According to a study done by The Henry J. Kaiser Family Foundation, the COVID-19 pandemic has been detrimental to a multitude of people’s mental health in addition to generating unaccustomed challenges for those already suffering from mental illness and substance use disorders. A KFF Health Tracking Poll from July 2020 also found that many adults are reporting specific negative impacts on their mental health and well-being, such as difficulty sleeping (36%) or eating (32%), increases in alcohol consumption or substance use (12%), and worsening chronic conditions (12%) due to worry and stress over COVID-19.
The effect of increased mental health issues has directly impacted the number of benzodiazepine prescriptions by physicians. A heavy influx of prescriptions have been prescribed to patients and a considerable number of healthcare workers.
What are Benzodiazepines?
Benzodiazepines (BZD), or street name “benzos,” are defined by the CDC as a class of psychoactive drugs whose core chemical structure is the fusion of a benzene ring and a diazepine ring. Benzodiazepines are sedatives that work by slowing down the central nervous system. Benzodiazepines are also defined as depressants, meaning they decrease brain activity, causing a relaxed mood, sleepiness, amnesia and irritability. The effects typically last between six and 24 hours. This class of drugs is most commonly prescribed to treat anxiety, insomnia and seizures.
The first benzodiazepine was synthesized in 1955. Due to safety margins and greater availability, benzodiazepines quickly replaced barbiturates in the medical field. Benzodiazepines are generally obtained by users through prescription. However, many users maintain their drug supply by getting prescriptions from several doctors, forging prescriptions or buying them illicitly.
The DEA identifies the most common prescription benzodiazepines as Valium®, Xanax®, Halcion®, Ativan® and Klonopin®. Alprazolam (Xanax®) and clonazepam (Klonopin®) are the most frequently seen benzodiazepines being used illicitly.
While benzodiazepines are generally seen as safe for use at two to four weeks, oftentimes doctors prescribe them for long-term use. This increases the risk of dependence, overdose and abuse by the patient.
Overprescription
Over the last few decades, there has been an enormous increase in the number of benzodiazepine prescriptions in America. With statistics steadily increasing and the COVID-19 pandemic, the surge of benzodiazepine prescriptions is borderline out of control. According to a study done by researchers Agarwal and Landon, Psychiatrists prescribing benzodiazepines have been stable (29.6% vs 30.2%) but primary care physicians have increased (3.6% vs 7.5%). Primary care accounted for roughly half the total benzodiazepine prescriptions.
The major issue with Primary Care Physicians (PCPs) prescribing medications is the ease at which patients obtain the medications. Any complaints of insomnia or anxiety almost guarantee a patient a benzodiazepine prescription from their personal primary care physician. The two problems that arise from this scenario are occasional exaggerations and incompetence from the patient and there not being a “proper” psychiatric evaluation. A complaint of anxiety should not warrant me the prescription of a medication that has common, serious side effects such as profound sedation, respiratory depression, coma and death. A single complaint of anxiety should not subject me to drug abuse, misuse, addiction, physical dependence and withdrawal reactions, which greatly increase with the use of this drug class.
This is not to say that anxiety and insomnia do not stipulate a need for medication. Instead, it is meant to highlight the ease at which the medication, which has profound risks, is acquired. The first line of treatment for anxiety and insomnia is psychotherapy; which should demand to be used before moving on to pharmacotherapy. Psychotherapy is hardly seen prior to receiving medications as such. Obviously, this is a monumental concern.
The complication we see with primary care prescribing benzodiazepines is the “easy fix” mentality. Frankly, the symptom-medication method is an unacceptable practice from our healthcare providers. There needs to be accountability in proper evaluations and proper medication dosing. There is a tremendous exigency for a switch to providing for the patient’s overall health and longevity of overall health; we need to see an approach to caring about patients’ holistic health from our primary care providers.
Eliminating Medication Overload
In January 2020, Lown Institute released “Eliminating Medication Overload: A National Action Plan.” The National Action Plan provides recommendations for policymakers, foundations, healthcare institutions, clinicians and patients across five key categories:
- Implement “prescription checkups,” medication reviews that give patients and clinicians opportunities to discontinue or reduce doses appropriately.
- Raise awareness among patients, clinicians and the general public about the potential harms of multiple medication use.
- Improve information at the point of care to ensure clinicians know exactly which medications their patients are taking, and to give clinicians accurate information about the harms and benefits of medications.
- Educate and train health professionals to reduce medication overload, by incorporating information on geriatric care and deprescribing training into professional schools and continuing education.
- Reduce pharmaceutical industry influence by limiting pharma sales rep visits to clinicians and direct-to-consumer advertising.
The preeminent way to eliminate medication overload is to uphold provider accountability. To facilitate accountability, education is required for both the patient and the provider. As with any circumstance, educate yourself before making any decisions. Understand that not every ailment must be treated with medication and that symptoms of poor mental health do not mean you have mental illness, although they very well could. Weigh the risks and proceed with due regard. The resources are out there.
If you or someone you know is seeking help for substance use, call the SAMHSA National Helpline at 1-800-662-HELP(4357).