Anxiolytics, hypnotics, and eternal sleep

YOUR DOSE OF MEDICINE

Data from the Centers for Disease Control and Prevention’s National Ambulatory Medical Center Survey reveal benzodiazepine prescriptions grew by 12.5 percent per year between 2002 and 2009. Data from the National Health and Nutrition Examination Survey suggest that prescriptions for sleep aids (sedatives and hypnotics) triple between 1998 and 2006. Four percent of adults in the United States aged 20 years or older and seven percent of adults aged 80 years or older report using a prescription sleep aid in the past month.

Aside from the addictive potential and their limited long term effectiveness, they may be associated with an increased risk of death.

At the University of Warwick, Conventry, England, analyzed data from a retrospective matched cohort study involving 34,727 patients aged at least 16 years who received prescriptions for anxiolytics or hypnotics and 69,418 patients who did not.

To reduce the likelihood that patients received a prescription that they did not fill, only patients receiving at least two prescriptions were included.

The average follow-up period was 7.6 years. The most commonly prescribed drugs were diazepam (48 percent), temazepam (35 percent), zopiclone (34 percent), and zolpidem (8 percent).

Significantly higher ratios for mortality were observed with the use of these drugs. Adjusting for potential confounders, the hazard ratio for mortality during the whole follow-up period was significantly elevated for the group receiving any sedative or hypnotic in the first year of recruitment into the study.

Dose responses were observed for study drugs. For example, the HR for patients receiving more than 90 dose during the first year was 4.51.

The patients who did not receive study drugs beyond one year were less likely to die than those who continued to take them.

They point out that these data translate into four excess deaths linked to use of these drugs per 100 people over 7.6 years after the initial prescription.

The biggest challenge will be to figure out how best to incorporate this information into our counseling of patients without sounding like we are “fear-mongering.” Fear-mongering doesn’t work – it just makes our patients more anxious, when what we really need to do is calm them down.

Cognitive-behavioral therapy works for insomnia, but patients report that they do not have the time.