Despite newer alternatives, doctors still frequently prescribe potentially addictive sleep aids. A new study in the journal Sleep shows that this is especially true for patients who are 65 or older and those who rely on public health insurance.
"Some of the most vulnerable populations in the United States are at greater risk of receiving prescription sleep medication with a high abuse potential," says Rajesh Balkrishnan, PhD, in a news release. Balkrishnan is Ohio State University’s Merrell Dow professor of pharmacy and one of the study’s authors.
Balkrishnan says doctors may be considering whether their patients have prescription drug coverage in deciding which drug to prescribe.
Balkrishnan and colleagues analyzed data from the National Ambulatory Medical Care Survey (NAMCS). They looked at 95 million visits to doctors related to sleep problems from 1996 to 2001.
Nearly two-thirds of those visits resulted in a prescription for medication, and three-quarters of those prescriptions were for a benzodiazepine.
Among patients given a prescription for sleep-related difficulties:
Visits by an established patient almost doubled the odds of having a prescription treatment for the sleep-related illness.
Among those receiving prescription medications for sleep-related difficulties, having public insurance increased the odds of a benzodiazepine prescription by 66 percent compared with those who had private insurance.
Those aged 65 or older were almost twice as likely to be prescribed a benzodiazepine compared with those who were aged 18-34.
Benzodiazepines are used as tranquilizers and muscle relaxants, and they can be highly addictive. Valium is one example, though it is not recommended for treating insomnia.
"Benzodiazepines are usually effective for just a few weeks when used to treat insomnia,” Balkrishnan says. “A person can develop a strong psychological and physical dependence on these drugs in a short time and experience severe withdrawal-like symptoms once he stops taking the medication.”
Newer Sleep Aids More Expensive
Benzodiazepines are often cheaper than newer sleep aids, such as Ambien, which don’t have the same addictive qualities.
"We need to understand the reasons for these disparities in order to stop this trend," Balkrishnan says. "There needs to be a move toward a more uniform prescription system, at least for certain types of medications. One possibility is to create guidelines that say let's reserve the most addictive benzodiazepines for patients for whom every other kind of treatment has been unsuccessful."
The study was funded by a grant from Takeda Pharmaceuticals of North America, which has applied for FDA approval for a new prescription sleep aid.
SOURCES: Balkrishnan, R. Sleep, 2005; vol 28(6): pp 709-713. News release, Ohio State University. News release, Takeda Pharmaceuticals of North America Inc.