Opinion: Too many older adults are taking risky sedative medications

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A recent investigation in Quebec uncovered a concerning trend: benzodiazepines — medications commonly used for sleep or anxiety — are being overprescribed. This investigation has prompted the Quebec College of Physicians to closely examine the usage of these medications.

But this issue extends beyond Quebec; across Canada, these medications are being prescribed at alarming rates.

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Benzodiazepines and other sedatives are often prescribed to older adults, 65 and older, for sleep or anxiety problems. But long-term use poses serious risks for this age group, including memory problems, falls and even an increased risk of death.

When benzodiazepines are taken with other sedating medications, there is also an increased risk of overdose and over-sedation. 

Despite these known risks, a 2022 report by the Canadian Institute of Health Information (CIHI) and Choosing Wisely Canada found that one in 12 Canadians over 65 are using these medications regularly.

The report also revealed significant variations in prescription rates across provinces and territories. For instance, in Saskatchewan, five per cent of adults over 65 use these medications regularly compared to over 20 per cent in New Brunswick. These differences likely stem from differing prescribing habits among physicians. Initiatives such as providing feedback to doctors about their prescribing habits, as proposed by the College of Physicians, can help address this issue.

The report also identified differences between groups, with women being nearly twice as likely as men to be prescribed these medications. Older women, particularly those over 90, are the most likely to be prescribed these medications, even though they are most at risk of problems.

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Often, patients start these medications to address short-term sleep disturbances or anxiety. However, they may continue using them longer than recommended, leading to chronic use.

Patients may also receive these medications in the hospital to help them sleep, but this can continue even after they are discharged.

Simple and safe alternatives exist, such as creating a healthy sleep environment, which studies show can be as effective as medications.

So, how can we ensure safer medication practices?

Studies show that when patients understand the risks of prescription medications, they are less likely to take them. Patients should speak with their doctors about potential side-effects and explore safer alternatives.

Pharmacists can also play a crucial role in reviewing medications and identifying those that can be reduced or discontinued.

Additionally, doctors can advocate for non-medication interventions to address sleep or anxiety issues. Simple lifestyle changes, like regular exercise or better bedtime habits, are often just as — and possibly more — effective than medications.

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If prescriptions are started, they should be time-limited, and patients and doctors can consider whether they need to be continued. 

Over-prescription of risky sedative medications is a challenging and widespread issue in Canada. It’s important for health care providers, regulatory bodies that oversee clinician practice and patients to collaborate in promoting safer, more effective care for Canadians.

By raising awareness of the risks and encouraging open conversations between patients and health-care providers to determine safer alternatives, we can enhance the well-being of our aging vulnerable population.

Dr. Wendy Levinson is chair of Choosing Wisely Canada and a professor of medicine at the University of Toronto.

Dr. Christine Soong is an academic hospitalist and associate professor in the division of general internal medicine at the University of Toronto.

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