In shadow of opioids, a sedative epidemic is taking root
While the abuse of prescription opioids has received widespread attention, benzodiazepine (BZD) sedatives have seen a similar growth rate, with prescription rates nearly doubling since 2003.
Why it matters: In the U.S., deaths associated with BZDs like Xanax and Valium have increased from 135 in 1999 to over 11,500 in 2017. The dangers of misusing these potentially addictive drugs are particularly acute for adults over 50, who have experienced the largest increase in BZD prescriptions.
What's happening: The increase in deaths and overdoses associated with BZDs has been driven by misuse. Although BZDs are intended to be used for less than 14 days, chronic use — over 120 days — is common.
- One-third of older adults’ BZD prescriptions are for long durations, often prescribed for insomnia and other sleep disturbances. This raises the risks of falls, fractures, motor vehicle accidents, addiction and dementia in an already vulnerable population.
- BZDs can intensify symptoms of common chronic diseases and cause adverse reactions with other medications — risks that increase with age.
- One-third of opioid-related overdoses and one-fifth of opioid-related deaths also involve BZDs, compounding the dangers.
- New research could better establish the scale of this growing problem. The majority of articles on BZD misuse predate the 139% increase in associated emergency visits between 2004 to 2010.
- Since the symptoms of BZD dependence overlap with — and exacerbate — the effects of aging, it's vital that older patients and their caregivers watch for increases in drug-seeking behaviors, memory problems, drowsiness and dizziness.
- Better enforcement of guidelines from state prescription drug monitoring programs would help ensure prescribing patterns acknowledge the risks of long-term BZD use.
What to watch: Policymakers are beginning to recognize the harmful side effects of BZDs and other hypnotics. Policy reform — coupled with prescriber accountability and provider and patient education — could mitigate dangerous trends of misuse.
Nambi J. Ndugga and Elsa Pearson are policy analysts at the Boston University School of Public Health (BUSPH). Melissa Garrido is the associate director of the Partnered Evidence-Based Policy Resource Center at the Veterans Health Administration and a research associate professor at BUSPH.