Sleeping pills: the most dangerous drug?
September 4, 2013 | By:
There are more addicts to benzodiazepines than there are to illegal drugs. Medical editor Jerome Burne, in a post adapted from his blog, makes the case against them
Benzodiazepines_sleeping pills-620 Corbis

‘Mother’s little helper’ is associated with increased risk of dementia. Photo by Corbis

Benzodiazepines are the serial offenders of the drugs cabinet with a cluster of pharmaceutical ASBOs to their name.

They’ve been around since the 1960s and are generally given if you are complaining of insomnia or anxiety. Family names include Temazepam (for sleep) and the tranquilliser Valium.

They have a charge sheet that would make any old lag proud. (Not least, they’re highly addictive and linked with daytime drowsiness, so they push up the risk of car crashes and falls.)

More recent heavyweight raps include an increased chance of developing dementia and cancer if you are a long-time user.

“The only other legally available drug that has a comparable risk to the benzodiazepines is cigarettes,” says Daniel Kripke, Professor of Psychiatry Emeritus at the University of California, who led a recent study into their safety. “These drugs should have a similar level of warning on them.”

Poster boys for bad prescribing

Benzodiazepines give an alarmingly clear example of how bad drugs can be and still are available. They are poster boys for dangerous and inappropriate prescribing. What is really worrying is the way this has virtually no effect on how many get handed out: around 15 million prescriptions in Britain last year.

You might think braving the benzos minefield was worth it because at least you got a good night’s sleep, but no.

“It might be OK to keep on prescribing these drugs if they were really effective,” says Professor Colin Espie, psychologist and head of the Sleep Centre at the University of Glasgow. “You could decide that the benefits outweighed the risks. The problem is that they don’t even work.”

So you don’t want to take them, right? The fact is, benzos could quite likely be coming to a drugs cabinet near you anyway because, in times of austerity, cases of insomnia, anxiety and depression soar.

What’s more, the likelihood of benzo contact shoots up sharply if you are close to anyone going into a care home or similar soon. These drugs are likely to become part of their daily drug cocktail, according to a recent study carried out at Queen’s University, Belfast.

The researchers found that while ten per cent of people over 65 living in their own homes were given drugs for sleep or anxiety, once they went into care that figure more than doubled, to 22 per cent; within six months it had reached an astonishing 60 per cent.

That immediately raises the issue of addiction. There are between one and one-and-a-half million benzo addicts in the UK, according to the All Party Parliamentary Group for Involuntary Tranquilliser Addiction. That’s more than any illegal drug.

What the studies show

Way back in 1988, official guidelines stated that sleeping pills shouldn’t be taken for longer than four weeks unless the insomnia was severe and disabling. Yet, for years, repeat prescriptions for them were common. Even two years ago, research by the King’s Fund in London found that one in five sleeping pill prescriptions were for longer than eight weeks.

Recently The Times took up cudgels on this issue and reported on plans by the BMA (British Medical Association) to hold meetings about it. Public health minister Anna Soubry is said to be looking into how best to support these addicts.

Good luck with that. An earlier Labour minister for health, Dawn Primarolo, had in opposition been a champion of benzo addicts, asking at least 50 questions on the topic in the Commons. Once in office she did nothing effective.

Then there is evidence emerging of links with other major disorders. At the beginning of last year, a large study in California found that people taking benzos had a higher risk of developing cancer –  and as much as a five times greater chance of dying sooner than those who had never taken them.

“Three per cent of people over 75 who are not on benzodiazepines will die in the next four years,” says Professor Kripke. “That goes up to 14 per cent if they are.”

By the end of 2012, another new risk associated with these drugs emerged in a study of benzodiaepine use and risk of dementia: they can increase your chances of developing Alzheimer’s.

This research, conducted in France, involved more than 1,000 older people and found that new use of benzodiazepines was associated with increased risk of dementia. The researchers commented mildly: “Considering the extent to which benzodiazepines are prescribed and the number of potential adverse effects of this drug class in the general population, indiscriminate widespread use should be cautioned against.”

Benzo warnings falling on deaf ears

But warnings about these drugs have a habit of falling on deaf ears. So maybe it wasn’t so surprising when a Canadian study into benzodiazepine use earlier this year reported that benzos were still being widely prescribed to patients with a nasty lung condition, despite strong official advice to the contrary.

This was a big and thorough piece of work, looking at 100,000 people aged 66 and older with COPD (chronic obstructive pulmonary disease, or emphysema), a condition that makes breathing difficult.

Both American and European guidelines say benzos should be avoided for the simple reason that they can make breathing even harder. So the patients were followed for five years, to track benzo prescribing.

Amazingly, the researchers found that not only did a third of patients get the drugs – but if your condition was severe, you were 40 per cent more likely to do so.

The resigned tone of the lead researcher is all too familiar: “Our findings are concerning because they tell us that the patients most at risk of being affected by the adverse events caused by the drug are the same ones that are using it with the most frequency.”

It’s all too clear that use of benzos doesn’t follow any evidence-based rules and that the benefits rarely outweigh the risk. Yet, apparently, when faced with patients who tick various benzos boxes, doctors are seized with some kind of evidence-based bypass.

Benzodiazepines were first discovered in 1960. They are older than many of the people reading this site. Yet, despite the clear dangers, they are still widely prescribed.

What’s really quite galling is that doctors often complain privately about their patients’ fear of pharmaceutical remedies. In the circumstances, is it any wonder?