B.C. Women's Addiction Foundation, 4500 Oak Street, E500B,
Vancouver, BC, V6H 3N1 · Telephone: 604.875.3756 Fax: 604.875.2039
Email: info@womenfdn.org
Website: www.womenfdn.org
July 30, 2001
Honourable Allan Rock
Minister of Health
Brooke Claxton Bldg., Tunney's Pasture
P.L. 0913C
Ottawa, Ontario, Canada
K1A 0K9
Dear Mr. Rock:
We are writing to express serious concerns about prescribing protocols and patient impacts related to the benzodiazepine class of drugs and benzodiazepine-like drugs (i.e., Zopiclone and Zolpidem).
As you are no doubt aware all benzodiazepines are highly addictive even in small quantities taken over short periods of time. Those who are prescribed benzodiazepines often suffer tolerance (withdrawal) effects while taking only prescribed amounts. These tolerance effects or effects experienced while withdrawing from benzodiazepines are extremely debilitating and can last many weeks or months.
If manifestations of withdrawal are not clearly explained or understood patients can become chronic users of the health system as they attempt to deal with a range of health problems (including gastric, neurological, neuro-muscular and cardiac problems).
Despite these risks, most benzodiazepines are often prescribed for non life-threatening problems (e.g., anxiety, grief, loss, muscle pain or spasms, PMS, insomnia or transient depression) for which other interventions would be more efficacious.
The literature also shows a clear association between benzodiazepines and other health risks, for example, between the use of benzodiazepines and hip fractures in the elderly. Prescribed benzodiazepines are also frequently implicated in industrial and motor vehicle accidents.
Despite the fact that the risks associated with benzodiazepines have been well reported in the literature for over twenty years there continues to be a lack of an appropriate response to this class of drugs by physicians and pharmacists. Specifically, we recommend that the following issues be addressed:
There is a need to clearly state and enforce prescribing guidelines.
Optimum prescribing guidelines for benzodiazepines recommend a limit of 7-14 days of use. However, these guidelines are not widely stated, publicized or adopted. No strict enforcement mechanisms exist at the provincial level.
There is also a need to monitor more systematically the framework within which benzodiazepines are prescribed, the rationale for prescribing them, and the status of current prescribing practices. For example, over 3 million prescriptions were written for benzodiazepines in 2000 for anxiety alone, and more than 1 million in B.C. It is, however, not known how many of those were repeat prescriptions, prescriptions for over a one month period or the dose strength of these prescriptions.
There is a need to inform patients fully of the risks associated with benzodiazepines, the potential impacts of addiction, the nature of addiction, the short and long term characteristics of drug withdrawal, as well as the best method of tapering off these drugs.
Many doctors are poorly informed about the addictive qualities of benzodiazepines and make invalid assumptions about their patients' physical or mental health while they are experiencing tolerance withdrawal or withdrawal symptoms. Because benzodiazepines profoundly affect the neurotransmitters, weeks or months are required after the drug is withdrawn before neurological and other GABA related functions are stabilized. Many physicians misinterpret this stage of recovery as requiring further medical or drug interventions. These further undermine the health of patients.
Physicians frequently do not provide patients with either correct information or reassurance about withdrawal effects. Pharmaceutical companies also should be required to fully disclose the risks associated with benzodiazepines usage and the symptoms of withdrawal through detailed and accurate drug insert information.
There is a need to establish a user-friendly drug reaction/interaction reporting system so that patients and physicians can easily report drug effects and interactions.
Systematic information is not currently available on the proportion of benzodiazepines users who suffer drug-related effects or the period at which drug effects commence. Because the onset of addiction is variable and highly individual specific estimates range from 4 weeks to 3 months or even one year for addiction to occur. A drug reporting system would provide some definitive information on this issue and would help identify the overall scope of the problem.
There is a need to establish an appropriate information and support system for those who wish to withdraw or who are withdrawing from benzodiazepines.
There are no specific services or direct support for those who have become addicted to benzodiazepines. Since complete withdrawal (acute and recovery stages) from benzodiazepines can take many weeks or months, traditional in-patient drug treatment is not appropriate or cost-effective. In addition, the vast majority of benzodiazepine users do not have addictive personalities or backgrounds. They were simply prescribed a drug by their doctors which they took in good faith, not realizing its effects. For this reason, traditional treatment programs are not appropriate. What is required is the establishment of a national agency that could provide:
Information on benzodiazepines and their effects;
Information on the symptoms of tolerance withdrawal and withdrawal;
Telephone and direct support and reassurance. Most patient support could be provided by telephone through access to a 1-800 telephone line;
Physician support and education.
We believe that benzodiazepine use has had enormous cost impacts on the health care system. For example, in B.C. in the year 2000, the leading class of prescribed drugs was psychotherapeutics (13.2% of all prescriptions). Fifty percent of these prescriptions were for Lorazepam, a benzodiazepine, which because of its short half life, is highly addictive.
There is no question that there are significant numbers of Canadians, particularly women, who are seriously affected by benzodiazepine use. Withdrawal from benzodiazepines, even from short-term use, can be a harrowing experience involving severe physical and psychiatric manifestations. Because most patients lack support and information they may never be able to withdraw and therefore suffer chronic ill health and mental health problems for the rest of their lives.
We strongly encourage the adoption of these recommendations in the context of the current review of legislation governing health protection.
Yours sincerely,
Sue McGowan
On behalf of The Women's Addiction Foundation
and Janet Currie, Benzodiazepine Awareness Network
Nancy Poole, Wavelength Consulting
Gail Malmo, Aurora Centre, BC Women's Hospital
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