just too absurd or troublesome to let go. The issue here is whether any benzodiazepine causes respiratory depression, and DocJames cites a Cochrane review focusing on a different subject in support of this relationship. This is not support because neither respiratory depression nor benzodiazepines was the focus of the review, and it is - indeed just a review of published work, not data in its own right. Actual primary data says something quite different, for example: G. E. Carraro, E. W. Russi, S. Buechi, and K. E. Bloch. Does oral alprazolam affect ventilation? A randomised, double-blind, placebo-controlled trial. Journal of Psychopharmacology 23 (3):322-327, 2009. Papers like this, done with modern methods, strongly deny a respiratory depressant effect of benzos, and can explain why earlier investigations were misinterpreted.
This isn't an idle discussion. The opioid overdose epidemic and its "association" with benzos is a very big deal in the US right now, with an immense amount of litigation surrounding it. In the midst of flaring accusations and repetitively-quoted misleading concepts, it is more important than ever to read the PRIMARY literature (not merely side issues mentioned in review literature). Verytas (talk) 17:04, 20 October 2019 (UTC)[reply]
The problem is reading primary research in isolation, which is why we prefer review articles, per WP:MEDRS. But anyway, your above study had the following methodology: “20 healthy men ingested 1 mg of alprazolam“. Your source then goes on to emphasise (“Oral alprazolam in a mildly sedative dose has no clinically relevant effect on ventilation in healthy, awake men.”) that the dose used is mild (I wouldn’t call 1 mg mild but the point is much higher doses are used in certain medical settings). Twenty is a very small number and since many, perhaps most, people sedated by benzodiazepines are far from “healthy” and also in medical settings, especially surgical and intensive care very high doses of benzodiazepines are more often used it means this source proves little. So really, your source is narrow and weak evidence. Your arguments really appear to be based on WP:SYN and I suggest you find reliable secondary sources, the more recently published the better, to support your position.--Literaturegeek | T@1k?20:00, 20 October 2019 (UTC)[reply]
Yes, reading literature in isolation has pitfalls, however, I offered that as only one example of far better methodology that prior efforts. I have personally and professionally reviewed the entire world literature on this specific subject without a personal agenda or financial COI, only a high-level mandate to present the best evidence-based medical/scientific information to our students, residents, and faculty. The literature is deficient in definitive well-conducted studies, but the best evidence that is available does not support the idea that benzos cause respiratory depression. The prevailing view among those of us professionally considering the question of benzos + {opioids or alcohol} and death by respiratory depression is that either (a) benzos are implicated solely because they tend to be abused by people who are also abusing opioids or alcohol, or (b) they reduce the anxiety someone may have that would otherwise prevent them from ingesting excessive opioids or alcohol.
As for your preference for "review articles", that has far greater pitfalls than reading primary literature. The Cochrane review being bandied about has barely a handful of sentences in a 156-page document that was focused on something else entirely, and the authors actually made no attempt to review the literature on respiratory depression. Regardless of your (admittedly valid) criticisms of the Carraro study, it was a randomised, double-blind, placebo-controlled trial, well written, published prominently, peer-reviewed, and it thoughtfully considered the world literature to date in its discussion. That is vastly better evidence to those of us who are actively prescribing benzos and opioids for people, and teaching others about it, than a handful of remarks in a 156 Cochrane review about another issue entirely.Verytas (talk) 22:07, 20 October 2019 (UTC)[reply]
It is not my preference but the consensus of the Wikipedia community to use secondary sources, per WP:MEDRS and WP:V. You literally would need to convert the thinking of 98% of the community to your line of thinking on primary sources for building an encyclopedia and then have the relevant policies and guidelines overhauled. If you reviewed all of the ‘entire world literature’ on the subject matter at hand then you will most likely have published a review article somewhere, surely. You could then cite that here in the article with consensus of other editors of course. I can’t imagine you took on such an enormous research effort for the fun of it. Do you know of a better review article or meta-analysis than the Cochrane source? Benzos are indeed relatively safe in overdose alone for healthy adults, but the literature does find that a synergistic effect occurs in combination with opioids or alcohol.--Literaturegeek | T@1k?23:18, 20 October 2019 (UTC)[reply]
No, literaturegeek, I am not opposed to secondary sources, but your secondary source is not appropriate to the question in this case.
Also, I most certainly did not do my review for the fun of it: https://glossipvgross.files.wordpress.com/2015/02/14-7955-ac_sixteen-professors-supporting-neither-party.pdf I was not among the amici curiae for this brief, merely consulted to review and verify facts prior to filing, but I certainly concur with the opinion. As for synergy, there is simply no evidence for it, no matter how many times a poorly written secondary source may suggest it.
All this so sorely reminds me about why I have not become more involved with editing Wikipedia, it's such an utter waste of time when someone's interpretation of a largely irrelevant review overrides genuine expertise with the primary literature. Verytas (talk) 06:16, 21 October 2019 (UTC)[reply]
Well the secondary source match my professional experience. I have seen "parenteral therapy for the management of status epilepticus" resulting in "hypotension, somnolence, respiratory failure"[1]Doc James (talk · contribs · email) 12:32, 21 October 2019 (UTC)[reply]
