Benzodiazepines most common substance in overdose deaths in 2016, ahead of oxycodone and fentanyl
Updated August 14, 2019 13:39:47
Benzodiazepines were involved in more drug-induced deaths in 2016 than heroin and methadone combined, but you would be hard-pressed to find any stories warning of their dangers on the front pages.
- Benzodiazepines are the single-most common drug type found in overdose deaths
- Nearly 6 million scripts for the anti-anxiety drug were handed out through the PBS in 2017-18
- Patients are regularly prescribed the drug for longer than the recommended 2-4 weeks
According to the Australian Bureau of Statistics, the sleeping and anti-anxiety pills were the most common single substance found in overdose deaths, ahead of opioids oxycodone and codeine and powerful narcotics like fentanyl.
“I have very grave concerns about the levels of benzodiazepine use in Australia,” Trent Zimmerman, chair of the House of Representatives Health Committee, told 7.30.
“There’s been a lot of focus on the risks of opioids and, at the same time, a lack of focus on the risks of benzos.”
Nearly 6 million scripts for this group of anti-anxiety sleeping pill medication were handed out through the Pharmaceutical Benefits Scheme (PBS) last financial year.
That figure does not include hospital and private scripts, which experts estimate also run to the millions.
Janet Shaw, manager of Reconnexion, Australia’s only sleeping pill addiction service, said there are more ambulance call-outs for benzos than heroin in Victoria.
“A very large proportion of people who take these tranquillisers for more than a few weeks find themselves in a dependency situation,” she said.
“And no-one’s talking about it.”
‘There was no informed consent’
Like many people, Perth fashion designer Aurelio Costarella started taking benzos as prescribed by his GP — the occasional one to help him sleep during stressful periods.
But when his anxiety spiralled into daily panic attacks five years ago, his psychiatrist prescribed him more and stronger doses.
“I went from one benzo to two benzos to three benzos, and twice daily, three times daily, and I didn’t question it because I thought I was being looked after,” he told 7.30.
“You shouldn’t be on a benzodiazepine for more than two to four weeks. Well, I was on three benzodiazepines for three to four years.”
Dependent on sleeping pills and plagued by anxiety, Mr Costarella’s life fell apart.
He closed his fashion business of 34 years to focus on the long and arduous task of withdrawing from the benzos.
Benzodiazepines need to be reduced in small doses, and he expects it will take up to three years to be off them completely.
What are benzodiazapines?
- Benzodiazapines are sleeping and anti-anxiety pills
- Brand names include Valium, Xanax and Normison
- Scientific names include temazapam, clonazepam, diazepam
- Clinical guidelines recommend use for 2-4 weeks maximum
- Nearly 1.6 million Australians took benzodiazepines last year (Dept of Health)
Benzo withdrawal can also be very difficult.
“I’ve been through periods where I’m not able to leave the house for weeks at a time,” Mr Costarella said.
“Because my central nervous system has been so compromised by the benzos, walking into a supermarket is akin to walking into a nightclub. It’s just so overwhelming.”
He is angry because he claims he was never made aware by his psychiatrist of the risks of addiction to benzos.
“There was no informed consent,” he said.
“Had I known [the risks of dependency and protracted withdrawal] I would have made very different decisions, but that power was taken away from me.”
The clinic where he was treated told 7.30 it does not comment on individual cases.
Mr Costarella complained about his psychiatrist’s treatment to the medical watchdog, AHPRA, but the complaint was not upheld.
Patient on prescribed benzos for 50 years
At Reconnexion they hear stories like Mr Costarella’s every day.
“About half of our clients have been prescribed, by their doctor, benzodiazepines for more than five years, about 8 per cent of our clients for more than 20 years,” Ms Shaw said.
“The other day, we had a phone call from someone who’d been prescribed these drugs for 50 years.”
Reconnexion offers the only specialised benzodiazepine withdrawal counselling service in the country.
From a small office in suburban Melbourne, trained volunteers take calls from people ranging in age from teenagers to septuagenarians.
Ms Shaw said most clients suffered from some cognitive impairment and pain and could not hold down jobs because of their benzodiazepine dependency.
“We know that benzodiazepines in older people are implicated in falls, in memory issues,” she said.
Hallucinating and violent: the problem of going cold-turkey
Mardella Bassett believed a 20-year benzodiazepine dependency was a factor in the sudden cognitive decline of her 92-year-old mother Beryl Cunnane.
“My mum was very active, very independent … she was extraordinary,” she told 7.30.
“[Now] the memory has gone … there’s no cooking, there’s no independence there.”
Mrs Cunnane has had to move in with her daughter after a brief but disastrous stay in hospital ended with the rapid onset of dementia.
Last year, after her mother had a fall and started experiencing some hallucinations, Mrs Cunnane was admitted to hospital near her home on Queensland’s Sunshine Coast.
In hospital, Mrs Cunnane refused to take the two benzodiazepines she had been prescribed long term, against clinical guidelines.
“What happens when somebody on benzos is taken off medication is they further hallucinate,” said Ms Bassett, gently holding her mother’s hands.
“And by this stage she’s not only hallucinating, she’s also getting violent.
“She’s a very frail little lady, and she now is starting to throw furniture around.”
The situation worsened when Mrs Cunnane was put on an antipsychotic, and sometime later, fell briefly unconscious.
Hospital records reported a rapid onset of dementia.
“Every area of her personality has changed since she came out of hospital,” Ms Bassett said.
Ms Bassett was astounded when she requested her mother’s medical records after the episode and discovered Mrs Cunnane had been on benzodiazepines for 20 years.
“That is so wrong when you are talking about these strong medications,” she said.
A meta-analysis into the relationship between dementia and benzodiazepines published this year found long-term benzo use increased dementia risk, though Dementia Australia said there was still debate about the links.
“This is a very important meta-analysis, although more research is needed to show there is a direct link between benzodiazepine use and the risk of dementia,” associate professor Michael Woodward, Dementia Australia’s honorary medical adviser, told 7.30.
He warned that anyone concerned about their benzo use should discuss it first with their GP.
“It is not wise to suddenly stop benzodiazepines,” he said.
Although the exact cause of Mrs Cunnane’s cognitive decline has not been pinpointed, Ms Bassett believes her long-term benzo use was a contributing factor to the cascade of events that saw her admitted to hospital with such disastrous results.
Mrs Cunnane’s GP said he could not comment because of patient confidentiality, but told 7.30 he always tried to stick to prescribing guidelines and, generally speaking, some patients who have been on drugs long-term can be reluctant to change medications.
Follow the guidelines
The president of the Royal Australian College of General Practitioners, Dr Harry Nespolon, conceded that although GPs are much more aware of the risks of benzos these days, they are still overprescribed.
“Do we rely on them too much as a therapeutic manoeuvre? Probably,” he told 7.30.
“But often, it’s so ingrained in the patient that it’s really difficult to get them to stop taking it.
“So that’s the challenge and that often takes multiple consultations, and often these consultations can be quite long, which is something that the system doesn’t support.”
Dr Nespolon said when used appropriately over short periods, benzodiazepines can be very helpful.
“In terms of sleeping and anxiety, used in the right patients for a short period of time they are very … beneficial drugs and they have low risk for patients,” he said.
“For patients who are taking multiple drugs or using benzodiazepines over a long period of time, that’s where the problems are.”
That is echoed by the pharmaceutical industry body Medicines Australia.
“As with all prescription medicines, benzodiazepines should only be prescribed within their approved uses and where clinically appropriate for an individual,” a spokesperson said in a statement to 7.30.
It is when benzodiazepines are mixed with other drugs such as opioids or alcohol that they can become lethal, usually by suppressing the respiratory system.
Mr Zimmerman’s Health Committee sleep inquiry report called for real-time script monitoring to be rolled out across the country, to help identify abuse.
But Ms Shaw said the vast majority of people who are being prescribed benzos for long periods are getting them from one prescriber.
“I think as a community, we should be so much more concerned about this than we actually are,” she said.
Mr Costarella said he just wants people to know about the risks as well as the benefits of benzodiazepines before they start taking them.
“They may work for some people, but not in my instance,” he said.
Reconnexion benzodiazepine helpline: 1300 273 266.
First posted August 12, 2019 18:26:07