Marta (fictitious name, the woman prefers to preserve her identity) started taking sleeping pills when she was 55, in a time of nervousness and stress and under medical prescription. He stopped taking it after five years, when he retired, but he got back into the habit. “A couple of years ago my husband had a very bad accident that almost killed him, I had anxiety again and I went back to the pills,” she argues. Now he wants to leave them again, but he knows it won’t be easy, and in September he will start a regimen under medical supervision to gradually get used to it. Like Marta, thousands of people, mostly elderly, are addicted to benzodiazepines. Indeed, they help sleep, but long-term consumption becomes problematic and different studies have shown that they present risks, especially for the elderly.
According to the International Narcotics Control Board, Spain leads the world in the consumption of benzodiazepines, hypnosedants that are often prescribed to sleep better due to their anxiolytic, hypnotic and muscle relaxing effects. It is estimated that in 2020 almost 110 daily doses were consumed in Spain for every 1,000 inhabitants. Only Belgium (84) and Portugal (80) come close to the Spanish rate, from which countries such as Germany (0.04 daily doses) distance themselves. The Edades 2022 survey indicates that 9.7% of the Spanish population had consumed hypnotics, with or without a prescription, in the last 30 days, and 7.2% of the population admits to taking them every day. According to the specialists, we are dealing with a public health problem. “These medicines are effective. When people try them, they notice that they sleep better. But they have a counterpart: their effect is limited, because the drug has tolerance. In other words, when you’ve been taking it for a while, your body gets used to it and it loses its effectiveness. Then you have to increase the dose and the possibility of undesirable effects increases”, explains Ramon Miralles, head of Geriatrics at Germans Trias hospital (Badalona).
Among the risks, the doctor mentions daytime sleepiness, which causes balance difficulties and favors falls. This increases the risk of fractures and hospitalizations, which, in the case of the elderly, involve high healthcare costs. Mental confusion may also appear. “Although there is no absolute certainty, some studies suggest that benzodiazepines can increase the risk of dementia”, points out Miralles. Finally, consumers have an easier time developing acute confusional syndrome during hospital admissions, which leads to longer stays.
“The high level of consumption in Spain is a problem for the safety of patients”, says Begoña Pascual, head of the Badalona Pharmacy Services Assistance service. In his view, too many drugs are prescribed to address situations that are not pathological and could be countered with non-pharmacological measures. Because? Because it is the fastest and cheapest 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 little bit,” reasons Dr. Miralles. “If you are in a hurry, or if the priority is other problems, during the quick consultation you don’t have time to explain other alternatives”.
The Be-Safe project, funded by the EU, aims to reduce the consumption of benzodiazepines by offering alternatives. Led by the Catholic University of Leuven (Belgium), six countries participate. In Spain, the Health and Aging Foundation of the UAB. “Through our research and collaboration efforts we aim to train and empower healthcare professionals as well as patients and their families, in order to provide them with the tools and resources needed to support them in the safe transition to leave the sleeping pills”, explains the director, Antoni Salvà.
Doctors, nurses and patients are interviewed regarding the factors that facilitate or complicate the goal of quitting the drug. These interventions will be defined this year. In 2024, a trial will begin in seven countries to test whether they are effective in the withdrawal process of the medication. The project aims to unify the strategies between the different countries and agents in terms of information and training to patients about non-pharmacological alternatives, such as habits (doing physical exercise, a ritual and a hot infusion before going to the bed, avoiding coffee and alcohol), the possible establishment of a support telephone, development of educational material or small psychotherapy interventions. “We don’t want to find a universal measure for everyone, but a treatment adapted to each person”, points out Miralles.
Due to the huge number of users and the level of addiction developed over time, the battle against the over-prescription of hypnotics is arduous and of uncertain outcome. “People start taking it, you get used to it and you no longer consider that it could harm you”, says Marta. He thinks he can stop it a second time, but not all at once: “I’m well enough to be able to sleep the hours my body needs, but it has to be done little by little.”
