TORONTO, Ontario — Anxiety medications falling under the benzodiazepine banner, like Valium and Ativan, have been prescribed to millions of patients for over 50 years. While recent decades have seen the dark side of prolonged “benzo” use become much more apparent, noteworthy new research presents the first-ever evidence that these types of drugs can be far less dangerous for users if they take them intermittently instead of continuously.
Scientists from the Centre for Addiction and Mental Health in Toronto say older patients who avoided taking their benzo prescriptions every single day reported fewer side-effects as well as reduced falls, hospitalizations, and deaths.
First introduced in the early 1960s, benzodiazepines quickly became a favorite among countless doctors and therapists. By 1977, benzos already attained the title of the most prescribed medicines globally. While these drugs continue to be prescribed today and are considered “reasonably safe and effective,” current doctors recognize benzos are more of an anxiety bandaid than a real solution.
These drugs come with a major addiction risk, as cutting off regular use will result in serious withdrawal symptoms that can even become life-threatening in certain scenarios. Besides that, regular benzo use is also associated with a major uptick in the risk of falls and fractures among older individuals. While benzos are still widely used, most doctors tend to prescribe more antidepressants (such as SSRIs) nowadays.
Up until now, most projects examining benzodiazepines focused solely on health outcomes for up to six to eight weeks. This means, according to researchers, there had been very little information gathered on the impact of long-term use over months and years. This lack of scientific data and research has led to conflicting views among many doctors and therapists. Some vehemently believe benzo prescriptions use should be limited to just a few weeks to avoid the risks of tolerance and dependence, while others assert these drugs should not be given to people over 65 at all. Meanwhile, another group of doctors continues to advocate long-term benzo use as being acceptable.
“Using a large, dataset from Ontario, Canada, we were able to examine how people over the age of 65 with anxiety or insomnia actually took benzodiazepines after starting them. We were also able to link this with other health outcomes. So this meant considering 57,000 people who took benzos regularly on most days over a period of six months (chronic users) and 113,000 matched people who took the medicines over a similar period, but with breaks where they didn’t take benzodiazepines (intermittent users). We then followed both groups for a further year. The results were striking,” says lead researcher Dr. Simon Davies of the Centre for Addiction and Mental Health in a media release.
“Our results show that changing the way people take benzos from chronic to intermittent could lead, over one year, to 20% fewer hip fractures 33% fewer in men, 7.5% fewer falls requiring hospitalization or emergency visits and a 24% fall in the chance of needing to go into long term care.”
Researchers want to be clear here — these are not mere short-term consequences. Falls are the leading cause of death for adults over 65 in both the United States and Canada, and estimates show that more than one in five elderly individuals who suffer a hip fracture die within a year.
“This work shows that where possible, patients over the age of 65 with anxiety or insomnia who are taking Ativan, Valium or another benzo long-term would better not to stay on the drugs continuously. In practical terms there will be some who can’t change or do not want to change. These results allow you to understand the excess risks of falls, fractures, emergency visits, long term care home admission and death that you are accepting using benzodiazepines chronically rather than intermittently,” Dr. Davies explains.
“Of course, these are still prescription drugs, so they need to be taken under the guidance of your clinician.”
“This is a very important study, confirming once again the long-term benzodiazepine use should not be encouraged. The risk of falls, as well as cognitive side effects and impaired driving skills – with the risk of road accidents – make chronic overuse of benzodiazepines a public health issue. Of course, there is a small group of patients who should have access to long-term use, but it is reasonable to assume that this group is currently too large,” notes Prof. Christian Vinkers of Amsterdam University Medical Centres.
The study is published in the Journal of Psychopharmacology. This research was also recently presented at the ECNP Congress in Barcelona, Spain.
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