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Experts discuss risks, benefits of benzodiazepines
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NEW ORLEANS — In a session here, Rakesh Jain, MD, MPH, of Texas Tech Health Sciences Center, Midland, Texas, and Saundra Jain, MA, PsyD, LPC, of the University of Texas at Austin, weighed the benefits and risks associated with benzodiazepines.
“Benzodiazepines are both helpful and problematic,” Saundra Jain said.
To illustrate this, Jain instructed the audience to raise a hand if they had witnessed negatives associated with benzodiazepines, which resulted in many hands going up. She then asked them to raise a hand if they had witnessed positives associated with benzodiazepines, and many of the same hands went up.
Risks
Research has linked benzodiazepines with accidental falls and hip fractures, dementia and overdose.
A questionnaire survey of 8,000 individuals indicated benzodiazepine use was associated with injuries outside of work and cognitive failures.
Risk for hip fractures increased up to 50% among older adults taking benzodiazepines.
A 2017 study among 70,718 individuals indicated benzodiazepine use was associated with an increased risk for hip fracture in participants with (adjusted HR = 1.4; 95% CI, 1.2-1.7) and without (aHR = 1.6; 95% CI, 1.3-1.9) Alzheimer’s disease.
A meta-analysis of eight studies among 66,177 participants, of whom 30,914 had dementia, indicated a 78% higher risk for dementia among participants who used benzodiazepines compared with those who did not.
A large Oklahoma State study showed three out of five drug overdoses were due to benzodiazepines.
“Where are these meds coming from?” Saundra Jain asked. “You can see, they are coming from our practices, our prescription tabs. So, if we’re going to share in the solutions, then we must also share in the responsibility of the problem.”
In addition, Rakesh Jain discussed the addictive nature of benzodiazepines and highlighted a recently understood link that showed gamma-aminobutyric acid (GABA) drugs are inhibitory.
Benefits
Despite these risks, benzodiazepines are often very helpful, many individuals benefit from them and use them safely for prolonged periods.
Many treatment guidelines recommend judicious use of benzodiazepines based on their efficacy and individuals who successfully receive long-term benzodiazepine therapy with no associated problems should not necessarily be taken off the medication, according to the Jains.
There are several positives associated with benzodiazepines, including low cost, availability, rapid symptom relief, and efficacy for many individuals.
“The goal of this presentation is not to create fear-mongering among us clinicians,” Saundra Jain said.
She asserted that framing any conversation on benzodiazepines as “good” or “bad” is fundamentally flawed.
Educate patients
It is important and effective to educate patients on the risks and benefits of benzodiazepines before prescribing them, according to the Jains.
The McGill Experience study indicated the power of educating patients.
In the study, researchers sent a mailer that identified risks, explained the tapering schedule and encouraged patients to initiate a conversation with their clinician.
Overall, 62% of the cohort initiated a conversation about benzodiazepine therapy cessation with a physician or pharmacist.
At 6-month follow-up, 27% of participants who received the mailer discontinued benzodiazepines, while 5% of the control group discontinued.
Dose reduction occurred among 11% of participants.
A JAMA Internal Medicine study published in 2014 showed all patient populations benefited from psychoeducation and a slow taper.
A Canadian Medical Association Journal study published in 2003 indicated adding cognitive-behavioral therapy to withdrawing or tapering improved outcomes among individuals with chronic insomnia.
At 3 months, discontinuation occurred in 77% of participants who received CBT compared with 38% of those who did not received CBT.
At 12 months, discontinuation occurred in 70% of participants who received CBT compared with 24% of those who did not receive CBT.
“We know there are positives [and] negatives [with benzodiazepines],” Saundra Jain said. “We invite you to take the data, look at it and make your minds up. The one thing I think we must do, as clinicians, [is] know the data; but our patients have to have that information too. [We must] make sure they’re informed.” – by Amanda Oldt
Reference:
Jain R, et al. Examining the risks and benefits from benzodiazepines. Presented at: U.S. Psychiatric and Mental Health Congress; Sept. 16-19, 2017; New Orleans.
Disclosure s : The researchers report financial ties with Addrenex, Allergan, Alkermes, AstraZeneca, Avanir, Forum, Janssen, Lilly, Lundbeck, Merck, Neos Therapeutics, Neurocrine Biosciences, Otsuka, Pamlab, Pfizer, Shionogi, Shire, Sunovion, Supernus, Takeda, Teva and Tris Pharma.