A record number of people have contacted the research team following the Prescription Nightmare report to share their experiences with benzodiazepines and Z-hypnotics.
Many tell us about the suffering they have experienced or are still experiencing with these medications. Some are wondering who to turn to for resources. Experts emphasize that those who want to wean themselves must do so at their own pace, and doctors should not deny care to their tolerant patients.
Sudden discontinuation (of these medications) is dangerous, emphasizes geriatrician David Lussier. Given the flood of reactions that the investigation report elicited, he urged affected patients not to abruptly stop taking their benzodiazepines or Z-hypnotics, as abrupt discontinuation could result in serious symptoms such as convulsions. The first step is to talk to your doctor about withdrawal, recalls this senior specialist.
The investigative report, broadcast on February 15, presented statements from patients who suffered from addiction to drugs from the benzodiazepine or Z-hypnotic family. The latter criticize their doctor for prescribing these medications over long periods of time contrary to recommendations and for not adequately communicating the risks associated with these treatments.
They also believe that these professionals failed to recognize the symptoms of tolerance and dependence and that they did not properly monitor their withdrawal.
Many viewers report experiencing addiction to these medications despite taking them as prescribed. While some can rely on their doctor's support to quit, others feel isolated and wonder where they can find the help they need.
Several people told Enquête that they had done the weaning on their own, without the help of a medical professional. Some of them used the withdrawal plans suggested in the Ashton Handbook, written by the British doctor Heather Ashton, who has become a world reference on benzodiazepine withdrawal issues. The manual has been translated into more than ten languages, including French, and is freely accessible online.
Camille Gagnon, pharmacist and deputy director of the Canadian Network for the Appropriate Use of Medications and Deprescribing, reiterates that awareness of the risks of these medications and withdrawal recommendations are a key element in successfully discontinuing medications.
She emphasizes that withdrawal can be monitored by a doctor, nurse and pharmacist. It is ideal if the doctor works with the pharmacist to initiate a prescription process, she explains, but in principle a pharmacist can accompany a patient through the weaning process alone.
“You have to go quietly.” HAS”
Geriatrist David Lussier is optimistic: Weaning off benzodiazepines is not always complicated, you have to take it easy, he says. He speaks of a withdrawal of six months to a year, sometimes less, sometimes more, adjusted depending on the patient. Gradually reducing the dose will help minimize possible withdrawal symptoms.
“We have to accept that we will experience a slight increase in anxiety,” adds Dr. Lussier added, meaning that reducing the dose may result in the return of the symptoms we are trying to treat or paradoxical side effects (e.g. anxiety and insomnia).
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David Lussier, geriatrician at the University Institute of Geriatrics of Montreal (IUGM).
Photo: Radio-Canada
Nicole Lamberson, medical board member of the Benzodiazepine Information Coalition in the United States, communicates daily with dozens of people addicted to these medications. She notes that many doctors seem to want to prescribe a structured withdrawal plan, although it is important to adapt to the patient.
One person might be able to wean themselves by reducing their dose by 10%, while another person is too sensitive and needs to stick to a 2.5% reduction every 30 days, She explains. We need to be flexible and allow the patient to control their reduction at the pace that is best for their body.
The only way to achieve such precise dose reductions is to use liquid versions of benzodiazepines, compounded preparations suitable for withdrawal.
Bertrand Bolduc, co-owner of the compound pharmacy Gentès et Bolduc, explains that these preparations are generally available to all patients who request them from their doctor or pharmacist.
You can go very, very, very slowly, reduce a fraction at a time, you can do almost anything, a lower dose capsule or a liquid oral suspension if that's more convenient, he said. The tools are available to pharmacists and doctors, anything is possible.
Therapy more effective than sleeping pills
Patients affected by addiction to these medications can also turn to support groups such as the Regroupement des resources alternatives en santémental du Québec (RRASMQ). “We have a guide that allows people to assess their needs and the impact of medication on their quality of life and help them get everything under control,” explains Mathilde Lauzière, co-responsible for practice training and development.
The group – made up of various mental health organizations – supports both people who are thinking about reducing their consumption and those who want to stop.
If people want to reduce (their consumption) or quit, we have a support area on the quitting process, preparing for the doctor's appointment and providing a good environment so that this process goes well.
In 2022, a citizens' committee, with the support of the RRASMQ, designed an information page (new window) and reports on medication, withdrawal and alternatives to taking medication. Medication.
Because there are non-pharmaceutical solutions: A recent study from Laval University showed that psychotherapy is as effective as sleeping pills in treating insomnia and also enables recovery. Reduce what experts call “nighttime performance anxiety.” or the fear of suffering from insomnia.
Weaning too painful for some seniors?
Despite the long-term risks associated with benzodiazepines and Z-hypnotics, many experts agree that sometimes it is best for a patient to continue taking these medications at all, especially in older people who have been taking these molecules for decades.
Dr. Lussier, a senior specialist, agrees: We don't do it (starting withdrawal symptoms in certain older people) because it would be too painful a process.
Nicole Lamberson emphasizes that retreat is not the best option for some. If they don't want to come off (the medication) or if they are unable to do so in their life, for example someone who is elderly or already frail, it might be better to keep them on benzodiazepines rather than even one Attempt to retreat.
