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More benzodiazepines, more deaths

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Diazepam

Addiction & Recovery News highlights benzodiazepine related problems from two recent pieces of research. The first is about benzodiazepines and early death. The British Medical Journal reports on a UK General Practice study:

We found evidence of an association between prescription of anxiolytic and hypnotic drugs and mortality over an average follow-up period of 7.6 years among more than 100 000 age and general practice matched adults. In patients who were prescribed these drugs, there was an estimated overall statistically significant doubling of the hazard of death (hazard ratio 2.08), after adjusting for a wide range of potential confounders, including physical and psychiatric comorbidities, sleep disorders, and other drugs.

In fact in people prescribed benzodiazepine drugs like diazepam, followed up for seven and a half years after the prescription started there were four excess deaths per hundred people. The way the study was done means we have to be careful how this is interpreted. Nevertheless, very concerning.

The other problems that benzo prescribing can cause are well known as the BMJ tells us:

…increased risk of dementia and other psychomotor impairments (daytime fatigue, ataxia, falls, and road traffic incidents) cancer pneumonia, and other infections…

Given this knowledge you would expect there to be cautious and frugal prescribing. In a second paper highlighted by Addiction & Recovery News they looked at prescribing patterns in the USA.

To better understand prescribing trends in their preliminary study, Dr Kao and his colleagues evaluated a database of 3.1 billion primary care visits documented in the National Ambulatory Medical Center Survey (NAMCS) between 2002 and 2009.

They found that 12.6% of the primary care visits involved benzodiazepine or opioid prescriptions.

After adjustment for demographic factors, payer status, psychiatric illnesses, and pain diagnoses, the prescription of benzodiazepines was found to increase by a rate of 12.5% per year (95% confidence interval [CI], 9.4% – 15.7%), while coprescribing with opioids increased by 12.0% per year (95% CI, 5.0% – 19.4%).

The researchers also evaluated data on 733 million emergency department visits in the same time period and found 32.4% of patients had benzodiazepine or opioid prescriptions.

And are we doing better this side of the pond? Back to the BMJ article:

Prescribing of hypnotic and anxiolytic drugs is common and increasing in places. In 2011-12 more than 16 million prescriptions for these drugs were written in general practice in England at a cost of over £60m ($100m; €73m) per annum. Benzodiazepines currently account for 62% and Z drugs (zaleplon, zolpidem, and zopiclone) 32% of total prescriptions for hypnotics and anxiolytics in primary care in England.

Surely something has to change.

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