Benzodiazepines - more addictive than heroin and deadlier than cigarettes

A report on the prescription of Benzodiazepines in the Dublin & North East Regional Health Authority Area.

A study published in the British Medical Journal Open in January found that anyone taking sleeping pills twice a month is four times more likely to die in the next two and a half years than someone taking none at all.

People taking high doses of temazepam, one of the benzodiazepine family of drugs, were six times more likely to die. Temazepam was dispensed 32,000 times in the HSE Dublin North East Region  in 2010.

Overall, people taking more then 132 pills a year suffered a 35 per cent increase in cancer.

Also, heavy users of zolpidem, one of the drugs in a newer (and supposedly less addictive) category of sleeping pills and tranquillisers, were nearly six times more likely to die in the near future. Some 103,700 of these were dispensed in the region but this doubles when the other Z's are taken into account.

A total of €4.4m was spent on benzodiazipines in the DNE regoion in 2010. The figures supplied to me are for the GMS system.  The health system does not seem to have any data for products sold outside of the medical card system.

Benzodiazepines are one of the most commonly prescribed medications in the world. Generally considered safe and effective for short-term use (3-4 weeks) in the treatment of anxiety, insomnia and seizures, the risk of overuse, abuse and dependence is a key concern.

The BMJ article concludes "Rough order-of-magnitude estimates at the end of the supplemental files suggest that in 2010, hypnotics may have been associated with 320, 000 to 507, 000 excess deaths in the USA alone.

"From this non-randomised study, we cannot be certain what portion of the mortality associated with hypnotics may have been attributable to these drugs, but the consistency of our estimates across a spectrum of health and disease suggests that the mortality effect of hypnotics was substantial. Even 10, 000 yearly excess deaths caused by hypnotics would be too many."

Back in November I asked the following question of the HSE

REGIONAL HEALTH FORUM - DUBLIN AND NORTH EAST
FÓRAM RÉIGIÚNACH SLÁINTE - BAILE ÁTHA CLIATH AGUS AN TOIRTHUAISCEART
28TH NOVEMBER, 2011

AGENDA ITEM NO. 4  REPLY TO QUESTION  REF: 28.11DENNISON59

Question:- “To ask the Manager for a report on the prescription of Benzodiazepines in the region for the last three years.” Submitted by Cllr. Kieran Dennison

Response:- Data in relation to the prescription of Benzodiazepines is only available through the GMS system and can only be provided in relation to patients under this Scheme. A response on this issue is currently being collated by Mr. Paddy Burke, National Director, Primary Care Reimbursement Services and we will forward information to members in due course.

The data was eventually supplied to me last week and can be accessed here . 

It has been covered by RTE Prime Time and the Northside People. The HSE response is outlined below. Ministers Kathleen Lynch and Roisin Shortall need to move on this issue.

HSE National Response

Minister Lynch has set up a national group comprising of representative of the Irish Medicines Board, Health Service Executive, Garda, Customs and Excise, Pharmaceutical Union of Ireland and the ICGP with regard to the current legislation around management of Benzodiazepines.

Addiction Services Response

The addiction service in Dublin North takes seriously the role of patient care and has established a clinical care committee to address how prescribing can be more standardised. 

The committee is looking at the opiate protocol and the substance misuse recommendations to see what strategies can be developed to influence prescribing patterns throughout the HSE Dublin North City in both Primary Care and Mental Health settings.

It is estimated that at least 30% of our doctors prescribe benzodiazepines when providing care for those with an addiction, those figures are for methadone clients. 

While the research has yet to be completed on cocaine and alcohol addictions, it is anticipated that the number of clients being prescribed benzodiazepines is much greater.

The issues surrounding the prescribing of benzodiazepines along with methadone and the possibility of these drugs being mixed with alcohol is a major problem. 

Within the addiction service, clients can avail of their methadone and other prescription drugs under the care of the same doctor who can ensure that the symptoms are managed in line with the individuals care plan. 

The problem lies in the lack of coordination between methadone clinic prescribing and benzodiazepine prescribing in a primary care setting.

 

Primary Care Response

The PCRS recently sent out information to each GP in relation to their prescribing of Benzodiazepines and “Z” drugs (Zolpidem).The purpose of this was to inform GP’s of their prescribing and where they were in relation to the national average of prescribing these items and to enable the GP to self audit their practice in relation to their prescribing. 

The GP’s were also reminded of the Department of Health and Children Guidelines for the prescribing of Benzodiazepines and given contact details of where they can access further information and assistance from the Health Service Executive.

Under the HSE Reach Out National Suicide Prevention Strategy

Action 20 Reducing Access to Means

The HSE has established a national working group on the 31st January 2012 with representative of Irish College of GP, College of Psychiatrists, Department of Health & Children, Pharmaceutical Union of Ireland, National Suicide Prevention Office.

This group is currently undertaking an analysis of means to be targeted and have narrowed the focus to looking at restricting access in particular to Benzodiazepines and will make recommendations. This group is working closely with Regional and Local Drugs Task Forces.