MONDAY Sept. 10, 2018 (HealthDay News) – When older people use drugs like Valium or Xanax to soothe anxiety or make them sleep, they run a high risk of becoming dependent on drugs, new research suggests.
In the study of nearly 600 adults with an average age of 78 years old, about one in four who were prescribed this type of benzodiazepine sedatives eventually used them for at least a year.
This is despite warnings against long-term use of the medication, especially among the elderly. Benzodiazepines – a class that also includes Ativan, Halcion and Klonopin – can increase the risk of car accidents, falls, broken hips and other harmful side effects, experts warn.
The new study "thus shows that we should help suppliers at the start of prescribing a benzodiazepine, by starting short-term prescription and involving patients in discussions about when to re-evaluate their symptoms and start reducing patient "said lead author Dr. Lauren Gerlach. She is a geriatric psychiatrist at the University of Michigan in Ann Arbor.
"We also need to provide information for these patients on effective non-pharmaceutical treatment alternatives, such as cognitive behavioral therapy," Gerlach said in a university press release.
A psychiatrist called the study a much-needed reminder for doctors.
"Doctors, including psychiatrists, continue to prescribe benzodiazepines [older] population at an alarming rate, "said Dr. Brian Keefe, medical director at Zucker Hillside Hospital at Glen Oaks, N.Y.
"However, multiple studies of many years have consistently shown an increased risk of falling, and fall with fractures in seniors taking these drugs, a risk that increases with the daily dose," said Keefe, who was not involved in the new study. .
In the study, Gerlach's team followed the use of benzodiazepine among 576 elderly who received their first prescription between 2008 and 2016. Few people have had psychiatric, psychological or psychosocial care in the past two years, according to the report.
On the whole, 152 of the patients maintained a current or recent prescription a year after the first prescribed a benzodiazepine, the study found.
The study usually included people who received their prescription from a general practitioner or another non-psychiatrist doctor, because that is how most elderly patients get benzodiazepines, explained the authors.
Gerlach's team discovered that the number of patients was lower and that these patients were used four times more often in the long term compared to minority groups.
Also, people whose original recipes were written for the largest number of pills were more inclined to become long-term users. In fact, the researchers reported nearly twice the risk of long-term use for every 10 extra days of prescribed medication.
And compared with short-term users, patients who were on long-term benzodiazepines were no longer likely to be diagnosed with anxiety or depression – two conditions that could justify the use of these drugs in the long term, Gerlach said.
Long-term users indicated earlier that they had sleep problems, although benzodiazepines are not recommended for long-term use as hypnotics. In fact, they can even worsen sleep as they are used longer, the researchers said.
"Since mental health providers see only a very small minority of older adults who have mental health problems, we need to better support primary care providers in managing care for these patients," Gerlach said. "We need to help them think critically about how certain recipes they write can increase the likelihood of long-term use."
So why do many doctors renew recipes even if it is not justified?
Keefe had one theory. "Reducing and eventually stopping these drugs can be uncomfortable for both parties," he said. So a reluctance to do this "may result in continuation of the status quo, even if this is not advisable in the longer term," Keefe says.
Dr. Harshal Kirane conducts addiction services at Staten Island University Hospital in New York City. He called benzodiazepine too much "a silent epidemic".
The new study "highlights a staggering gap between guidelines and practice examples," Kirane said, and "underlines a continued dependence on narcotic drugs for the resolution of symptoms, such as insomnia, which can be improved by numerous other healthier options."
Kirane said that doctors should do more to guide patients with insomnia or other complaints to safer, non-pharmaceutical solutions.
The report was published online on September 10 in the journal JAMA Internal medicine.
For more information about benzodiazepines, visit the American National Institute on Drug Abuse.
SOURCES: Brian M. Keefe, MD, medical director, Zucker Hillside Hospital, Glen Oaks, N.Y .; Harshal D. Kirane, M.D., Director of Addiction Services, Staten Island University Hospital, New York City; University of Michigan, press release, 10 September 2018