Prescriptions for benzodiazepines, a common class of drugs mainly used to treat sleep and anxiety disorders, have seen a general decline in the last seven years in Ontario.
But a new report reveals prescriptions have risen significantly for women aged 19 to 24, despite the provincial trend. That is renewing concerns about the impact of prolonged use of the common drug, known to cause dependence and overdoses when combined with opioids, and the need to clearly communicate these risks to patients.
The report, authored by the Ontario Drug Policy Research Network (ODRPN) and St. Michael’s Hospital, is a first look at how benzodiazepines, some of the most commonly used prescription drugs, are administered in Ontario since the province’s Narcotics Safety and Awareness Act was passed in 2011. The law enables the Ministry of Health to monitor the prescribing of controlled substances.
While overall prescriptions for benzodiazepines in Ontario fell 13 per cent between 2013 and 2019, the report revealed prescriptions for women aged 19 to 24 have risen by 30 per cent in that same timeframe — “a striking finding,” said Tonya Campbell, research program manager of ODPRN at St. Michael’s and lead author of the report.
The report also found that benzodiazepine use in Ontario remains high. Around one in 18 Ontarians received a prescription in 2019 — a quarter of whom were prescribed opioids at the same time.
The prevalence and associated risks with benzodiazepine use is why the report’s authors, led by a citizen panel, felt it was important to dive deeper into the data to determine both trends and areas that need further study, Campbell said.
“We know that benzodiazepines can be harmful when used long term or in combination with opioids, but there’s certainly a lack of data on the prevalence of benzodiazepine use on a population level, and among young groups in particular,” Campbell said.
The report found a decrease in prescriptions both generally and specifically in men 75 and older, whose benzodiazepine use fell 29 per cent in the last seven years. Campbell said some of the decline is due to new regulations on prescriptions introduced by the 2011 Narcotics Act.
Other reasons include the rise of deprescribing movements that have shifted from benzodiazepine treatment toward either alternative medications or treatments like psychotherapy, she added.
Despite the decline in use among older adults, the use of benzodiazepines remains high for Ontarians over 65, one in nine of whom have received a prescription in 2019. Around 80 per cent of these seniors are prescribed opioids as well, usually for pain treatment. Campbell said this is a cause for concern as the risk for dependence overdose is higher among older adults.
“Even though it is decreasing, (the prescription rate) is still quite high overall,” Campbell said.
As for the rise in prescriptions among young women, Campbell said it mirrors a national increase of young people diagnosed with mood anxiety disorders. She said women tend to have a higher rate of diagnoses, partly because they are more likely to seek medical help. But even when accounting for those disparities, women are still more likely to be prescribed anti-anxiety medication, she said.
In spite of ODPRN’s detailed, 33-page report, many unknowns remain, including the reasons behind more than 50 per cent of benzodiazepine prescriptions in Ontario, especially among seniors, due to data quality issues. Another unknown is how long young people are put on benzodiazepine treatment. The general recommended length of treatment, Campbell said, is a maximum of four to six weeks.
“Because of that lack of data on younger populations, there’s a need for highlighting where improvements in prescribing can be made,” Campbell said, as well as further research.
One recommendation, she said, is the creation of clinical guidelines that can help doctors and pharmacists best prescribe benzodiazepines for those who need them. The class of drugs is not only used to treat sleep and anxiety disorders, but also for seizure disorders among children, and sometimes as a sedative before a dental procedure.
Health Canada recently updated its labelling practices for benzodiazepines in October to clearly communicate risks, including severe withdrawal symptoms and harms when used with opioids — a step in the right direction, Campbell said.
“We just want to emphasize the need for appropriate and careful prescribing, and also recognizing that people do have different needs” for using the drug, Campbell said.
“It’s really up to the prescriber to make sure that is communicated.”
- Nadine Yousif, Local Journalism Initiative Reporter, Toronto Star
