Benzodiazepines: Widely Prescribed, Dangerous Sleep and Tranquilizer Drugs

Two recent reports have shed more light on the problem of overprescribing sleep drugs in the U.S. and on the sometimes frightening consequences of their use. The studies examined benzodiazepines, a class of widely used drugs prescribed mainly for anxiety and insomnia.

Commonly used benzodiazepines include alprazolam (XANAX, XANAX XR), lorazepam (ATIVAN, LORAZEPAM INTENSOL), clonazepam (KLONOPIN) and diazepam (DIASTAT, DIASTAT ACUDIAL, DIAZEPAM INTENSOL, VALIUM). Public Citizen lists all benzodiazepines as Do Not Use for sleep problems.

The two papers studied the overprescribing of these drugs and possible links to Alzheimer’s disease.

Benzodiazepine use in America

A paper published in December 2014 in the journal JAMA Psychiatry provides an overview of U.S. benzodiazepine use by age, duration of use and type of benzodiazepine (short- or long-acting, referring to the length of time the drug’s effects last in the body).[1]

The researchers estimated that approximately 5 percent of all U.S. adults had filled at least one prescription of a benzodiazepine in 2008, which translated into almost 75 million benzodiazepine prescriptions nationally.

Benzodiazepine use increased with age, from 2.6 percent at ages 18-35 to 8.7 percent in 65- to 80-year-olds. The study also found an age-related increase in the number of people using the drugs long-term (defined as 120 days or more). Among benzodiazepine users, the number of patients using the drugs long-term increased from about 15 percent of 18- to 35-year-olds to 31 percent of 65- to 80-year-olds. In all age groups, women were about twice as likely as men to use a benzodiazepine.

Considering the many adverse effects that are attributed to this group of drugs, particularly in the elderly, it is unsettling to discover threefold greater use in the oldest segment of the population studied (the 65- to 80-year-olds) compared with the youngest. The twofold higher rate of long-term use in that same population is also alarming.

Another risk: Alzheimer’s disease

There are many problems associated with benzodiazepine use, especially in the elderly, who are more likely to have other health problems and whose bodies may not be able to process these drugs as well. Adverse effects known to be related to benzodiazepine use include compromised cognitive function, reduced mobility, impaired driving ability and increased risk of falling — and, thus, of fractures.[2]

But two groups of researchers rec-ently have found other adverse effects associated with benzodiazepine use. Of particular interest, a 2014 study published in the British Medical Journal found a link between benzodiazepine use and Alzheimer’s disease in elderly patients.[3]

The researchers found a statistically significant 43 to 51 percent increased risk of Alzheimer’s disease in those who had used benzodiazepines at any time in the six years before diagnosis. The risk increased with the number of daily doses taken over time, from 32 percent for those who took 91 to 180 doses over time to 84 percent for those who took more than 180 doses.

Looking at the different forms of benzodiazepines (long- versus short-acting), the researchers found that those taking a long-acting form had a 70 percent increased risk of Alzheimer’s disease — versus a 43 percent increased risk for those taking a short-acting form.

It is important to note that these drugs are controlled substances[4] — that is, they have the potential for abuse and dependency, similar to alcohol or opioid pain relievers. If patients take these drugs for a long time, even at therapeutic doses, they may become physically dependent and are at risk for often-serious withdrawal symptoms if they stop the drugs suddenly.

What You Can Do

Common-sense measures you can take to help you sleep at night include:

• Pursue regular physical activity, but avoid vigorous exercise too close to bedtime.
• Avoid the use of caffeine-containing products, nicotine and alcohol, especially later in the day.
• Go to bed only when you feel tired.
• Use the bed and bedroom only for sleep and sex.
• Get up at the same time every morning regardless of how much sleep you obtained the night before (use an alarm clock if necessary).
• Avoid late-day naps.[5]

If you are using benzodiazepines, do not stop suddenly but work out a schedule, with your physician, for slowly tapering your dose, to avoid or reduce the chance of severe withdrawal symptoms.

References

[1] Olfson M, King M, Schoenbaum M. Benzodiazepine use in the United States. JAMA Psychiatry. 2014. doi:10.1001/jamapsychiatry.2014.1763. [published online]

[2] Ibid.

[3] De Gage SB, Moride Y, Ducruet T et al. Benzodiazepine use and risk of Alzheimer’s disease: case-control study. BMJ 2014;349:g5205.

[4] U.S. Drug Enforcement Administration. Drug Scheduling. http://www.dea.gov/druginfo/ds.shtml. Accessed February 10, 2015.

[5] Sleeping pills and tranquilizers. WorstPills.org. /chapters/view/20. Accessed February 18, 2015.