Irish Times view on Benzodiazepine use: a cause for concern

Benzodiazepines are a family of drugs used in the short-term treatment of problems with sleep and anxiety. When first approved for use, their potential for addiction and tolerance was not recognised.

Now, strict prescribing guidelines mean they should not be routinely prescribed for more than four weeks. Benzodiazepines and a newer class called z-drugs are together classified as benzodiazepine and Z- drug receptor agonists (BZRAs).

BZRAs work by dampening down communication between brain cells. This results in depressed brain activity, thereby facilitating sleep and reducing anxiety. Inappropriate long-term use leads to dependence, tolerance and a dulling of cognitive capacity. As a result, BZRA use in older people increases their risk of falls. Driving may also be impaired and recent research has suggested a putative link between long- term use and the development of dementia.

All of which makes last week's disclosure by the Department of Health that Ireland has the highest rate of chronic benzodiazepine use in people over 65 in the OECD a cause for concern. The new report found that Ireland has the highest rate of chronic benzodiazepine prescription in 16 out of 34 OECD countries. Use by women over 65 in Ireland was 40 per cent higher than for men.

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BZRA prescribing in the Republic has declined in the last decade in response to revised guidelines. Legislation introduced in 2017 made it an offence to be in possession of certain benzodiazepines and Z-drugs without a valid prescription. So why is chronic BZRA use in older people in Ireland relatively high?

Prescription forging, illegal importation and a relative lack of non-drug treatment for anxiety and insomnia, especially for medical card patients, are factors. And there are limited facilities for treating people who are addicted to BZRAs.

We need further research into the reasons for international differences in chronic BZRA use. And we must resource and implement specialist programmes to help older people, in particular, to deal with benzodiazepine addiction.