Benzos: Beware the baddest drugs in a doctor’s armoury.

Benzodiazepines are the serial offenders of the drugs’ cabinet with a cluster of pharmaceuticals ASBOs to their name. They’ve been around since the 1960s and are generally given if you are complaining of the likes of insomnia or anxiety – family names include temazepam (for sleep) and the tranquillizer valium.  

They have a charge sheet that would make any old lag proud – highly addictive, linked with day time 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 ,” says Daniel Kripke, Professor of Psychiatry Emeritus  at the University of California, San Diego who led a recent study into their safety “is cigarettes. These drugs should have a similar level of warning on them.”

What’s prompted me to write about them is the report last week from Which? magazine, complaining that manufacturers such as Seven Seas and Vitabiotics have been making “exaggerated and misleading claims” for the benefits of their products for heart heath, joints and digestion. The evidence they rely on for this comes from the system set up by the EU for testing a whole range of natural products which has been criticised for being heavy handed and inappropriate.

That’s not a debate I want to go into here. Originally I was going to look at the risks and benefits of several of the drugs regularly given to older people with such chronic problems as joint pain and gut problems – the same group that are likely to try the Seven Seas or Vitabiotics products.If you are looking at the value of over the counter remedies, it makes sense to consider what else people might have tried and why they might have given up on them.

Poster boy for dangerous prescribing

But it soon became clear that  benzodiazepines were an alarmingly clear example of just how bad drugs could be and still be available. They were a poster boy for dangerous and inappropriate prescribing. And what is really worrying is the way this has virtually no effect on how many get handed out – around 15 million prescriptions last year. So what are the chances that there is always a careful evaluation of the risks and benefits of other drugs?

You might think braving 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.”

In fact benzos could quite likely be coming to a drugs cabinet near you because in times of austerity cases of insomnia or anxiety and depression soar. And the likelihood of benzo contact shoots up sharply if you are close to anyone going into a care home or similar soon.

More addicts than street drugs

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 only 10% of people over 65 living in their own homes were getting drugs for sleep or anxiety, once they went into care that doubled to 22% and within 6 months it had reached an astonishing 60%.

That immediately raises the issue of addiction. There are between a million and one and a half million benzo addicts in the UK, according to the All Party Parliamentary Group for Involuntary Tranquilliser Addiction – more than any illegal drug. 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 and 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 (Health chiefs seek way forward on lives ruined by tranquillizers – Jan 8 2013) and described how the BMA (British Medical Association) planned 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 minster for health, Dawn Primarolo, had been a champion of  benzo addicts in opposition, asking at least 50 questions on the topic in the Commons. Once in office she did nothing effective.

And then there is evidence emerging of links with other major disorders. At the beginning of last year a big study 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 will die in the next four years, who are not on benzodiazepines,” says Professor Kripke. “That goes up to 14% if you are.”

A raised risk of Alzheimer’s

By the end of that year another new risk associated with these drugs emerged – they can increase your chances of developing Alzheimer’s. Conducted in France the study involved over a thousand 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.”

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

This was a big thorough piece of work looking at 100,000 people 66 and older with COPD (chronic obstructive pulmonary disease). It’s  known colloquially as  emphysema and it makes breathing difficult.  Both American and European guidelines say benzos should be avoided for the simple reason that they can make breathing even harder.

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, then you were 40% more likely to get the drugs.

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 to be 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. And it is equally hard to believe that this never happens with other drugs.

The point is that many of those who turn to non-drug alternatives are often refugees from a state where they fear for their safety because collateral damage from friendly fire is all too common. Complaining about the lack of solid evidence for the treatments they are trying is like pointing out that refugee camps don’t follow proper building regulations.