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Benzodiazepines Cheaper
Addictive Drugs Most Often Prescribed for Sleep
Problems in Older Patients
About half of prescriptions for insomnia patients of
all ages results in addictive drug prescription Boomers and Senior
Citizens much more likely to get it
June 1, 2005 - Nearly one out of two visits to a
doctor's office for help with a sleep disorder result in the
prescription of potentially addictive medications despite the
availability of other treatments, a new study reports. People 50 and
older were about 5 times as likely to receive a drug treatment as were
18 to 34-year-olds. And people 65 and older were twice as likely as the
18- to 34-year-olds to receive prescriptions for benzodiazepines. If
covered by Medicare or Medicaid they were also twice as likely to get
benzodiazepine prescriptions as patients with private health insurance.
The drugs, called
benzodiazepines, are often a cheaper alternative to some newer types
of medicines that don't have the same potentially addictive side
effects, said Rajesh Balkrishnan, the study's lead author and the
Merrell Dow professor of pharmacy at Ohio State University .
Some of the most vulnerable populations in the
United States are at greater risk of receiving prescription sleep
medication with a high abuse potential, he said.
The study, which appears in the current issue of
the journal Sleep, includes data from 94.6 million office visits in the
United States over a six-year period. Patients included in the data set
sought help for sleep-related difficulties in outpatient physician
offices.
Balkrishnan and his colleagues gathered six years
of outpatient office visit data from 1996 to 2001 from the National
Ambulatory Medical Care Survey (NAMCS). The NAMCS includes information
on patient demographics, the reason for a visit, a patient's diagnosis,
the medication prescribed and the therapeutic and preventive services
recommended during that visit. The majority of patients went to family
practice physicians, internal medicine providers or psychiatrists.
Using information from the NAMCS, the researchers analyzed the treatment
patterns of patients 18 and older who reported sleep problems.
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Many health care providers
don't take public health insurance. This means that these
patients, regardless of their age, are more likely to receive
cheaper benzodiazepines as treatments for their sleep problems.
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Nearly two-thirds of those visits resulted in
medication prescriptions for a person's sleep difficulties, and
three-quarters of those prescriptions were for a benzodiazepine. (Five
of the 13 kinds of benzodiazepines on the market in the United States
are indicated for treating insomnia.)
The other 25 percent of patient visits for sleep
disorders ended with prescriptions for non-benzodiazepine medications.
Benzodiazepines were widely prescribed for anxiety
and other stress-related problems in the 1960s and 1970s. These drugs,
which have a calming effect on the nervous system, are still prescribed
as muscle relaxants and tranquilizers. (Valium is one example of a
benzodiazepine, although it is not recommended for treating insomnia in
the United States.)
Benzodiazepines are usually effective for just a
few weeks when used to treat insomnia. But addiction can develop
relatively quickly, Balkrishnan said.
A person can develop a strong psychological and
physical dependence on these drugs in a short time, and experience
severe withdrawal-like symptoms once he stops taking the medication, he
said.
Psychiatrists were four times as likely to
prescribe newer non-benzodiazepine drugs during patient visits compared
to family practice and internal medicine physicians.
Psychiatrists may be more informed than other
kinds of doctors about newer, non-benzodiazepine drugs, Balkrishnan
said. Or psychiatrists may see patients with more complex problems in
whom other therapies such as over-the-counter medications have failed.
Overall, the study suggests that some physicians
do consider other options before jumping to prescribe a drug to treat
sleep problems, he said.
But many health care providers don't take public
health insurance, Balkrishnan said. This means that these patients,
regardless of their age, are more likely to receive cheaper
benzodiazepines as treatments for their sleep problems.
And elderly people, 65 and older, with private
health insurance were more likely to receive benzodiazepines.
We need to understand the reasons for these
disparities in order to stop this trend, Balkrishnan said. There needs
to be a move toward a more uniform prescription system at least for
certain types of medications.
One possibility is to create guidelines that say
let's reserve the most addictive benzodiazepines for patients for whom
every other kind of treatment has been unsuccessful.
While the study did not look at the types of
non-drug treatments prescribed to treat sleep disorders, such as
behavioral therapy, the researchers found that nearly half (48 percent)
of patient visits resulted in a drug prescription, while 14 percent of
the office visits resulted in a combined prescription of medication and
behavioral therapy. Just five percent of patient visits resulted in
prescribed behavioral therapy only.
The study was funded by a grant from Takeda
Pharmaceuticals of North America, Inc., Lincolnshire, Ill. The study
does not discuss any specific products of the sponsor company.
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