e a l t h P r o m o t i o n
drugs often incorrectly prescribed
Study Group Drs. Gerry Mugford
and Terrence Callanan are members of the Canada-U.S. Maine
Benzodiazepine Study Group. Dr. Mugford is chair of the epidemiology
and policy stream.
A survey to assess
benzodiazepine prescribing patterns of doctors in Maine found that many
patients are given long-term prescriptions for this class of drugs,
despite established guidelines that recommend they be used for no more
than a month.
By Sharon Gray
A survey to assess
benzodiazepine prescribing patterns of doctors in Maine found that
many patients are given long-term prescriptions for this class of
drugs, despite established guidelines that recommend they be used
for no more than a month.
“The survey focused on reasons to
prescribe this drug class as well as how physicians’ personal
prescribing patterns reflect established guidelines,” said Dr. Gerry
Mugford, an assistant professor of Pharmacy, Medicine and Psychiatry at
Memorial, and chair of the epidemiology and policy stream of the Canada-U.S.
Maine Benzodiazepine Study Group.
“We found differences between general
practitioners and specialists, older versus more recent medical
graduates, rural versus urban prescribing patterns and gender
differences among prescribing physicians.”
The first benzodiazepine in 1959 was
chlordiazepoxide (librium). Since then, physicians have increasingly
prescribed a variety of benzodiazepines rather than the older and
more-addictive barbiturates for problems such as insomnia and anxiety.
Although guidelines state that benzodiazepines should not be prescribed
for more than 30 days, Dr. Mugford said the Maine survey found that a
large number of patients have been on these drugs for more than 90 days,
with some taking them continuously for up to 20 years.
“They are often used inappropriately and
we believe that the North American prevalence of 10 per cent use is very
under-reported,” Dr. Mugford said. “There is no hard evidence that
long-time benzodiazepine use helps the patient. On the contrary, it is
often implicated in hip fractures, traffic accidents, adverse drug
events and suicides.”
Physicians prescribe benzodiazepines for
anxiety, insomnia, depression, movement disorder, alcohol withdrawal,
muscle relaxation and grief reaction. Dr. Mugford said that women,
especially poor women over 65, have prescribing and usage rates of about
20 per cent. “We have observed rates in some female population samples
up to three times that that of the general population.”
The Maine survey of approximately 190
physicians found that over 96 per cent of them currently prescribe
benzodiazepines. Factors such as pressure from well-educated patients,
and from emotionally-upset patients who have been on benzodiazepines a
long time, can influence their decision to prescribe the drugs. “A large
number of physicians use their own personal judgment rather than
official guidelines in their decision to prescribe. In our survey, 87
per cent had given benzodiazepine prescriptions beyond 90 days and a
major reason they gave was chronic anxiety although there is little
evidence to suggest benzodiazepines are an effective treatment for this
The survey found that general
practitioners or family doctors were more likely to prescribe
benzodiazepines than psychiatrists, and most likely to prescribe ativan,
valium and restoril. The survey asked the physicians which
benzodiazepines they were prescribing, with a list of 14 to choose from.
Some added in drugs which they thought were benzodiazepines but which
Family doctors were more likely to be
influenced by manufacturing information than psychiatrists, although
when it came to prescribing beyond 90 days there was no difference in
the reasons given between family doctors and psychiatrists. Female
doctors reported a higher rate of prescribing for “grief reaction” and
were less likely to prescribe beyond 90 days. “Female physicians gave
more reasons for prescribing benzodiazepines and were more influenced by
side effects and drug interactions.”
Dr. Mugford said although the survey
sample was small, it represented a variety of ages, a range of community
sizes in urban and rural areas, and was gender balanced. “We see this as
a pilot study and it is evident a broader-based survey would be useful.
We need to explore the attitudes physicians have towards guidelines and
why they don’t follow them. We have a major concern over the use of
benzodiazepines in seniors because of drug interaction when the dose is
increased because of tolerance.”
Memorial University is the academic centre
for three streams of the Canada-U.S. Maine Benzodiazepine Study Group.
Dr. Terrence Callanan, chair of the Discipline of Psychiatry, is a
founding member and senior academic partner of the group, which started
four years ago.
Dr. Mugford has been a member of the Maine
group for three years and was recently appointed chair of the
epidemiology and policy stream. Dr. Mugford and fourth-year Memorial
psychiatry resident Dr. Anjana Chawla attended the third annual Maine
Benzodiazepine Study Group International Conference held last fall in
Bangor, Maine. Dr. Chawla won the Resident Award at this meeting for her
paper on imovane (zopiclone), a short-acting sedative-hypnotic used in
the short-term treatment of insomnia. Dr. Chawla showed that imovane can
be addictive in some patients.
Story reprinted courtesy of the "Memorial