Once prescribed, 25% of elderly become dependent on benzodiazepines: JAMA

According to a new study, published in JAMA Internal Medicine once prescribed, 25% of the elderly become dependent on sedatives like benzodiazepines. The initiation of the drug may be well-intentioned to calm anxiety, improve sleep or ease depression. But prescriptions of benzodiazepines may lead to long-term use among one in four older adults who receive them.

Although there are warnings against long-term use of these drugs, especially among older people regarding increased risk of car crashes, falls and broken hips, and other side effects, the findings point to a greater need for better education of healthcare providers, and the public, about the risks associated with these drugs.

Gerlach and her colleagues from the University of Michigan, VA and Perelman School of Medicine at the University of Pennsylvania, analysed benzodiazepine use by low-income older adults in a Pennsylvania program that helps with drug costs.

The researchers found that of the 576 adults who received their first benzodiazepine prescription from 2008 to 2016, 152 still had a current or recent prescription a year later. The study only included people whose benzodiazepines were prescribed by non-psychiatrists, as the majority of older adults who use benzodiazepines have their prescriptions written by primary care physicians or other non-psychiatrists.

The treatment guidelines recommend only short-term prescribing if any, these long-term patients were prescribed nearly 8 months' worth of medication after their initial prescription.

That rate of long-term use is concerning enough in itself, says Lauren Gerlach, D.O., M.Sc., the lead author of the study and a geriatric psychiatrist at U-M.

"This shows that we need to help providers start with the end in mind when prescribing a benzodiazepine, by beginning with a short-duration prescription and engage patients in discussions of when to reevaluate their symptoms and begin tapering the patient off," she says. "We also need to educate providers about effective non-pharmaceutical treatment alternatives, such as cognitive behavioural therapy, for these patients."

Gerlach points to two other concerning findings from the review of records and detailed interviews with program participants. Long-term benzodiazepine users were no more likely to have a diagnosis of anxiety, which is sometimes an indication for long-term use.

"This study provides strong evidence that the expectations set out by a provider when they first write a new prescription carry forward over time," says David Oslin, M.D., of Penn Medicine and the Philadelphia VA, and senior author of the paper. "When a physician writes for 30 days of a benzodiazepine, the message to the patient is to take the medication daily and for a long time. This expectancy translates into chronic use which in the long run translates into greater risks like falls, cognitive impairment and worse sleep."

White patients were four times more likely to have gone on to long-term use. Those whose initial prescriptions were written for the largest amounts were also more likely to become long-term benzodiazepine users. For just every 10 additional days of medication prescribed, a patient's risk of long-term use nearly doubled over the next year.

Also, long-term users were more likely to say they had sleep problems, despite the fact that benzodiazepines are not recommended for long-term use as sleep aids and may even worsen sleep the longer they are used.

Benzodiazepines have a high addictive potential and substantial risks for falls, cognitive dulling, and sleep impairment, therefore, starting elderly with benzodiazepines is a high-risk prospect.

For more details click on the link: doi:10.1001/jamainternmed.2018.2413