What are Benzodiazepines and what are they used for?
Benzodiazepines are a family of drugs used to induce sleep and to treat anxiety. They are also used as anticonvulsants and for intravenous sedation. Short-acting ones are used as hypnotics, while longer acting ones tend to be used as tranquillisers.
The five most commonly dispensed benzodiazepine type drugs in Ireland between 2005-2015 were diazepam, alprazolam, temazepam, zopiclone, and zolpidem. The last two drugs are examples of z-drugs, more modern versions of benzodiazepine that were erroneously thought to have a more favourable side effect profile when first licensed.
Benzodiazepines dampen down communication between brain cells. This results in depressed brain activity, allowing you to fall asleep more easily. For people with anxiety, the drugs calm the central nervous system.
Prescribing guidelines suggest benzodiazepines not be prescribed for a period greater than four weeks.
What are the side effects?
Most of the disadvantages of benzodiazepines are linked to inappropriate long-term use; it leads to dependence, tolerance and causes problems when the person attempts to stop the drug. Research has also linked benzodiazepine use to an increased risk of falls in older people.
Benzodiazepines dull our cognitive capacity, with users becoming noticeably sluggish. There are obvious dangers to driving and operating machinery when this occurs. And as the effect of the drug wears off, people become irritable and may develop cognitive impairment.
Is their use rising or falling?
A paper by researchers in the department of pharmacy at the Royal College of Surgeons in Ireland found that a third of medical card patients were receiving benzodiazepine and z-drug prescriptions on a consecutive basis for more than three months. Prescription rates were highest for women aged over 65.
The study, Benzodiazepine and Z-drug prescribing in Ireland: An analysis of national prescribing trends from 2005-2015, found a decrease of 26.5 per cent in benzodiazepine prescribing in Ireland over the 11-year period. However z-drug prescribing rates increased by up to 14.4 per cent between 2005 and 2015.
The National Healthcare Quality Reporting System report, published on Monday, found that Irish people over 65 are the highest consumers of benzodiazepine medicine in the OECD.
Are there any alternatives to benzodiazepines?
The best alternative does not involve medication. Psychotherapy, especially cognitive behavioural therapy, is helpful in the management of both insomnia and anxiety. However access to qualified therapists is a problem, especially for those covered by the medical card scheme.
There is a cohort of older patients who became addicted to benzodiazepines many years ago. It can be difficult for them to come off the drugs, although participation in a formal withdrawal programme leads to up to 10 per cent of patients successfully weaning themselves off a benzodiazepine.
Why are rates of use by over 65s in Ireland so high?
There are a number of possible reasons for Ireland topping the chart. The OECD data is incomplete, with no data available for half of the countries. It may also reflect historical prescribing practices here.
The relative availability of community-based cognitive behavioural therapy in different countries, as an alternative treatment for anxiety and insomnia, would be an important factor. Further research is needed to tease out the reasons for international differences in benzodiazepine prescribing.