PROVINCE HOUSE TO HOME: ‘Know your medications. Ask questions.’

Leo Glavine
Published on April 5, 2016
A regular column from MLA Leo Glavine

Over-prescribing psychoactive medications to our seniors is a serious problem and a substantive public health concern.

A significant increase in the number of benzodiazepines prescribed to seniors, particularly in senior care homes, has led to the need to develop a monitoring, accountability and educational system in many jurisdictions. Having the drugs available scientifically does not necessarily mean we have to use them so freely. We need to protect our seniors from the potential adverse effects of benzodiazepines, such as lorazepam (Ativan), diazepam (Valium) and alprazolam (Xanax), to name only a few.

Benzodiazepines work by depressing the central nervous system and are widely prescribed for insomnia, anxiety, sedation and pain. Rational use of these medications depends on the differences in potency, elimination rates and patient requirements.  The World Health Organization and the American Psychiatric Association recommend that prescriptions not exceed a duration of one day to four weeks. Longer-term usage may be prescribed for alcohol withdrawal, generalized anxiety and panic disorders, and end-of-life care, but these usages are also now in question.

All benzodiazepines are classified as controlled substances and can lead to abuse and addiction. Other potential side effects include dizziness, confusion and unsteadiness, leading to short-term memory loss, falls and accidents. These side effects are usually caused by over-usage.

Addiction and withdrawal from these medications requires alert medical supervision to taper the drugs and monitor symptoms. It is important to discuss this with your care-provider. Do not stop a medication without medical advice and support.

According to the Beers List of Criteria for Potentially Inappropriate Medication Use in Older Adults, benzodiazepines should only be used for short term, severe symptoms. However, millions of older patients worldwide are prescribed these benzodiazepines for sleep disturbances or mild insomnia. These medications are sedative, but they do not induce a natural sleep and can cause rebound insomnia (worsening) after stopping the prescription, if taken for too long. Other medications are contraindicated for seniors: Valium, Librium, Darvon, and Elavil. Because older patients may have decreased liver function and ability to metabolize and eliminate medications, long-acting benzodiazepines are particularly dangerous for side effects.

Recent benzodiazepine research published in the British Medical Journal has revealed another alarming side-effect: dementia. According to this study, patients who begin taking Xanax, Ativan or Valium after the age of 65 have a 50 per cent increased chance of developing dementia within 15 years. They advise that, “considering the extent to which benzos are prescribed and the number of potential adverse effects, indiscriminate widespread used should be cautioned against.” This is a serious public health concern that needs to be addressed.

Until we have hired more professionals, and developed a stringent monitoring system and protocol for these medications, I am asking patients and loved ones to be their own advocates. Know your medications. Ask questions.  Are there alternatives? Is therapy also available? Which foods should I consume? How long should I use this medication? What are the side effects? How much physical activity will improve my sleep patterns? Discuss with your physician the timeline for taking the medication, as well as the decreasing dosages for tapering off.  Ask your doctor to weigh, with you, the risks and benefits. Consider alternatives whenever possible.

Children today learn the importance of being their own advocates.  Seniors should, too.  It is your health, your body, your life. Speak up.