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Benzos and Seniors - The Problem We Whisper About

National Recovery Month Report: Benzos and Seniors - The Problem We Whisper About

By Don Drake, Connelly Law Offices, Ltd.

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As we wrote in a previous blog, the month of September has been dedicated to National Recovery Month, an annual national observance that aims to promote and support new evidence-based treatment and recovery practices. This month-long event celebrates the strong and proud recovery community in the United States and recognizes the dedication of service providers and communities that enable recovery in all its forms.

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Boomers are no strangers to abusing drugs

Substance abuse and misuse among seniors is more prevalent in this generation than in past ones. The Baby Boomer generation has a higher likelihood of abusing prescription medications and using illicit drugs. There are several reasons for this phenomenon.

Firstly, it is cultural. Baby Boomers grew up in a time when drugs were widely available, and their use was associated with a certain allure and rebellion against the mainstream.

Secondly, aging Boomers may turn to illicit drugs as a coping mechanism to deal with grief and loss issues, such as the death of a spouse or the end of a career.

Drug abuse and addiction can have significant implications for the physical, mental, and financial health of seniors. Therefore, discussing this issue is not only important but necessary, especially in any organization that provides services to seniors. In today's blog, we will look at benzodiazepines, a widely prescribed medication for seniors that has the potential for abuse.

What They Are

Benzodiazepines are a type of medication commonly prescribed to treat anxiety, insomnia, and other related conditions. However, new research has revealed that the long-term use of benzodiazepines may increase the risk of car crashes, falls, cognitive impairment, and broken hips among older adults. Despite the warnings on the label and numerous studies available to medical practitioners, up to ten percent of women and six percent of men between the ages of 65 and 80 have filled at least one prescription for benzodiazepines over a single year. The abuse of benzodiazepines is a significant concern, with the number of people who misuse or abuse these drugs increasing every year. It is estimated that over thirty million Americans use benzodiazepines annually, and this number is expected to rise as our citizens continue to grow older.

How They Work

Benzodiazepines work by binding to specific receptors in the brain and central nervous system, which typically respond to the neurotransmitter gamma-aminobutyric acid (GABA), resulting in a wide range of therapeutic benefits. They are often used to treat anxiety, insomnia, seizures, muscle spasms, and alcohol withdrawal symptoms. By slowing down the communication between the brain and body, benzodiazepines can help reduce the severity of these conditions.

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Image from Recovery Connection

This drug is also known to produce feelings of euphoria, but the exact mechanism by which they achieved this effect was a mystery for a long time. In 2011, a team of researchers led by Dr. Christian Lüscher at the University of Geneva in Switzerland conducted a study to shed light on the brain pathways that are involved in addiction. One of the key questions they sought to answer was how benzos interact with the brain and whether they have the potential to cause addiction.

Through their research, the team found that the euphoric effect of most drugs, including benzos, is achieved by a spike in the levels of the neurotransmitter dopamine. As stated earlier, when benzos interact with the brain, they enhance the effect of the neurotransmitter GABA. This interaction indirectly affects the levels of dopamine, leading to the euphoric effect that users experience. While opioids and heroin act directly on dopamine receptors in the brain, benzos affect the levels of dopamine uniquely, making them less addictive than opioids but no less abused.

Some of the most commonly prescribed benzos, in tablet form, include:

  • alprazolam (Xanax)

  • clobazam (Onfi)

  • clonazepam (Klonopin)

  • clorazepate (Tranxene)

  • chlordiazepoxide (Librium)

  • diazepam (Valium)

  • lorazepam (Ativan)

  • temazepam (Restoril)

  • triazolam (Halcion)

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Benefits and Dangers

When it comes to treating anxiety and sleep disorders, healthcare professionals need to be aware of the potential risks associated with benzodiazepine use, particularly the potential for abuse and overdose. Lorazepam (Ativan) and Oxazepam (Serax) are considered safer benzodiazepine options due to their short half-lives (see more on the half-life of drugs in our next section), which means they do not linger in the system or produce active metabolites that can lead to a higher risk of abuse or accidental overdose. Oxazepam, in particular, is considered safe due to its low abuse and overdose risk among benzodiazepines, as well as its even shorter half-life than lorazepam.

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Benzos are associated with falls in the elderly

When it comes to treating panic disorder, the FDA approves only two benzodiazepines: alprazolam (Xanax) and clonazepam (Klonopin). Although both are effective, providers tend to avoid prescribing clonazepam to older adults because of its longer half-life and tendency to build up metabolites. Similarly, they tend to avoid prescribing alprazolam because of its higher potential for abuse and the more severe withdrawal syndrome it can cause.

Providers should also avoid prescribing benzodiazepines that build up metabolites or have a long half-life, as these factors increase the risk of adverse effects. Patients who are prescribed benzodiazepines should be closely monitored to ensure that they are not experiencing any adverse effects, and healthcare professionals should consider alternative treatments when possible to reduce the potential risks associated with benzodiazepine use. It is crucial for healthcare providers to educate patients on the potential risks and side effects of these medications.

What Does Half-Life Mean?

The half-life of a drug refers to the time taken for the plasma concentration of a drug to reduce to half its original value. This is an important parameter that helps to estimate how long it takes for a drug to be removed from the body, and hence, the duration of its effects.

For instance, if we consider the case of Ambien, a popular sleep aid medication, its half-life is approximately 2 hours. After taking Ambien, the plasma concentration of the drug would be reduced to half in about 2 hours. Subsequently, after another 2 hours, the remaining blood levels would be reduced by another half, resulting in a quarter of the original concentration. This process would continue in a comparable manner, such that it takes about 5.5 half-lives for a drug to be eliminated from the body. In the case of Ambien, it would take approximately 11 hours (2 hours X 5.5) to be eliminated from the body.

It is important to note that the elimination of a drug from the body varies from person to person, depending on several factors such as age, weight, other medications taken, medical conditions present, kidney and liver function, and more. Therefore, while half-life is a useful parameter to estimate the duration of a drug's effects, it should be taken as a guide or an estimate, rather than an exact measure.

In some cases, it may take longer than expected for a drug to be eliminated from the body, and in other cases, it may be eliminated much faster. Hence, it is always advisable to consult a healthcare professional before taking any medication, especially if you have any underlying medical conditions or are taking other medications.

Benzos and Opioids

When a patient who is already using an opioid is prescribed benzodiazepines, the likelihood of negative consequences increases significantly. While it is rare to die from a benzodiazepine overdose, unlike barbiturate overdose, there is an elevated risk of accidental overdose when benzodiazepines are taken with opioids. This is because benzodiazepines are involved in approximately 80% of opioid-related deaths and can raise the risk of opioid overdose deaths by two to four times.

Both opioids and benzodiazepines can suppress breathing, but they do so in different ways. Therefore, it is essential to carefully consider the risks and benefits of prescribing benzodiazepines to patients already using opioids to avoid any unintended and potentially fatal consequences.

Benzos and Dementia

According to a recent study conducted by Saint Louis University School of Medicine, patients aged sixty-five and above who have been diagnosed with anxiety are at a higher risk of being diagnosed with dementia. Additionally, exposure to benzodiazepine, a medication commonly used to treat anxiety, was found to be associated with a 28% increased risk of dementia. However, the study also revealed that there was no significant association between these medications and incident dementia when benzodiazepines were prescribed to patients with an anxiety disorder. These findings suggest that certain medications used to treat anxiety may have an impact on the risk of developing dementia, and further research is needed to better understand this relationship.

Signs of Addiction

When it comes to identifying the physical symptoms of benzodiazepine addiction, it's important to consider both the dosage and the effects. The Center for Substance Abuse Research at the University of Maryland categorizes these symptoms as either short-term or long-term, depending on the level of dosage.

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Benzo withdrawal can be dangerous in seniors

In terms of short-term effects, low to moderate doses of benzodiazepines can cause impaired motor coordination, drowsiness, lethargy, fatigue, confusion, depression, altered vision, slurred speech, stuttering, vertigo, tremors, respiratory depression, nausea, constipation, dry mouth, abdominal discomfort, vomiting, and diarrhea. Higher dosages can lead to more extreme short-term effects, such as extreme drowsiness, slowed reflexes, mood swings, hostile and erratic behavior, and euphoria.

Long-term effects of benzodiazepine addiction take time to manifest, as the drug can accumulate in fatty tissues. These effects can include impaired thinking, memory, and judgment, disorientation, confusion, slurred speech, muscle weakness, and lack of coordination. Other signs someone is addicted to benzos include:

  • The individual wants to stop or reduce the number of benzos they are taking but is unable to do so due to physical or psychological effects.

  • Feeling like you can’t work, relax, sleep, or function without using them.

  • There is an increase in the tolerance to the benzo, meaning the individual needs to take more to achieve the desired effect.

  • The individual suffers withdrawal symptoms when they stop taking them, including anxiety (worse than before they started using them), depression, hypersensitivity, physical tremors, and sleep disturbances.

Red Flags when Prescribing

When prescribing medication for patients with a history of addiction, particularly those who have struggled with opioid use disorders, healthcare providers need to exercise caution and consider alternative medications that do not pose the risk of addiction. Similarly, when prescribing medication for older adults or individuals with an elevated risk of falling, healthcare providers need to be mindful of the increased potential for falls associated with this class of drugs.

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Sleep apnea patients require special attention

Patients with sleep apnea also require special consideration, as benzos can cause respiratory depression, which can be particularly dangerous for individuals with this condition.

In addition to the above, healthcare providers should also be cautious when prescribing medication for patients with chronic nonspecific anxiety, such as those with borderline personality disorder. While benzodiazepines may provide temporary relief, long-term use of these medications has been found to negatively impact problem-solving skills, which can exacerbate the underlying condition.

A Final Word

It is concerning that benzodiazepine use is on the rise among older adults, who constitute the largest group of users of these drugs. While benzodiazepines are effective in treating some clinical symptoms, they are also associated with serious side effects and the potential for addiction. Despite recommendations from many national geriatric organizations to avoid the use of benzodiazepines among older adults, research indicates that these medications are still widely prescribed among this population.

Healthcare providers should stay informed on the appropriate indications for the use of these medications, with a strong emphasis on discontinuing their use as quickly as possible. Alternative pharmacological and nonpharmacological measures should be employed wherever possible to mitigate the risks associated with the use of benzodiazepines among older adults. This may include cognitive behavioral therapy, relaxation techniques, or other forms of therapy that can help manage anxiety and other related conditions.

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Please note that the information provided in this blog is not intended and should not be construed as legal, financial, or medical advice. The content, materials, and information presented in this blog are solely for general informational purposes and may not be the most up-to-date information available regarding legal, financial, or medical matters. This blog may also contain links to other third-party websites that are included for the convenience of the reader or user. Please note that Connelly Law Offices, Ltd. does not necessarily recommend or endorse the contents of such third-party sites. If you have any particular legal matters, financial concerns, or medical issues, we strongly advise that you consult your attorney, professional fiduciary advisor, or medical provider for advice.

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