They are used regularly to treat seniors for anxiety, insomnia, seizures and pain but can have severe side-effects on seniors which include cognitive impairments and emotional dullness when used long-term. These medications are extremely addicting and have serious and traumatic withdrawal symptoms, up to and including death. Seniors are prescribed these drugs more than any other group in the United States. No, it’s not opiates, it’s benzodiazepines, the “other” drug epidemic for our seniors.
Today’s newspapers, law enforcement agencies and politicians continue to focus on the “Opioid Epidemic” as America’s major drug problem however little attention is paid to the use of benzodiazepines among all demographic groups and especially among seniors. In fact, among all groups, benzodiazepines account for over 30% of drug overdose rates in the United States, according to the Centers for Disease Control.
The effect of benzodiazepines on people are quite profound. They can
eliminate the ability to feel danger in younger users and when mixed with alcohol, death can result. Currently in the United States, it is estimated that over 5 percent of the adult populations are using them and of that group, nearly a quarter are long time users and addicted. In 2015, the United States saw a 500 percent increase in benzodiazepine overdose deaths.
On March 6, as I was putting the finishing touches on this blog, the BBC ran a story on the dramatic increase in benzodiazepine use and deaths in Great Britain. Glorified by hip-hop artists in that country, Xanax, the benzodiazepine of choice for those who use these drugs, is now being mixed with fentanyl, a deadly opioid and resulting in a spike in overdose deaths.
This drug can kill in large doses and withdrawal from it can be even more
deadly. So as its use increases on the street and among the drug culture, benzos have been a major problem for America's seniors for decades and it continues to get worse.
One long-term study by the National Institutes of Health raised serious concerns about the use of this class of medications in senior citizens. The study found that among all adults 18 to 80 years old, about 1 in 20 received a benzodiazepine prescription in 2008, the period covered by this study.
This number rose substantially with age, from 2.6 percent among those 18 to 35, to 8.7 percent in those 65 to 80, the oldest group studied. Long-term use — considered a supply of the medication for more than 120 days — also increased markedly with age. Of people 65 to 80 who used benzodiazepines, 31.4 percent received prescriptions for long-term use versus 14.7 percent of users 18 to 35.
In all age groups, women were about twice as likely as men to receive benzodiazepines. Among women 65 to 80 years old, 1 in 10 was prescribed one of these medications, with almost a third of those receiving long-term prescriptions. More current numbers suggest that the number of prescriptions being written for benzos have not slowed down.
So what are benzodiazepines and why have they become so widely used? To understand this, let's take a look at America's love affair with prescription drugs.
Those of us who are baby boomers and watch old television programs on “ME TV” or other vintage television channels hear the physicians of the time talk about prescribing tranquilizers for those who had experienced a traumatic event. The tranquilizers of that time, a class of medications called barbiturates, became the go to remedy for all things nerve and stress related.
The drug of choice at the time for 'the nervous American' 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’ (it was considered a “weakness” for men to take them, as they treated their anxiety with alcohol, a discussion for another time). Their use was so widespread that it was not uncommon to see signs posted in neighborhood pharmacies proclaiming that they were out of Miltown with the promise that ‘more will be here tomorrow’.
But the wonders of these drugs were short-lived. It turned out that Miltown and other barbiturates were quite addictive and created dependence in its users. Pharma had to find a new medication to address America’s hunger for a ‘feel-good’ drug. Enter benzodiazepines, discovered accidentally while researching an alternative for barbiturates.
When benzodiazepines hit the market in the mid-1960s, they were touted as a
safer alternative than barbiturates and embraced by the medical profession as the next “wonder-drug” to treat the “nervousness and anxiety” of the American people.
By the mid-1970s, benzodiazepines had become one of the most prescribed drugs in most developed countries, including the United States. As these medications 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 exists 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 they are 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 problematic issues associated with benzodiazepine use.
In research published in late 2017 and early 2018, benzodiazepine and related
drug use was associated with a 40 percent increase in mortality among persons with Alzheimer's disease, according to a study released from the University of Eastern Finland. The findings were published in the International Journal of Geriatric Psychiatry.
The study found that the risk of death was increased right from the initiation of benzodiazepine and related drug use. The increased risk of death appeared to result from the adverse events associated with these drugs, including fall-related injuries, such as hip fractures, as well as pneumonia and stroke.
One theory put forward by the researchers, based at several institutions across Finland, is that the sedative effects of benzodiazepines may increase the risk of pneumonia by boosting the likelihood of aspiration of saliva or food into the lungs.
This theory correlates with the study’s finding that pneumonia risk is highest at the start of benzodiazepine use, as the sedative effect is more pronounced initially before tolerance is built up, the study stated.
When it came to stroke risk, the researchers found that the use of benzodiazepines was associated with a 20 per cent increase in the risk of stroke among persons with Alzheimer's disease although the mechanism involved was not quite clear.
The findings encouraged a careful consideration of the use of benzodiazepines and benzodiazepine-like drugs among persons with Alzheimer's disease, as stroke is one of the leading causes of death in this population group.
And because of the sedative effects of benzodiazepines on seniors, falls and resulting bone injuries and hip fractures also increased. The researchers found that people with both Alzheimer’s and hip fracture were more likely to stay in hospital for longer periods if they were taking benzodiazepines than if they were not — which is concerning given the negative impact that prolonged stays in hospitals can have on the general health and well-being of people with dementia.
It is not just falls that effect seniors taking these drugs. Studies show there is an increase in auto accidents in this group 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 (using two different drugs together actually magnify the effects of both) resulting in potentially deadly outcomes.
Mixing benzodiazepines and opioid medications can also be deadly. The major
concern when mixing these two classes of drugs is also over sedation. This is the inability to wake up or respond to stimuli which, of course, increases the risk of falling or even slipping into a coma. Both opioids and benzodiazepines can change breathing patterns and result in depressed breathing patterns leading to a lack of oxygen to the brain and eventually shutting down vital organ systems resulting in 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 we mentioned earlier. 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 and potentially deadly.
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.
Next Week - The Scams Associated With The New Medicare Cards
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. Attorney Connelly is the managing attorney of Connelly Law Offices, Ltd. with offices in Pawtucket, RI and Mystic, CT.