Use of “tranquilizer” medications associated with highest risk of death and increased risk of HCV infection in Downtown Eastside

published on May 17, 2016

Use of medication class a higher risk of death than illegal drugs like heroin and cocaine

Vancouver, BC [May 17, 2016] The serious dangers associated with use of benzodiazepine (BZD) medications, also known as “tranquilizers”, have been highlighted in a pair of peer reviewed research studies. The misuse of prescription medications has garnered growing public attention as overdose deaths have skyrocketed across the country. BZDs are controversial and addictive psychiatric medications commonly used for promoting sleep and relieving acute anxiety. While post-marketing studies have suggested they are largely ineffective for these indications, their use has been associated with injury, accidents and overdose deaths.

In a new study published by the US Centers for Disease Control and Prevention journal Public Health Reports, researchers from the BC Centre for Excellence in HIV/AIDS (BC-CfE) and the University of British Columbia’s Department of Medicine, studied the impact of BZD use on mortality rates in Vancouver’s Downtown Eastside. The study found Downtown Eastside drug users who use BZDs had a mortality rate almost twice that of drug users who did not use BZDs.

“Use of benzodiazepines was more strongly associated with risk of death than all other traditional illicit drugs of abuse such as heroin and cocaine,” said senior author Dr. Thomas Kerr, Professor of Medicine at the University of British Columbia and Director of the BC-CfE’s Urban Health Research Initiative. “This study underscores the urgent need to include BZDs in the discussion around the negative public health effects of addictive prescription drugs, as this medication class clearly carries significant risks for severe health-related harms.”

The peer reviewed studies come in the wake of the expert report “Together, we can do this: Strategies to address British Columbia’s prescription opioid crisis,” published in November 2015 and endorsed by over 80 leading health professionals across the province, which comprised key recommendations to address this important issue in B.C., including adding the requirement for BZD prescribing on a duplicate prescription pad in the same way opioid prescriptions must be written. The study reinforces this call and, given the known limited clinical effectiveness and known serious harms of BZD, recommends physicians be educated regarding the need to use alternative medications or psychosocial approaches that are safer than BZD.

Published last Friday in the prestigious American Journal of Public Health, another study by BC-CfE researchers looked at the relationship between BZD use and hepatitis C (HCV) infection in a similar cohort of Downtown Eastside drug users. Here, BZD use was associated with an elevated rate of HCV infection. Specifically, HCV infection rates were almost 70 per cent higher among persons who used BZD when compared to those who did not use BDZs. The cost of treating hepatitis C infection in B.C., as quoted by a pharmacy in the Lower Mainland, is between $60,000 and $74,000 per person for a 12-week course of treatment without taking into consideration PharmaCare coverage or individual private insurance coverage. This study highlights yet another harmful consequence of BZD use, underscoring the urgent need to increase awareness of safety, risks, and the limited evidence base for the use of this medication class to treat insomnia and anxiety.

“Given the highly addictive nature of benzodiazepines, and the associated increased risk of infectious disease acquisition and death associated with their use, physicians should exercise extreme caution when prescribing benzodiazepines or better avoid this practice altogether,” said Dr. Keith Ahamad, an addiction medicine physician, BC-CfE Clinician Scientist and study author.

Data from the study “The impact of benzodiazepine use on the mortality among polysubstance users in Vancouver, Canada” in the journal Public Health Reports were derived from 2802 PWID in Vancouver between May 1996 and November 2013. Study participants were interviewed on a semi-annual basis to collect information on drug use and other risk behaviours. Rates and causes of death were examined through linkages with the provincial vital statistics database.

Data from the study “Benzodiazepine use and hepatitis C seroconversion in a cohort of persons who inject drugs in the American Journal of Public Health” were derived between May 1996 and November 2013 from 440 initially HCV negative PWID in Vancouver. Study participants were tested for HCV and interviewed on a semi-annual basis to collect information on HCV status, drug use and other risk behaviours.