Health professionals are sounding the alarm over the heightened risk of death linked to the use of psychiatric drugs, which was highlighted in a pair of Vancouver-based studies published this month.
Benzodiazepine (BZD) is a class of psychiatric medications known as “tranquillizers” which can reduce the body’s drive to breathe and are used to treat anxiety, sleep disorders, seizures, and other conditions. They include commonly prescribed drugs such as Valium, Xanax, and Ativan.
The first of the two studies, which involved researchers from the B.C. Centre for Excellence in HIV/AIDS (BCCfE) and the University of B.C., looked at the impact of BZD use on mortality rates and established that use of BZDs was linked to a higher risk of death than illegal drugs.
“There’s a lot of research that’s been done on more traditional drugs of abuse, other illegal drugs like heroine, cocaine, amphetamines — but not a lot is known about the abuse of this kind of drug,” said Dr. Keith Ahamad, a clinician scientist with the BCCfE and an addictions physician at St. Paul’s Hospital.
The study followed a cohort of 2,802 drug users in Vancouver’s Downtown Eastside between 1996 and 2013. Participants were interviewed semi-annually over a median duration of just over five-and-a-half years each. By the end of the study, 527 (18.8 per cent) of the participants had died.
Researchers found that the mortality rate was 1.86 times higher among the drug users who used BZD, compared to those who did not. Ahamad noted that even after researchers isolated other factors that could influence mortality, such as use of other drugs, infections, and high-risk behaviours, the mortality rate remained high among BZD users.
A second study conducted on a smaller group within the same cohort examined the link between BZD use and hepatitis C (HCV) infection. Of the 440 HCV-negative individuals who participated in the study, 158 reported prescribed or illicit BZD use, and 142 participants contracted HCV during the course of the study.
The study found that BZD was associated with a higher rate of HCV infection: Infection rates were 1.67 times higher among study participants who used BZD, compared to those who did not.
“There’s not a lot of scientific evidence to say these people should be on these medications chronically,” said Ahamad, acknowledging there is a tendency to lean on prescription psychiatric drugs though other non-pharmacological measures — such as counselling, breathing techniques, psycho-sociological treatment — are available.
Dr. Thomas Kerr, professor of medicine at UBC, echoed those sentiments: “Too often, we’re looking for an answer in a pill, and too often, we neglect other treatment options.”
Both doctors noted that there is very little evidence to support long-term use of BZDs.
“The interesting thing about this is that it’s a prescription drug and people think they’re safe,” Ahamad said. “But as it turns out, we’re probably prescribing these drugs in a way that’s leading to harm.”
Kerr noted that the rise in BZD-related deaths — “It’s been an epidemic brewing for many, many years” — very closely mirrors a rise in opioid-related deaths that has been widely documented. He cited a fourfold increase in BZD-related deaths in the United States between 1999 and 2014, and also noted that there are 50 per cent more deaths each year in the U.S. due to psychiatric medicine than heroin.
“These studies really reveal how very dangerous these drugs are, and they should be used with great caution,” Kerr said. “We can’t just focus on opioids, we need to look at other medications that are used in combination.”
Ahamad believes much of the onus is on doctors to be properly educated before prescribing BZDs. He also acknowledged that the lack of family doctors has led to many people visiting walk-in clinics, where patient records may not accurately record an individual’s drug or treatment history. Kerr noted there also needs to be a strengthening in how prescriptions are monitored and prescribed.
“There are risks that come with these medications and we need to be very, very careful about how we’re prescribing them,” Ahamad said.
The studies were published in Public Health Reports and the American Journal of Public Health.