Marta (fictitious name, the woman prefers to keep her identity) began taking sleeping pills at the age of 55, in a time of nervousness and stress and under medical prescription. She stopped taking them after five years, when she retired, but she got back on the habit. “A couple of years ago my husband had a very bad accident that almost killed him, I got anxiety again and went back to the pills,” she argues. Now she wants to quit again, but she knows that it will not be easy, and in September she will begin a regimen under medical supervision to gradually wean her off. Like Marta, thousands of people, mostly elderly, are addicted to benzodiazepines. Indeed, they help to sleep, but their long-term consumption becomes problematic, and different studies have shown that they present risks such as dependence, cognitive deterioration or falls.
According to the International Narcotics Control Board, Spain leads the world in benzodiazepine consumption, hypnosedatives that are often prescribed to improve sleep due to their anxiolytic, hypnotic, and muscle-relaxing effects. It is estimated that in 2020 almost 110 daily doses per 1,000 inhabitants were consumed in Spain. Only Belgium (84) and Portugal (80) come close to the Spanish rate, from which countries such as Germany (0.04 daily doses) are far behind. The Edades 2022 survey indicates that 9.7% of the Spanish population had used hypnosedatives, with or without a prescription, in the last 30 days, and 7.2% of the population admits to consuming them daily. According to specialists, we are facing a public health problem. “These drugs are effective. When people try them, they notice that they sleep better. But it has a downside: its effect is limited because the drug is tolerated. That is, when you have been taking it for a while, the body gets used to it and loses effectiveness. Then you have to increase the dose, and the possibility of undesirable effects increases”, explains Ramon Miralles, head of geriatrics at the Germans Trias hospital (Badalona).
Among the risks, the doctor cites daytime sleepiness, which causes clumsiness or balance difficulties and favors falls, which increases the risk of fractures and hospitalizations which, in the case of the elderly, imply high health costs. Mental confusion may also appear. “Although there is no absolute certainty, some studies suggest that benzodiazepines may increase the risk of dementia,” says Miralles. Lastly, consumers are more likely to develop acute confusional syndrome on hospital admissions, which leads to longer stays.
“The high level of consumption in Spain is a problem for patient safety,” says Begoña Pascual, head of the Badalona Serveis Assistencials pharmacy service. In her opinion, too many drugs are prescribed to address situations that are not pathological and could be dealt with by non-pharmacological measures. Because? Because it is the fast and economic way. Pill and sleep. “Since non-pharmacological interventions cost a little more effort and you don’t have time, we professionals overlook this issue a bit,” reasons Dr. Miralles. “With the rush, or with the fact that the priority is on other problems and the consultation is fast, you don’t have time to explain other alternatives.”
The Be-Safe project, funded by the European Union, seeks to reduce the consumption of benzodiazepines by offering alternatives. Led by the Catholic University of Louvain (Belgium), six countries participate. In Spain, the Fundació Salut i Envelliment of the UAB. “Through our research and collaborative efforts we aim to train and empower both healthcare professionals and patients and their families, in order to provide them with the necessary tools and resources to support them in the safe transition off sleeping pills” says its director, Antoni Salvà.
Doctors, nurses and patients are interviewed regarding the factors that facilitate or complicate the objective of stopping the drug. This year these interventions will be defined. In 2024, a trial will begin in seven countries to test whether they are effective in the medication withdrawal process. The project aims to unify the strategies between the different countries and agents in terms of information and training for patients on non-pharmacological alternatives, such as habits (performing physical exercise, a ritual and a hot infusion before going to bed, avoiding drinking coffee and alcohol), the possible establishment of a support telephone number, preparation of educational material or small psychotherapy interventions. “We do not want to find a universal measure for everyone, but rather a treatment adapted to each person,” says Miralles.
Due to the enormous number of users and the level of addiction developed over time, the battle against the excessive prescription of hypnosedatives is arduous and the outcome is uncertain. “People start to take it, you get used to it and you no longer consider that it could harm you,” says Marta. She thinks that she will be able to quit a second time, but not suddenly: “I think I’m well enough to be able to sleep the hours my body needs, but you have to go little by little.”
