In one study, Greg Rhee, Ph.D., an adjunct assistant professor in the University of Minnesota College of Pharmacy, examined prescribing trends in outpatient settings of opioids and benzodiazepines. His analysis found that between 2006-07 and 2014-15, the prescription rates of benzodiazepine drugs such as Xanax and Halcion increased from 4.8 percent to 6.2 percent; the rate of prescription opioids alone increased from 5.9 percent to 10 percent, and the co-prescribing rate of both benzodiazepines and opioids increased over time from 1.1 percent to 2.7 percent, respectively.
“Because both benzodiazepines and opioids carry high-risks for older adults, the increasing use of these medications is concerning,” said Rhee, a health services researcher and pharmaco-epidemiologist specializing in population-based outcomes research and health care policy.
Demographic and clinical factors associated with co-prescriptions of benzodiazepines and opioids include: being female, chronic care visits, receipt of six or more simultaneously prescribed medications and clinical diagnoses of anxiety and pain.
Benzodiazepines are sedatives frequently prescribed to help with anxiety, insomnia and conditions like depression. They include Alprazolam (Xanax, Niravam) diazepam (Valium), clonazepam (Klonopin), and lorazepam (Ativan). Both benzodiazepines and opioids are considered potentially harmful and addictive drugs in older adults because they increase the risk of morbidity and mortality in this population.
Another study led by researchers from the University of Michigan, Ann Arbor, found that benzodiazepine use among all U.S. adults was higher than previously reported, and that use by adults ages 50–64 now exceeds use by those ages 65 and older. Previous studies found the highest use was among those 65 and older.
As this Medscape article reported, misuse of benzodiazepines accounted for nearly one-fifth of overall use among the estimated 30.6 million adults taking these drugs. Adults 50 and older were more likely than younger adults to use a benzodiazepine more often than prescribed and to use a benzodiazepine to help with sleep.
Researchers suggested that patients prescribed stimulants or opioids should be monitored for benzodiazepine misuse. They also noted that some misuse may reflect limited access to health care generally and behavioral treatments specifically and that some misuse could be reduced with improved access to behavioral interventions for sleep or anxiety.
Previous research has detailed the risky long-term use of these drugs, like this study in JAMA which found that one third of prescriptions for older adults were for long-term use, despite recommendations against this practice. Guidelines warn against extended use of these drugs, especially among older people, because they can increase the risk of car crashes, falls and broken hips, as well as side effects like confusion, cognitive impairment, and delirium.
Paula Span’s article in The New York Times puts a human face on this problem and details how older adults become unwittingly dependent or addicted. Lisa Esposito’s story in U.S. News discusses findings from additional studies — noting that side effects of benzodiazepines can be more serious for older adults, due to the way their bodies break down medications.
Story ideas for journalists:
- How are health insurers, hospital/clinics or even local pharmacies increasing awareness and educating older adults about the use and misuse of these drugs?
- What about efforts to encourage physicians to cut back on prescriptions?
- Have pharmacists in your area seen an uptick in prescriptions or renewals?
- Since benzodiazepines are often the default for anxiety, insomnia, or depression, what other options are available, and well-tolerated by older adults?
- This tip sheet covers substance use disorders and older adults.
- And remember that over-the-counter drugs also have risks for seniors.