Nearly one out of two visits to a doctor's office for help with a sleep disorder result in the prescription of potentially addictive medications, a new study reports.
Office visits by older patients and those with publicly funded health insurance plans were nearly twice as likely to result in the prescription of these kinds of medications.
The drugs, called benzodiazepines, are often a cheaper alternative to some newer types of medicines that don't have the same potentially addictive side effects, said Rajesh Balkrishnan, the study's lead author and the Merrell Dow professor of pharmacy at Ohio State University.
“Some of the most vulnerable populations in the United States are at greater risk of receiving prescription sleep medication with a high abuse potential,” he said.
The study, which appears in the current issue of the journal Sleep, includes data from 94.6 million office visits in the United States over a six-year period. Patients included in the data set sought help for sleep-related difficulties in outpatient physician offices.
Balkrishnan and his colleagues gathered six years of outpatient office visit data – from 1996 to 2001 – from the National Ambulatory Medical Care Survey (NAMCS). The NAMCS includes information on patient demographics, the reason for a visit, a patient's diagnosis, the medication prescribed and the therapeutic and preventive services recommended during that visit. The majority of patients went to family practice physicians, internal medicine providers or psychiatrists.
Using information from the NAMCS, the researchers analyzed the treatment patterns of patients 18 and older who reported sleep problems.
Nearly two-thirds of those visits resulted in medication prescriptions for a person's sleep difficulties, and three-quarters of those prescriptions were for a benzodiazepine. (Five of the 13 kinds of benzodiazepines on the market in the United States are indicated for treating insomnia.)
The other 25 percent of patient visits for sleep disorders ended with prescriptions for non-benzodiazepine medications.
Benzodiazepines were widely prescribed for anxiety and other stress-related problems in the 1960s and 1970s. These drugs, which have a calming effect on the nervous system, are still prescribed as muscle relaxants and tranquilizers. (Valium is one example of a benzodiazepine, although it is not recommended for treating insomnia in the United States.)
“Benzodiazepines are usually effective for just a few weeks when used to treat insomnia. But addiction can develop relatively quickly”, Balkrishnan said.
“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,” he said.
Office visits by people 50 and older were about 5 times as likely to result in a drug treatment for sleep problems as were visits by 18- to 34-year-olds.
And people 65 and older were twice as likely as the 18- to 34-year-olds to receive prescriptions for benzodiazepines. Visits by patients with Medicare or Medicaid – the federally subsidized health insurance plans – were also twice as likely to result in benzodiazepine prescriptions as visits by patients with private health insurance.
Psychiatrists were four times as likely to prescribe newer non-benzodiazepine drugs during patient visits compared to family practice and internal medicine physicians.