Natives awash in addictive sedatives
by Ann Rees
The Vancouver Province
December 31, 2001
A Province investigation has found that doctors in B.C. are handing out an increasing number of high-risk sedatives to natives, and the provincial health officer fears they are being prescribed for the wrong reasons, writes Staff Reporter Ann Rees.
The number of natives in Western Canada prescribed highly addictive sedatives is soaring, a Province investigation has found.
Up to one in three native women over 40, and up to one in four men in the same age group, were prescribed addictive benzodiazepines such as Valium and Ativan last year.
B.C.'s provincial health officer, Dr. Perry Kendall, said the data warrants further investigation into prescribing practices.
"Benzodiazepine use and misuse has been a long-standing issue of concern," he said. "Obviously there are some issues here."
Kendall fears the drugs may be prescribed for the wrong reasons - in effect, numbing the patient to physical and mental pain resulting from harsh reality.
"The questions is, if people are depressed and anxious because of poor physical health which is related to discrimination or marginalization, is the appropriate response to medicate them? I wouldn't think so," said Kendall.
"A better approach would be to try to address the determinants of health that are making them less healthy."
Benzodiazepines, which can be addictive within weeks, are primarily used to control anxiety, depression and insomnia. They are provided free to status natives through Health Canada's Non-Insured Health Benefits (NIHB) program. About 704,000 status natives across the country are eligible for the coverage.
Drug-addictions expert Dr. Garth McIver said doctors who prescribe benzodiazepines continuously are courting disaster.
"What we need to realize is that benzodiazepines are addictive."
Health Canada, in a 1996 review of benzodiazepine use by NIHB clients, said: "The risks of these drugs often outweigh therapeutic benefits."
Despite the warning, the number of NIHB patients prescribed the drugs continues to climb.
In Western Canada, the number increased from 28,238 in 1996 to 35,377 in 2000, a leap of about 25 per cent, according to data obtained by The Province through Access to Information legislation.
That increase is the opposite to treatment trends for the general population.
There was a four-per-cent decline in the number of benzodiazepine prescriptions across Canada between 1997 and last year, according to statistics compiled by IMS Health, a private health information company.
The Province data show status natives in Western Canada were the most likely to be prescribed benzodiazepines.
More than 22 per cent of status native women over 40, and 14 per cent of native men in the same age group, were prescribed benzodiazepines last year.
Alberta ranks a dubious first with about 30 per cent of native women over 40 prescribed the drugs. About 22 per cent of Alberta native men over 40 were also prescribed the drugs.
Nationwide, the drugs were prescribed to about 18 per cent of all NIHB female clients over 40, and about 12 per cent of male clients over 40.
In B.C. the numbers were close to the national averages, with 18 per cent of women over 40 and 10 per cent of men of the same age prescribed the drugs last year.
"There is a huge problem here that is certainly not going to be dealt with on a prescription pad," said First Nations Summit leader Bill Wilson.
The underlying causes of depression and anxiety are ignored, he said.
"When you look at the conditions that they are in, it would be a surprise to me if they did quit drugs and alcohol and stopped committing suicide.
"We are not dealing with the core problem in all of this. If we had healthy communities that were thriving and had an economy, in all probability, we wouldn't be as interested in doing drugs and alcohol.
"Prescribing drugs to people to get them high for a little while is just as bad as any other kind of drug abuse.
"You simply become comatose and forget about the suffering that you are involved in."
Stewart Phillip, president of the Union of B.C. Indian Chiefs, said prescribing tranquillizers to so many natives is tantamount to "sedating poverty."
The 1996 Health Canada report showed most NIHB patients received multiple prescriptions - putting them at high risk of addiction.
It found about half of the patients in Western Canada - almost 14,000 individuals - received three or more prescriptions for benzodiazepines, averaging 7.7 prescriptions per client per year.
"A significant number of clients use these medications on a long-term basis," said the report.
About 20 per cent of clients in Western Canada received an "excessive" 12 or more prescriptions over the year reviewed, according to the 1996 report.
"The drugs should not generally be prescribed for longer than a few weeks," said McIver.
"You use them clinically when it is indicated for short periods of time. Short-term use is certainly less than three months. In general practice I wouldn't be using them for more than two to three weeks."
Medical experts say it is generally better practice to use non-addictive alternatives such as anti-depressants like Prozac and Paxil, which have proven just as effective in treating long-term depression and anxiety for most patients.
As a result, they are more commonly prescribed for the general public than benzodiazepines.
"It is encouraging to know that the No. 1 medication now prescribed in the U.S. for anxiety disorders is Paxil," said McIver.
But The Province data show more status natives were last year prescribed the addictive sedatives than the safer anti-depressants.
The data show 53,634 NIHB clients were prescribed benzodiazepines last year, compared to 49,462 clients who were prescribed anti-depressants.
The health system has failed to adequately deal with issues of native mental health, said Dr. Isaac Sobol, chief medical officer for Northern B.C. and chairman of the B.C. Medical Association's aboriginal health committee.
"There has been no comprehensive effort to deal with mental health problems in First Nations communities," said Sobol.
Remote communities across B.C. face chronic doctor shortages. Mental-health specialists such as psychiatrists and psychologists are rarely found outside of main urban centres.
"I don't think we have a good system in place [in the North] that would deal with that with anybody, much less First Nations where you've got kind of an epidemic of psycho-social problems," said Sobol.
Access to professional therapists is sorely lacking for natives on reserves, said Chief Margery McRae, who heads the health committee for the First Nations Chiefs' Summit.
The federal government provides funding for drug and alcohol counsellors, and some bands also have mental-health workers.
But confidentiality is a concern in small communities where everyone is either related or knows one another, said McRae.
"One of the sad things within our communities is even though we do have care workers - like drug and alcohol workers or mental-health workers - because they are community people, many of us won't go to them for simple fact of confidentiality. You don't want everybody to know your business."
The only successful way to deal with mental-health issues is to take a holistic approach, said McRae, who sat on a national native mental-health committee whose recommendations are before Treasury Board in Ottawa.
"Drugs wouldn't be the only source of action," McRae said. "They would look at everything - the social, the economic, the education. Set up an action plan."
Dr. Jay Wortman, Pacific regional director for Health Canada's First Nations health branch, does not believe benzodiazepines are being over-prescribed.
He said Health Canada's 1996 study showed natives were no more likely to be prescribed benzodiazepines than poor people on social assistance.
"We compared them to a social-services population because we thought that the socio-economics would probably be most similar," said Wortman. "The difference between First Nations clients and the social-services clients wasn't extraordinary."
McIver said while doctors may prescribe more tranquillizers to impoverished and traumatized populations, that doesn't make it good medical practice.
"People come to you with a very situational depression with a history of emotional, physical and sexual abuse, and the doctor has not too many resources to treat this other than with the prescription pad," said McIver.
"I think a lot of times this is a very well-meaning prescriber ... trying to medicate away a lot of socio-economic issues with a very disenfranchised population."
The Province data on status natives show that women are almost twice as likely to be prescribed benzodiazepines than men, with 34,055 receiving the drug Canadawide, compared to 19,779 men.
Use also increases significantly with age. About 97 per cent of the patients prescribed benzodiazepines were 20 or older.
Meanwhile, patients with addictions to benzodiazepines and other prescription drugs such as Tylenol with codeine are becoming increasingly common at native treatment centres.
"Eventually with these prescription drugs people become addicted to them," said Wayne Christian, director of the First Nations Round Lake Treatment Centre in Armstrong.
A survey of his former clients in 1996 showed 27 per cent reported an addiction to prescription drugs, compared to about eight per cent in 1985.
He believes the rate would be even higher if the survey were conducted today.
And benzodiazepines are among the worst drug habits to shake.
"It is a drug that takes a much longer detox procedure than almost anything else," said addictions specialist McIver.
Recovery is even more difficult if the patient is also suffering from alcoholism, still a huge problem on many native reserves.
Christian said most of his clients have turned to drugs and alcohol to "deaden" the pain of emotional and even physical trauma.
"Up to 95 per cent of clients at Round Lake reported "a history of some kind of trauma, personal trauma, whether it was residential school, sexual abuse, physical violence, abandonment - those types of issues," he said.
"I think a lot of it is people utilizing those kind of drugs to deaden that pain."
Former B.C. Mental Health Advocate Dr. Nancy Hall also believes the health system has failed to provide proper mental-health-care for natives.
"We don't have a grip on aboriginal mental-health services and we don't have a grip on anxiety disorders," Hall said.
"So if you have a population that has every reason to have anxiety disorders and there is no acknowledgment that this a legitimate concern, it is not surprising."
The Province statistics should be seen as a red flag, said Carole Dawson, of the First People's Health Counsel and a member of the Provincial Aboriginal Health Services Strategies who also works at the Union of B.C. Indian Chiefs as co-ordinator for health and families programs.
"We are looking at statistical data," she said. "That statistical data is flesh and blood that is suffering somewhere."
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