Health Canada has asked pharmaceutical companies to put stronger safety labels on benzodiazepines and other sedative drugs prescribed for sleep and anxiety disorder to better reflect their serious risks.
Doctors have long prescribed benzodiazepines such as lorazepam (brand name Ativan), alprazolam (Xanax) and clonazepam (Klonopinin) in the short term to treat anxiety, insomnia and certain seizure disorders. But people can become dependent and an overdose can result in a coma or even death.
Pharmacist Mina Tadrous is also a scientist at Women’s College Hospital and an investigator with the Ontario Drug Policy Research Network (ODPRN).
“They work really well, but they’ve also become part of popular culture,” Tadrous said. “People talk about ‘popping a Xanax’ and using different types of drugs, so that’s becoming more and more common.”
On Friday, Health Canada said its requested updated language around the risks of:
- Problematic use and substance use disorder.
- Severe withdrawal symptoms,
- Harm when taken with opioids, which may cause deep drowsiness, respiratory depression, coma and death.
- Falls and fractures in specified populations.
Cheyenne Johnson of the BC Centre on Substance Use said benzodiazepines are frequently misused with opioids, which can be fatal.
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Johnson said the new warnings shouldn’t prompt doctors to suddenly take long-term users off benzodiazepines but taper off use to avoid adverse health effects that could increase risk if used with illicit drugs.
“The vast majority of overdoses are from multiple substances, including other CNS depressants like alcohol and benzodiazepines,” said Johnson, a registered nurse.
In British Columbia, more than a quarter of prescription overdose deaths included benzodiazepines, she said.
Pharmacists say when the drugs are mixed, the risks don’t just add, they multiply.
Johnson said as with opioids, more careful prescribing could prevent problems from starting.
The U.S. Food and Drug Administration added similar warnings to benzodiazepines in September.
Warnings also apply to insomnia medications
In Canada, the stronger warnings will also apply to newer drugs such as eszopiclone (sold as Lunestra) and zopiclone (Imovane) prescribed for insomnia. These medications technically aren’t benzodiazepines but carry the same potential for misuse, Tadrous said.
“In the pharmacy, I saw patients chronically on these medications for long periods of time that were completely off label and sort of had telltale signs of potential misuse and abuse of these drugs, and yet we treated them like they were not like benzodiazepines,” Tadrous said.
He said it’s a “thoughtful step” for Health Canada to add the warnings to sleep medications, which are also useful.
“But they do have some concerns and I think that the public should know about that.”