by Lancelot Herpin '21
The benzodiazepines e
pidemic has remained overlooked, perhaps due to the national attention on the opioid crisis. Last month, a group of Stanford researchers published a study they conducted in the New England Journal of Medicine on the increase in dosage and prescriptions of benzodiazepines. Dr. Humphreys and his team reported that between 1996 and 2013, the number of adults who were prescribed benzodiazepine increased from 8.1 million to 13.5 million (67% increase) and that the quantity of benzos increased from 1.1 kg to 3.6 kg lorazepam-equivalents per 100,000 adults (more than tripled). The number of overdose deaths involving benzos has also increased, from 1135 to 8791 from 1999 to 2015 (almost eight-fold increase).
Bezos are particularly dangerous when they are paired with opioids, which is becoming increasingly common in elderly adults. The rates of coprescription have nearly doubled in the last decade, increasing from 9% to 17% from 2001 to 2013.
Aside from the risks of overdose, benzos have many harmful side effects which are enhanced in elderly adults. Short-term use of these drugs has proven beneficial, but prolonged use can lead to developing tolerance, addiction, and worsened anxiety. It can also contribute to insomnia and cause death. The use of benzos is also linked with cognitive decline and increased risk of injuries caused by the dizziness from the drug intake. Dr. Humphrey notes that persistent use of benzos can become harmful at older ages, because older bodies metabolize drugs differently.
Benzodiazepines work by binding to the allosteric site of GABA-A receptors (Gamma Amino Butyric Acid), ligand gated chloride channels responsible for reducing neuronal activity, and increasing their affinity for GABA. The binding of GABA to these receptors opens the chloride channel and allows chloride ions into the neuron. This influx of chloride hyperpolarizes the neuron, making it less likely to fire. Thus, benzos decrease the number of neurons firing, alleviating the symptoms of seizures and anxiety caused by the over-stimulation of the brain.
Many safer alternative treatments exist, such as serotonin-reuptake inhibitors, behavioral changes, and improved sleep hygiene. Dr. Humphreys proposes different methods to fight this epidemic, like requiring prescribers to check the state’s prescription drug monitoring program (PDMP) to avoid prescribing benzodiazepines with opioids and implementing more education about safe benzodiasepine prescribing in medical education.
So far, combatting this issue has proven difficult. The addictive effects of benzos make it more difficult to stop because the dose must be decreased gradually to prevent withdrawal effects, a process which can take from 6 to 12 months according to Dr. Maust, a psychiatrist at the Veterans Administration Ann Arbor Health Care System. The Stanford reachers also highlight the lack of attention the benzo epidemic has received compared to the opioid epidemic. As a result, policymakers have not addressed the impending issue.
However, the growing infrastructure in response to the opioid crisis could be used to reduce the overprescription and misuse of benzodiazepines. We will probably see increased regulation and cut backs on prescription of benzos, similar to what happened with opioids. In the future, the opioid and benzodiazepine epidemics will likely be addressed in tandem using the same resources.
Sources
http://www.nejm.org/doi/full/10.1056/NEJMp1715050
https://www.drugabuse.gov/drugs-abuse/opioids/benzodiazepines-opioids