New Study Shows Increased Risk Of Death With Sleeping Pills And Tranquilizers

A recently published study in the United Kingdom has found a more than threefold increase in risk of death in those using tranquilizers or sleeping pills compared with people not using those drugs.[1] The results were similar to those of a study published two years ago examining sleeping pill use in people in the United States, which found a more than threefold greater risk of dying in people using these drugs compared with a control group not using them.[2]

Worst Pills, Best Pills News has long been concerned with the massive use of both tranquilizers and sleeping pills because of their addictive properties and other toxicities, compounded by the unreasonably low thresholds many physicians have for prescribing them. More recently, according to the authors of the U.K. study, concerns about the effect of these drugs on premature mortality have been fueled by studies documenting increased risk of dementia, daytime fatigue, lack of coordination, falls, road traffic incidents, pneumonia and other infections.

The U.K. study

The purpose of the more recently published larger study, according to the authors, was to find out whether people taking tranquilizers or sleeping pills, or both, are at significantly increased risk of death compared with people not taking these drugs and to estimate the magnitude of any increased risk. To answer these questions, the authors analyzed prescribing data from U.K. primary care records.

The study followed, for an average of 7.6 years, approximately 35,000 people in the United Kingdom who started using tranquilizers or sleeping pills between 1998 and 2001, and also followed more than 69,000 people not using these drugs. Those observed were 16 and older and visited one of 273 primary care practices in England, Scotland, Wales and Northern Ireland.

More than two-thirds of those in the study used only one of the three classes of sleep-related drugs: 47 percent of participants used benzodiazepines, 14 percent used Z-drugs and 8 percent used a large variety of other tranquilizers and sleeping pills. (See the table below for examples of benzodiazepines and Z-drugs.)

Adjusting for the differences in baseline characteristics between the two groups and for potential confounding factors that may affect mortality risk (for example, age, sex and history of various physical and psychiatric disorders), the study found that, in the first year after recruitment, the overall risk of death for those using any of the aforementioned drugs was 3.3 times greater than the risk for non-users. Increased doses of drugs from all three classes further increased the risk of death.

The three classes of drugs were associated with different increases in death rates. The benzodiazepines increased the risk 3.7-fold; the Z-drugs, 3.2-fold; and the other drugs, 2.1-fold.

During long-term follow-up (after the first year of using these drugs), there were approximately four more deaths per 100 people than there were in the non-users.

Since these are not results from randomized trials, it is possible that other factors could account for some of the differences in death rates between users and non-users. However, as the authors point out, multiple adjustments were made for co-existing diseases and other factors that might influence the death rate. Importantly, these findings are consistent with long-held suspicions that these drugs are associated with premature mortality, and the results align with those of previous studies also reporting such increased death.

Sleeping Drugs and Tranquilizers Designated By Public Citizen's Health Research Group as Do Not Use

* Do Not Use except for panic disorder
** Not available in the U.S.

What You Can Do

Along with the ever-increasing evidence of the dangers of tranquilizers and sleeping pills, there is now clearer evidence of increased rates of premature death. We therefore recommend that you do not use sleeping pills or tranquilizers to treat insomnia or anxiety.

Alternatives to tranquilizers for anxiety

According to noted British psychiatrist Dr. Malcolm Lader:

Until recently most anxious patients in the United Kingdom were treated with tranquilizers, usually a benzodiazepine. However, recognition that these drugs can cause dependence even at normal therapeutic dosages has led to a re-evaluation of drug therapy, and the value of non-pharmacologic treatments is increasingly being recognized.[3]

British doctors who have written about nondrug alternatives for the treatment of mild to moderate anxiety (and similar problems) say that:

The best treatment is likely to be brief counseling provided by the general practitioner or by another professional working in the practice. Such counseling need not be intensive or specially skilled. It should always include careful assessment of the causes of the patient’s distress. Once these have been identified, anxiety may often be reduced to tolerable levels by means of explanation, exploration of feelings, reassurance, and encouragement.[4]

What else can be done? Talking to nonmedical people — a friend, a spouse, a relative, a member of the clergy — may help to identify causes of anxiety and potential solutions. Gathering the courage to talk about difficult concerns will generally be a better solution than taking pills. For some people, a specialized form of psychotherapy can treat anxiety. If indeed medication is needed, it is best to see a psychiatrist.

Getting regular exercise can also help relieve anxiety.

Alternatives for sleeping pills

In the December 2013 issue of Worst Pills, Best Pills News, we discussed this issue, again referring to nonpharmacologic alternatives to sleeping pills. These include stimulus control (for instance, using a bed only for sleep and sex and getting up at the same time every morning regardless of hours slept) and sleep hygiene (avoiding caffeine and establishing a regular bedtime routine, for example).

References

[1] Weich S, Pearce HL, Croft P, et al. Effect of anxiolytic and hypnotic drug prescriptions on mortality hazards: retrospective cohort study. BMJ. 2014;348:g1996. doi: 10.1136/bmj.g1996. Published March 19, 2014.

[2] Kripke DF, Langer RD, Kline LE. Hypnotics’ association with mortality or cancer: a matched cohort study. BMJ Open. 2012;2:e000850. doi:10.1136/bmjopen-2012-000850. Published February 27, 2012.

[3] Lader M. Anxiety and its treatment. Scrip Magazine. 1992;46-48.

[4] Catalan J, Gath D, Edmonds G, Ennis J. The effects of non-prescribing of anxiolytics in general practice. I. Controlled evaluation of psychiatric and social outcome. British Journal of Psychiatry. June 1984;144:593-602.