The Dose19:40What do I need to know about benzodiazepines?
Within 10 minutes of disclosing his sleepless nights to his family doctor, Georges Marcoux had a little white pill in his hand.
His doctor in Shediac, N.B., prescribed him a sleeping pill, Oxazepam, which gave him relief for a few weeks.
“I got the prescription, and that’s it. Nobody was asking questions. I was not asking questions.”
But 35 years later, Marcoux realized he had been taking the same pill to help him sleep every night.
After seeing a story in the paper about a study correlating long-term benzodiazepine use to risk of cognitive impairment, he knew it was time to quit.
These pills, part of a class of drugs called benzodiazepines, have been around since 1955. Their use and misuse are portrayed in songs, movies and most recently in the TV series White Lotus and The Pitt.
A 2024 study published in the journal Sleep Medicine, surveyed about 4000 Canadians, and 15 per cent of all respondents said they had used a sleep medication.
The study also found that one in four respondents 65 and older, and about one in 10 between 36 to 49, used a prescribed sleep medication in the preceding 12 months.
According to a study published in the Canadian Journal of Public Health in 2023, a range of studies peg the prevalence of benzodiazepine use between five and 10 per cent of the populations in Canada and the United States between 1996 and 2019.
But there are serious risks that come with taking benzodiazepines, and medical experts say the drug is being over-prescribed.
Dr. Paxton Bach, a specialist in addictions medicine at Vancouver’s St. Paul’s Hospital, told Dr. Brian Goldman, host of CBC podcast The Dose, that once a dependency to the drug is formed, it takes a lot of effort to quit.
What are benzodiazepines?
Benzodiazepines are prescription medications primarily used for short-term treatment of specific medical conditions such as acute anxiety, panic attacks or severe situational stress.
Doctors may prescribe them to stop or prevent seizures, provide temporary relief for sleep disorders, as a muscle relaxer or to help manage alcohol-withdrawal symptoms.
Taking benzodiazepines comes with risks, said Bach, who is also a clinical assistant professor at the University of British Columbia.
“It’s crucial to understand that these medications are intended for very brief use — typically only a few days to a week — because they can quickly lead to physical dependence.”
What are the risks of taking benzodiazepines?
Within days to weeks of regular use, patients can develop a habit, said Bach.
“Withdrawal symptoms range from increased anxiety and restlessness to potentially life-threatening complications, like seizures or coma.”
He said side effects to taking the drug include sedation, decreased cognitive function, impaired reflexes, and increased fall risk.
“Long-term use can lead to tolerance, requiring higher doses to achieve the same effect, and can be more challenging to discontinue than even opioid medications.”
When combined with other substances, such as opioids or alcohol, Bach said, benzodiazepines dramatically increase overdose risk.
A Radio-Canada investigation into the use and side-effects of benzodiazepines such as Ativan and Xanax reveals the drugs are often overprescribed and there isn’t enough education for doctors or patients about the risks — including falls, fractures and addiction.
Why are physicians worried about benzodiazepines?
Dr. Camille Gagnon, assistant director at the Canadian Medication Appropriateness and Deprescribing Network, said there’s a serious problem with benzodiazepines being over prescribed.
While benzos can be useful to patients with the qualifying symptoms, Gagnon said physicians should “also recognize that these are not the best approach for patients, especially not long term.”
Gagnon recommends other alternatives to insomnia treatment, such as psychological therapy, but said there are barriers to accessing those options, such as high-costs and lack of publicly-funded psychotherapists.
She said access to medication, whether it’s from a pharmacist or unprescribed, is often the more accessible option.
Bach said he’s noticed some of his patients had been prescribed benzodiazepines without proper communication of the risks. He said that is a key factor physicians should take into account to prevent dependency.
“I hope that patients who’ve been on one of these medications long term have been communicating with their prescriber about the risks and benefits,” said Bach.
“There are certainly times when longer-term use of benzodiazepines may be needed, but in general, these are medications that are primarily intended for very short-term use,” he said.
Twelve people who spoke to Radio-Canada’s Enquête said they were prescribed the drugs by a doctor, but most said they were not warned about side effects, including life-altering withdrawal symptoms.
How do I quit taking benzodiazepines?
Quitting benzodiazepines suddenly can be extremely risky, said Bach.
It can cause serious withdrawal symptoms, which can range from mild symptoms like anxiety, insomnia, and restlessness, to severe complications including seizures, delirium, coma, or even death.
“If you think of benzodiazepines as sort of a blanket or a break on the brain activity, and that’s withdrawn very suddenly, you can imagine things kind of kick into overdrive.”
Bach said quitting can take from months to years, but he believes anyone can make a plan with their physician to stop using these medications.
“In my experience, anyone and everyone can taper off these medications eventually. It’s just about making sure we take the time and provide that level of engagement to do so in a careful and thoughtful way, such that we minimize that risk and maximize the chance of success.”
It’s not easy to quit, said Gagnon, but it’s certainly possible with help from a primary-care provider.
“The goal is to make it collaborative. It’s totally modifiable. It’s something that evolves with the person, and it can be done for sure.”
Marcoux has been off of benzodiazepines for two years now, but he says it wasn’t easy.
“I was a little bit scared and I had withdrawal symptoms … but I am much happier without it.”
He made a plan with his family doctor to reduce the dosage of his benzodiazepine every three months.
“I questioned my choice to stop often when I was trying to cut it off, but I knew I had to try,” said Marcoux.
He said he created a personal goal to try and wean off his medication within a year, and stuck to it.
“Now I’m turning 80 and I whistle in the morning and I feel better. It’s something that I have never felt before.”
