2024-02-24 09:01:37
A record number of people contacted the teamInvestigation to recount their experience with benzodiazepines and Z-hypnotics, following on from the Prescription Nightmare report.
Many tell us about the suffering they have experienced or continue to experience with these medications. Some wonder where to turn and ask for resources. Experts insist: those who wish to wean themselves must do so at their own pace, and doctors must not cut off supplies from their tolerant patients.
Stopping suddenly (these medications) is dangerous, underlines geriatrician David Lussier. Faced with the influx of reactions provoked by the report ofInvestigation, he implores affected patients not to abruptly stop taking their benzodiazepines or Z-hypnotics. Serious symptoms such as seizures may occur if stopped abruptly. The first step is to talk to your doctor about withdrawal, recalls this senior specialist.
The Investigative report broadcast on February 15 presented testimonies from patients who suffered from dependence on drugs from the benzodiazepine or Z-hypnotics family. The latter criticize their doctor for having prescribed these drugs to them for long periods, which is contrary recommendations, and for not having adequately communicated the risks associated with these treatments.
They also believe that these professionals did not know how to recognize the symptoms of tolerance and dependence and that they did not properly supervise their withdrawal.
Many viewers say they are affected by an addiction to these medications, even though they are taken as prescribed. While some have the support of their doctor to wean themselves off, others feel isolated and wonder where to find the help they need.
Several people confided to Investigation have undertaken weaning alone, without the help of a health professional. Some of them used the withdrawal plans proposed in the Ashton Manual, written by a British doctor, Heather Ashton, who has become a world reference in benzodiazepine withdrawal. Its manual has been translated into more than ten languages, including French, and is available online for free.
Pharmacist and deputy director of the Canadian Network for the Appropriate Use of Medications and Deprescribing, Camille Gagnon affirms that awareness of the risks of these medications and recommendations for withdrawal is the key element in successfully stopping taking medications with success.
She emphasizes that withdrawal can be supervised by a doctor, a nurse practitioner and a pharmacist. The ideal is for the doctor to team up with the pharmacist to begin a deprescribing process, she explains, but a pharmacist can in principle support a patient alone in withdrawal.
“You have to go quietly »
Geriatrician David Lussier is optimistic: weaning off benzodiazepines is not always complicated, you have to take it slowly, he says. He talks about weaning from six months to a year, sometimes less, sometimes more, adapted depending on the patient. Reducing the dose gradually helps minimize potential withdrawal symptoms.
We must accept that we will have a small rebound in anxiety, adds Dr. Lussier, which means that reducing the dose can lead to the return of the symptoms we wish to treat or even paradoxical side effects (this is i.e. anxiety and insomnia).
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David Lussier, geriatrician at the University Institute of Geriatrics of Montreal (IUGM).
Photo : Radio-Canada
Nicole Lamberson, a medical board member of the Benzodiazepine Information Coalition in the United States, communicates daily with dozens of people addicted to these drugs. She notes that many doctors seem to want to impose a structured weaning schedule, even though it is important to adapt to the patient.
One person might be able to wean themselves off by reducing their dose by 10% while another will be too sensitive and need to stick to a 2.5% reduction every 30 days, she explains. We must be flexible and allow the patient to control their reduction at the pace that works for their body.
The only way to make such precise dose reductions is to use liquid versions of benzodiazepines, compounded preparations suitable for withdrawal.
Bertrand Bolduc, co-owner of the Gentès et Bolduc compounding pharmacy, explains that these preparations are, in principle, available to all patients who request them from their doctor or pharmacist.
You can go very, very, very slowly, go down a fraction at a time, you can do almost anything, a lower dosage capsule, or a liquid oral suspension if that’s more practical, he said. The tools are available for pharmacists and doctors, everything is possible.
Therapy more effective than sleeping pills
Patients affected by an addiction to these medications can also turn to support groups such as the Regroupement des resources alternatives en santé Mental du Québec (RRASMQ). We have a guide to allow people to assess their needs, the impact of medications on their quality of life, to help them sort it all out, explains Mathilde Lauzière, co-responsible for training and practice development.
The group – made up of different mental health organizations – provides support both to people who plan to reduce their consumption and to those who want to stop it.
If people wish to reduce (their consumption) or wean themselves, we have a support section on the weaning process, to prepare for the appointment with the doctor, to surround themselves well so that this process goes as well as possible.
In 2022, a citizens’ committee, supported by the RRASMQ, designed an information site (New window) and testimonials about medications, withdrawal and alternatives to taking medications.
Because non-pharmaceutical solutions exist: a recent study from Laval University showed that psychotherapy is as effective as sleeping pills in treating insomnia and also helps reduce what experts call “nocturnal performance anxiety” or the fear of suffering from insomnia.
Withdrawal, too painful for some seniors?
Despite the long-term risks associated with benzodiazepines and Z-hypnotics, many experts agree that sometimes it is best for a patient to continue taking these medications, particularly in the case of older adults who are taking these molecules for decades.
A specialist in seniors, Dr. Lussier agrees: We do not do it (start withdrawals in certain elderly people), because it would be too painful a process.
Nicole Lamberson points out that for some, withdrawal is not the best option. If they don’t want to stop (the medications), or if they’re not in a position in their life, for example, someone who is elderly or already frail, it might be best to leave them on benzodiazepines and don’t even try weaning.
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