TUESDAY, Sept. 11, 2018 -- When older people use drugs like Valium or Xanax to calm anxiety or help them sleep, they run a high risk of becoming drug-dependent, new research suggests.
In the study of almost 600 adults averaging 78 years of age, about one in four who were prescribed these types of benzodiazepine sedatives ended up using them for at least a year.
That's despite warnings against long-term use of the drugs, especially among older people. Benzodiazepines -- a class that also includes Ativan, Halcion and Klonopin -- can raise the risk of car crashes, falls, broken hips and other harmful side effects, experts warn.
So the new study "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," said lead author Dr. Lauren Gerlach. She's a geriatric psychiatrist at the University of Michigan in Ann Arbor.
"We also need to educate providers about effective non-pharmaceutical treatment alternatives, such as cognitive behavioral therapy, for these patients," Gerlach said in a university news release.
One psychiatrist called the study a much-needed reminder for doctors.
"Clinicians, including psychiatrists, continue to prescribe benzodiazepines to this [older] population at an alarming rate," said Dr. Brian Keefe, medical director at Zucker Hillside Hospital in Glen Oaks, N.Y.
However, "multiple studies over many years now have consistently demonstrated an elevated risk of falls, and falls with fracture in seniors who take these medications, a risk that increases with daily dose," said Keefe, who wasn't involved in the new research.
In the study, Gerlach's team tracked benzodiazepine use among 576 older adults who were given their first prescription between 2008 and 2016. Only a few had had any psychiatric, psychological or psychosocial care in the past two years, the report noted.
Overall, 152 of the patients maintained a current or recent prescription one year after being initially prescribed a benzodiazepine, the study found.
The study mostly included people who got their prescription from a primary care doctor or other non-psychiatrist physician, because that's how most older patients get benzodiazepines, the authors explained.
Breaking the numbers down, Gerlach's team found that white patients were four times more likely to use these drugs over the long term, compared to minority patients.
Also, people whose initial prescriptions were written for the largest number of pills were more likely to become long-term users. In fact, for every 10 additional days of drugs prescribed, the risk of long-term use nearly doubled over the next year, the researchers reported.
And compared to short-term users, patients who took benzodiazepines long term were not any more likely be diagnosed with anxiety or depression -- two conditions that might justify using these drugs long term, Gerlach said.
Long-term users were more likely to say they had sleep problems, however, even though benzodiazepines are not recommended for long-term use as sleep aids. In fact, they may even worsen sleep the longer they're used, the researchers said.
"Since mental health providers see only a very small minority of older adults who have mental health issues, we need to support primary care providers better as they manage these patients' care," Gerlach said. "We must help them think critically about how certain prescriptions they write could increase the chance of long-term use."
So why do so many physicians renew prescriptions, even when it's not justified?
Keefe had one theory. "Tapering and ultimately stopping these medications can be uncomfortable for both parties," he said. So, a reluctance to do so "may result in continuation of the status quo, even when it's not advisable over the longer term," Keefe believes.
Dr. Harshal Kirane directs addiction services at Staten Island University Hospital in New York City. He called benzodiazepine overuse "a silent epidemic."
The new study "highlights a staggering rift between guidelines and real-world practices," Kirane said, and "underscores a persistent reliance on narcotic medications for resolution of symptoms, such as insomnia, that can be improved by numerous other healthier options."
Kirane said physicians must do more to help guide patients with sleeplessness or other complaints towards safer, non-pharmaceutical solutions.
The report was published online Sept. 10 in the journal JAMA Internal Medicine.
For more on benzodiazepines, visit the U.S. National Institute on Drug Abuse.
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