A recent survey in Quebec has discovered a worrying trend: benzodiazepines – medications commonly used for sleep or anxiety – are being overprescribed. This investigation prompted the College of Physicians of Quebec to closely examine the use of these drugs.
But this problem goes beyond the borders of Quebec; Across Canada, these medications are being prescribed at an alarming rate.
Benzodiazepines and other sedatives are often prescribed to people aged 65 and older for sleep or anxiety problems. However, long-term use poses serious risks for this age group, including memory problems, falls, and even an increased risk of death. When benzodiazepines are taken with other sedative medications, there is also an increased risk of overdose and excessive sedation.
Despite these known risks, a 2022 Report by the Canadian Institute for Health Information (CIHI) and Choosing Wisely Canada revealed that one in 12 Canadians over the age of 65 use these medications regularly.
The report also found significant variations in prescription rates between Canadian provinces and territories. For example, in Saskatchewan, five percent of people over the age of 65 use these medications regularly, compared to more than 20 percent in New Brunswick. These differences probably come from doctors' prescribing habits. Initiatives such as providing information to doctors about their prescribing habits, as well as proposed by the Collège du Québeccan help resolve this issue.
The report also identified differences between groups, with women almost twice as likely as men to be prescribed these drugs. Older women, especially those over 90, are most likely to be prescribed these medications, even though they are at greatest risk of problems.
Often, patients begin taking these medications to treat short-term sleep problems or anxiety. However, they may continue to use them for longer than recommended, leading to chronic use.
Patients may also receive these medications in the hospital to help them sleep, but this may continue even after they are discharged. Simple and safe alternatives exist, such as creating a healthy sleep environment, which studies show can be as effective as medication.
So how can we ensure safer medication practices?
Studies show that when patients understand the risks of prescription drugs, they are less likely to take them. Patients should initiate conversations with their doctor about potential side effects and explore safer alternatives. Pharmacists can also play a crucial role in reviewing medications and identifying those that can be reduced or discontinued.
Additionally, doctors may recommend non-drug interventions, such as lifestyle changes, to address sleep or anxiety problems. Simple lifestyle changes, like regular exercise or better bedtime habits, can help provide relief without resorting to medication. These changes are often just as effective, or even more effective, than medications.
If prescriptions are started, they should be time-limited, and patients and doctors can determine whether they should be continued.
Overprescription of unsafe sedative medications is a difficult and widespread problem in Canada. It is important that health care providers, regulatory bodies that oversee the practice of clinicians, and patients work together to promote safer and more effective care for Canadians.
By raising awareness of the risks associated with these medications and encouraging open conversations between patients and healthcare providers to determine safer alternatives, we can reduce risks and improve the well-being of our aging and vulnerable population.
Wendy Levinson And Christine Song are internal medicine doctors.