Benzodiazepines: good or bad medicine?

Editorial T his month Canadian Family Physician presents the results of a survey of Belgian family physicians, which was designed to elicit their attitudes toward prescribing benzodiazepines (BZDs) and the barriers they perceived to nonpharmacologic methods as alternative ways to manage stress, anxiety, and insomnia (page e398). Anthierens and colleagues 1 remind us how widespread the use of BZDs has become: in Belgium, 1 patient in 3 takes BZDs daily and in a habitual way; in Europe, a survey revealed that almost 10% of the population are taking BZDs over long periods; and in Canada, the rate of BZD use over long periods is about 3.4%. The authors also remind us how difficult it is to stop taking these medications once you have started. Among the 948 family physicians surveyed, almost half (46%) did not see any problem with prescribing BZDs; approximately one-quarter considered habitual use of BZDs to be justified if patients felt better and were not experiencing secondary effects; and 71% believed that it was correct to prescribe BZDs for a week. It was the older physicians who mostly considered the use of BZDs as being justified. In the opinion of the authors, such revelations were troubling, particularly in consideration of the risks associated with prescription of these medications: " The benefits associated with sedative use are marginal and are outweighed by the risks, particularly in people older than 60 years of age .... Long-term use, even at therapeutic dosages, has been associated with tolerance, dependence, and withdrawal effects. " 1 In light of such statements, we would be right to ask why these medications have not simply been taken off the market if they are so pernicious. Moreover, for years we have been reminded that BZDs have been abused and that using them is risky. As Anthierens et al state, " It is now widely accepted that BZD prescribing has many risks, including tolerance, dependence and misuse, as well as BZD-induced depression, cognitive impairment, and psychomotor impairment. " 1 Contradictory advice Contrary to these affirmations and the beliefs set forth, the literature is not as adamant regarding the deleteri-ous effects of BZDs. Other published articles have stated the following: • Chronic BLOCKINuse BLOCKINof BLOCKINBZDs BLOCKINat BLOCKINa BLOCKINstable BLOCKINdose BLOCKINto BLOCKINmanage BLOCKINanxi-ety and panic disorders is not associated with neuro-psychologic impairment and does not cause problems in most patients. 2 • Clinical experience has shown that even over …