As the Nova Scotia government moves to start monitoring benzodiazepine prescriptions, an addictions consultant for the Capital District Health Authority says he's worried the sedatives are inappropriately prescribed.
Benzodiazepines, also known as benzos, are primarily prescribed for anxiety, both for long-term disorders and acutely, like before a colonoscopy. They can also aid with insomnia and act as a muscle relaxant. The classification includes drugs like Xanax, Valium and Ativan.
Dr. Ronald Fraser, a consulting psychiatrist for the Halifax health authority, says benzodiazepines do help people, but they’re not always the best option.
'We have this expectation that we should never experience any distress or discomfort at any point in time of our lives and if we do there should be a pill to remedy that.' - Dr. Ronald Fraser
“I do worry that not everyone is necessarily prescribing them in that matter... We have this expectation that we should never experience any distress or discomfort at any point in time of our lives and if we do, there should be a pill to remedy that. So if people are experiencing anxiety, which is a normal experience, it’s not always a disorder. It shouldn’t always be pathologized. If we don’t experience anxiety then we don’t survive as a species,” he said.
Fraser, also the director of inpatient detoxification services at the McGill University Health Centre, says there are other remedies for anxiety and insomnia like a lifestyle change, but they often take time and more effort.
“There’s been a shift in entitlement in the terms of I want a pill and I want a pill today... Everybody wants a quick fix. Everybody wants a pill.”
In 2013, 272,206 benzodiazepine prescriptions were dispensed under Nova Scotia’s public drug plans, about 39,000 more than in 2009. Over the same five-year period of time, the patient count grew by 847. This meant that while the patient count increased by only 2.5 per cent, the number of prescriptions dispensed went up by 16.7 per cent.
Judy McPhee, the executive director of pharmaceutical services in Nova Scotia, calls the numbers “stable."
“We’re currently in the middle of implementing a drug information system for the province and they will be monitored when that is up and running,” she said. “They can be overused and so we just want to monitor that use.”
When the system is introduced, Nova Scotia will join provincial governments including Ontario and British Columbia that have already begun tracking benzodiazepine use.
Fraser says the drug can be addictive.
“They’re a little bit like, it’s an oversimplification, but a little bit like alcohol in a pill form. They make people feel very relaxed, they make people feel somewhat numb... So they have an abuse potential,” he said.
“Everything is a little bit dulled. We worry about escalating doses, we worry about people becoming disinhibited or their judgment being impaired."
The doctor says benzodiazepines have less addictive potential than opioids, which are already tracked under the Nova Scotia Prescription Monitoring Program.
Fraser says some patients risk withdrawal if their medication runs out or they don’t have access to the pills.
“It can be potentially life-threatening,” he said. “Sometimes I’ve seen people on them for 20 years and they have tremendous difficulties getting off them.”
Fraser stressed the drugs can be incredibly helpful when they’re used correctly.
“I would also be equally concerned if people shied away from these very useful medications out of fear,” he said.
The prescription numbers obtained through the Department of Health and Wellness don’t cover people paying for the drug through their private drug plan or in cash. Only about 23 per cent of Nova Scotia’s population is registered under its public drug plans.
The pills prescribed for anxiety or as sleeping aids that include such names as: