The “Opioid Epidemic”. It dominates television news, is the subject of multiple magazine and newspaper articles and monopolizes radio talk shows from coast to coast. But there exists another class of medications that have just as much, if not more, of an impact upon our seniors. They are the benzodiazepines.
These drugs hit the scene in the 1960s as medical professionals searched for a safer alternative to barbiturates and other ‘tranquilizers’ of the time that were widely prescribed as a way for deal with ‘extreme nervousness’, especially for women.
If you are a buff of movies made in the 1950s, you have no doubt witnessed multiples movie scenes where women confront crisis and lose control, only to have a doctor rush to her aid with a “tranquilizer to help her sleep”. The culture of the time was that women needed these “little helpers” to deal with everyday life. Men, on the other hand, were viewed with disdain if they requested such help to deal with a “case of the nerves” and avoided using such medications (although they usually turned to alcohol to deal with their anxiety, opening the door to other unpleasant outcomes such as family disputes, job loss and alcoholism).
The drug of choice at the time for anxiety was Meprobate or Miltown (named after Milltown, the town in New Jersey where it was manufactured). Hitting the market in the mid-50s, Miltown and other ‘mild’ tranquilizers, like Equanil and Reserpine, became the most prescribed medications in history up to that time.
They were marketed as “miracle drugs” used to treat the anxiety and stress of the ‘everyday housewife’. Their use was so widespread, it was not uncommon to see signs posted in neighborhood pharmacies proclaiming that they were out of Miltown but ‘more will be here tomorrow’.
As with all so-called miracle drugs, their wonders were short lived. It turned out that Miltown was quite addictive and created dependence in its users. Pharma had to find a new medication to address Americans looking for a ‘feel-good’ drug.
About the time Miltown had hit the market, another class of drugs was also discovered but put on the back-burner due to the popularity of Miltown. These drugs became known as Benzodiazepines and were developed by accident in a search for a less toxic medication to replace barbiturates. Embraced at the time by medical professionals, benzodiazepines were viewed as a safer alternative to some of the older medications that were used to treat “nervousness and anxiety”.
By the 1960s, these drugs had replaced Miltown in popularity and quickly became part of the pop culture. Valium, the most popular of the benzodiazepines, were seemingly in every medicine cabinet in America. So widespread were their use that the Rolling Stones had a hit record in 1966 called “Mother’s Little Helper” about the hazards of Valium marketed mostly to housewives on both sides of the Atlantic.
Some of the lyrics from this song are telling:
By the mid-1970s, benzodiazepines had become one of the most prescribed drugs in most developed countries. As these meds reached their height of popularity, the initial euphoria exhibited by medical professionals began to wane. By the 1980s, warnings on the negative effects of long term benzodiazepine use was issued with seniors being one of the groups targeted. Despite this concern, Benzodiazepines continued to be a hugely popular class of drugs.
Today, benzodiazepines are considered to be so dangerous for seniors that a group of physician geriatric experts have indicated that there is no safe level of use in elderly patients. So concerned about the dangers of these drugs, the Food and Drug Administration (FDA) has issued a black box warning for them. This is the strictest warning put on the labeling of prescription drugs or drug products by the FDA when there exists reasonable evidence of serious hazards with a drug. Even with this warning, benzodiazepines continue to be prescribed for the elderly at alarmingly high rates.
Benzodiazepines are most commonly prescribed to treat anxiety and sleep problems in seniors. Although they are quite effective in addressing these issues, they also have serious risks especially when used for a long period of time, including dependence and unpleasant withdrawal symptoms.
Some of the direct effects of benzodiazepines on seniors include drowsiness, confusion, mental clouding, lethargy and the inability to concentrate. Other side effects include blurred vision, night wandering, incontinence, nightmares and appetite changes. Secondary dangers of these drugs include cognitive difficulties, falls and fractures due to impaired balance and automobile accidents.
To understand why these drugs are so harmful it’s important to understand physical changes that occur with age. The process of aging tends to slow nearly all body functions, including the liver, which means it takes longer for a senior’s body to process the drug. In addition, an aging body also tends to store this medication in fat cells. Given this, the level of benzodiazepines in the body of a senior tends to be higher than a younger person taking the same amount and can approach toxic levels even when taken as directed.
As the body stores the medication, the accumulation of the drug continues as the body is unable to effectively eliminate it. Because of this dangerous cycle, the side effects become atypical and can lead to a misdiagnose of dementia.
But there may be even more issues associated with long term benzodiazepine use.
According to a Harvard study, there may also be a link between these drugs and Alzheimer’s disease. The study states that those over the age of 65 who had taken a benzodiazepine for three months or less had about the same dementia risk as those who had never taken any. Taking the drug for three to six months raised the risk of developing Alzheimer’s by 32% and taking it for more than six months boosted the risk by 84%. However, some subsequent studies have contradicted the Harvard research citing the fact that Alzheimer’s disease may have already been present in its early stage which prompted the prescription for these medications.
The Harvard researchers acknowledged that the use of benzodiazepines could be just a signal that people were trying to cope with anxiety and sleep disruption—two common symptoms of early Alzheimer’s onset. But the studies that contradicted the Harvard research have also been called into question.
Although the use of benzos and their contribution to Alzheimer’s may be under dispute, one thing that is not subject to argument are other issues that occur for seniors who use benzodiazepines. Falls caused by these drugs that result in hip fractures are associated with significant morbidity, mortality, loss of freedom and a financial burden to families and to the medical system.
There is also an increase in auto accidents and the risk of suicide among those taking benzodiazepines over the age of 65 is four times higher than those of the same age not using these drugs. Benzodiazepines in the elderly also appear to contribute to aggressive behaviors and physical toxicity due to interactions with other prescribed and over the counter medications.
Another issue with seniors and benzodiazepine medications is the deadly combination that can occur when these drugs are used with alcohol. A recent study shows that seniors who go to hospital emergency rooms because of a drug interaction is usually the result of combining these two powerful sedatives which results in a synergistic effect, meaning that each drug amplifies the effect of the other, causing exaggerated side effects.
Mixing benzodiazepines and opioid medications can also be deadly. The major concern when mixing these two classes of drugs is oversedation. This is the inability to wake up or respond to stimuli which, of course, increase the risk of falling or even slipping into a coma. Both opioids and benzodiazepines can change breathing patterns and result in depressed breathing leading to a lack of oxygen to the brain and eventually shutting down vital organ systems leading to brain damage and even death.
So how do you know if someone you love is taking these drugs? Check the bottles. Below is a list of some of the most commonly prescribed benzodiazepines:
Be especially concerned if this person is exhibiting some of the symptoms I mentioned earlier. And above all else, if visiting a medical professional about odd behaviors or symptoms that may indicate the presence of dementia, provide them with the list of medications they are taking.
Also keep in mind that these drugs are designed for short-term use. If someone has been using them regularly for more than a few weeks, know that withdrawal symptoms can be powerful.
More importantly, never suggest stopping any medication without consulting the prescribing physician. It could be that the benefits of benzodiazepines may very well outweigh the possible side effects.
As with most things in life, be aware, be informed and ask questions.
Attorney RJ Connelly III, practices in the area of elder law. This area of law involves Medicaid planning and asset protection advice for those individuals entering nursing homes, planning for the possibility of disability through the use of powers of attorney for the both health care and finances, guardianship, estate planning, probate and estate administration, preparation of wills, living trusts and special or supplemental needs trusts. He represents clients primarily in the states of Rhode Island, Connecticut and the Commonwealth of Massachusetts. He was certified as an Elder Law Attorney (CELA) by the National Elder Law Foundation (NELF) in 2008. Attorney Connelly is licensed to practice before the Rhode Island, Massachusetts, Connecticut, and Federal Bars.