The Dec 17th issue of “The Journal of the American Medical Association Psychiatry” (JAMA Psychiatry) contained a paper describing the over prescribing of a class of sedatives or tranquilizers called benzodiazepines.
“Benzos” are all related in chemical structure and include some of the best selling drugs ever created – Valium, Xanax and Ativan.
These have been advertised as effective and harmless medicines to relieve mild anxiety and handle insomnia.
The truth about benzodiazepines is far different and the same issue of JAMA Psychiatry also contains an editorial by a pharmacology PhD calling for a stricter classification of these drugs as controlled substances. (They are currently a Schedule IV controlled substance in the USA which puts them just a bit more dangerous than a Schedule V such as cough syrup with codeine.)
Out in real life these drugs have been shown to be dangerous to the physical and mental health of patients, especially the elderly and they are quite addictive.
Dr. Mark Olfson, a psychiatry professor at Columbia University Medical Center in New York and his colleagues studied US retail pharmacy records and reported in JAMA Psychiatry that benzodiazepines are being prescribed to the elderly in increasing amount despite known harmful side effects.
They found that nearly 12 percent of women 65-80 years old were using benzodiazepines regularly in 2008 and 6 percent of all men used them. The percentages climbed higher as the patients aged.
The American Geriatrics Society states that the elderly should not be receiving these drugs at all. It has been shown in research that older people on benzodiazepines have an increased the risk of falls and impaired thinking, mobility and driving skills.
A geriatric nurse, Donna Fick, who is a Penn State University professor, stated that “These drugs have very dangerous side effects – falls, delirium, and they have been linked to dementia.”
Long term use leads to addiction and painful and sometimes deadly withdrawal symptoms when patients try to discontinue them without a careful, medically monitored rehabilitation program.
In an amazing admission from a psychiatrist, Dr. Oflson said, “You can reduce the use of these medications through legislation, but I don’t know that you’ll improve the quality of care very much. A smarter way forward would be to increase non-pharmacological treatments for sleep and anxiety.”
He goes on to describe non-pharmacological treatments for sleep and anxiety that do work.
Dr. Olfson advises patients with sleep problems to increase their exercise and exposure to light and learn techniques for winding down at the end of the day.
Professor Fick advises people with sleep difficulties to try modifying their behavior with simple things like not drinking caffeine after 11 a.m., drinking warm milk or herbal tea at bedtime, increasing exposure to light, doing some exercise and avoiding naps.
She also cited studies that show that just a back rub, a warm drink and listening to a relaxation tape provided a feasible alternative to sedatives for elderly patients in a hospital setting.
Even more condemnation of these drugs by a doctor can be found in the accompanying JAMA Psychiatry editorial by Nicholas Moore, MD, PhD from the Department of Pharmacology at The University of Bordeaux, Bordeaux, France.
Dr. Moore calls for benzodiazepines to be controlled substances in the same class as other dangerous addictive substance and that they be put on a tight dispensation schedule using limited-duration prescriptions with no refills.
Elderly patients predominantly are being given these drugs on a long term basis despite the known dangers of doing this.
It clearly is quite profitable for the drug companies to do so. And one can imagine some hospital and nursing home staff consider it’s easier for them as caregivers to handle a group of sedated patients rather than facing a lively bunch of senior citizens who are able and willing to speak their mind.
Dr. Moore says in treating insomnia or anxiety with benzodiazepines they work no better than placebos. He describes the typical cycle: “After an initial improvement, the effect wears off and tends to disappear. At that point, what happens when patients try to stop taking benzodiazepines is that they experience withdrawal insomnia and anxiety. The usual conclusion is “You see, they work. When I stop them, I get worse.” Initially, patients get better before returning to the pretreatment state and then get worse than before treatment began when they attempt to stop taking benzodiazepines. After a few weeks of treatment, patients are actually worse off than before they started (or at least not better) and cannot stop taking the drug.
This type of drug causes amnesia and loss of control; one drug called triazolam was found to be used as a date-rape drug because of these qualities.
In France he cites 3,000 annual falls and hip fractures by elderly on these drugs and estimates 10,000 to 12,000 such accidents in the US.
Drivers on them have more vehicle crashes.
There is clear evidence that prolonged use of these sedatives is associated with an increased risk of dementia.
The “British Medical Journal” published a study that concluded:
“Benzodiazepine use is associated with an increased risk of Alzheimer’s disease… Unwarranted long term use of these drugs should be considered as a public health concern.”
Dr Moore ends his editorial asking, “Will we have to wait for class actions against manufacturers, prescribers, or regulators whenever a patient taking benzodiazepines dies after a fall or develops Alzheimer disease? There are other treatments for generalized anxiety and insomnia. How seriously do we still need benzodiazepines? Are we ready to pay for them collectively?”
Over in Britain lawsuits have appeared against General Practioners and patients have won them. In 2002, Ray Nimmo, who was prescribed Valium for 14 years, won his case against his GPs in Scunthorpe.
The British press reported an increase in clinical negligence cases by patients left physically and psychologically broken by “indefensible” long-term prescribing of addictive tranquillizers such as Valium and other benzodiazepines.
It was estimated in 2009 that there were 1.5 million involuntary tranquillizer addicts in the UK. More than 6.6 million benzodiazepine prescriptions for anxiety were dispensed by England’s pharmacies in 2010.
When even a renowned psychiatric journal is telling us of the dangers and overuse of these drugs, it’s time that physicians stop prescribing them to our elderly citizens.