Benzodiazepine-Like Hypnotics and the Associated Risk of Road Traffic Accidents

Orriols, Ludivine; Philip, Pierre; Moore, Nicholas; Castot, A; Gadegbeku, Blandine; Delorme, Bernard; Mallaret, Michel; Lagarde, Emmanuel

doi:10.1038/clpt.2011.3

Cited by 100 publications

(82 citation statements)

References 20 publications

(24 reference statements)

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“…3,50 Similar to previous studies, 7,8,14,20,51 we found adults had increased odds of long-term sedative use if they were women, if they had low incomes and if they had relatively poor health status. We also found that having a surname of Chinese or South Asian origin was associated with a protective effect on the odds of long-term sedative use.…”

Section: Discussionsupporting

confidence: 76%

“…When reporting prevalence rates for the adult population, we age-standardized annual statistics using the 2013 population in 4 age categories (45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59)(60)(61)(62)(63)(64), 65-84 and ≥ 85 yr). We termed participants between the ages 18 and 44 years "young adults," those between ages 45 and 64 years "middle-aged adults" and those 65 years of age and older "older adults."…”

Section: Discussionmentioning

confidence: 99%

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Long-term sedative use among community-dwelling adults: a population-based analysis

et al. 2017

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

Long-term sedative use among community-dwelling adults: a population-based analysis

et al. 2017

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“…Also, controlled trials prove that many hypnotics impair next-day driving performance. Moreover, hypnotics are epidemiologically associated with an increased rate of driver-at-fault vehicle crashes as well as falls and serious infections [13,[27][28][29][30][31][32][33][34][35][36]. Other studies show that hypnotic use is associated with new cancer incidence [37][38][39].…”

Section: Over-adjustment Of Confoundersmentioning

confidence: 99%

Mortality Risk of Hypnotics: Strengths and Limits of Evidence

Kripke

2015

Drug Saf

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Sleeping pills, more formally defined as hypnotics, are sedatives used to induce and maintain sleep. In a review of publications for the past 30 years, descriptive epidemiologic studies were identified that examined the mortality risk of hypnotics and related sedative-anxiolytics. Of the 34 studies estimating risk ratios, odds ratios, or hazard ratios, excess mortality associated with hypnotics was significant (p \ 0.05) in 24 studies including all 14 of the largest, contrasted with no studies at all suggesting that hypnotics ever prolong life. The studies had many limitations: possibly tending to overestimate risk, such as possible confounding by indication with other risk factors; confusing hypnotics with drugs having other indications; possible genetic confounders; and too much heterogeneity of studies for meta-analyses. There were balancing limitations possibly tending towards underestimates of risk such as limited power, excessive follow-up intervals with possible follow-up mixing of participants taking hypnotics with controls, missing dosage data for most studies, and over-adjustment of confounders. Epidemiologic association in itself is not adequate proof of causality, but there is proof that hypnotics cause death in overdoses; there is thorough understanding of how hypnotics euthanize animals and execute humans; and there is proof that hypnotics cause potentially lethal morbidities such as depression, infection, poor driving, suppressed respiration, and possibly cancer. Combining these proofs with consistent evidence of association, the great weight of evidence is that hypnotics cause huge risks of decreasing a patient's duration of survival. Key PointsMost sleeping pills e.g., benzodiazepines and ''Z'' benzodiazepine agonists (like eszopiclone) are associated with early death, and they most probably cause serious increases in mortality.Benzodiazepine agonist sleeping pills and diphenhydramine should not be prescribed for insomnia, except in long-term controlled trials and hospice care.

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“…Although it has been suggested that Z-drugs have a lower potential for abuse and dependence, 9 their use can also be problematic because of their effects on human performance and driving. 10,11 Because of these potential adverse effects, clinical practice guidelines have advised against the use of benzodiazepines and Z-drugs for longer than 4 weeks, and health agencies worldwide have undertaken anti-benzodiazepine and anti-Z-drug campaigns, not without controversy. [12][13][14][15][16][17][18] However, the dearth of published research studies on this subject suggests that such recommendations have not had a significant impact on the use of benzodiazepines and Z-drugs in various countries.…”

mentioning

confidence: 99%

Use of benzodiazepines and related drugs in Manitoba: a population-based study

et al. 2014

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Background: Despite their favourable toxicology profile, benzodiazepines and the related Z-drugs (zopiclone, zolpidem and zaleplon) have been associated with physiological tolerance, dependence and addiction. Evidence of harm (e.g., falls, motor vehicle collisions and cognitive disturbances) has been reported in older populations. The aim of this study was to determine the relation between users' characteristics and the use of benzodiazepines and Z-drugs in Manitoba over a 16-year period. Methods:This time-series analysis was based on prescription data from Apr. 1, 1996, to Mar. 31, 2012, obtained from the Drug Product Information Network database of Manitoba. We obtained sociodemographic information on benzodiazepine and Z-drug users from the Population Registry and determined changes in utilization rates over time using generalized estimating equations.Results: Overall, the prevalence of benzodiazepine use remained stable at about 61.0 per 1000 population between 1996/97 and 2011/12; however, the prevalence of Z-drug use increased steadily from 10.9 to 37.0 per 1000 over the same period. In older people (≥ 65 yr), the incidence of benzodiazepine use decreased from 55.5 to 30.3 users per 1000, whereas the incidence of Z-drug use increased from 7.3 to 20.3 users per 1000 over the study period. Among those 18-64 years of age, the incidence of benzodiazepine use decreased from 30.1 to 27.6 users per 1000, but the increase in incidence of Z-drug use was more than 2-fold. The youngest population (≤ 17 yr) showed the lowest rates of use of these drugs. The highest rates of use were observed among older women and the low-income population.Interpretation: Over the study period, benzodiazepines have been prescribed less frequently to older patients in Manitoba; however, zopiclone prescribing has continued to increase for all age groups. The reasons for this increase remain to be determined. AbstractCMAJ OPEN, 2(4) E209 Research CMAJ OPEN Methods Study populationAll Manitoba residents registered with the provincial health care system who were prescribed a benzodiazepine or a Z-drug between 1996/97 and 2011/12 were included. No age restrictions were applied, but patients were stratified by sex and age (0-17, 18-64 and ≥ 65 yr). Location of residence (urban v. rural) and socioeconomic status were also assessed. According to validated definitions, 23 incident (new) users were defined as people who had not received a prescription for any of the medications of interest in the year before receiving their first prescription, while prevalent users for each fiscal year were defined as people who had received at least 1 pres cription for a medication of interest that year.

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Benzodiazepine-Like Hypnotics and the Associated Risk of Road Traffic Accidents

Cited by 100 publications

References 20 publications

Long-term sedative use among community-dwelling adults: a population-based analysis

Long-term sedative use among community-dwelling adults: a population-based analysis

Mortality Risk of Hypnotics: Strengths and Limits of Evidence

Use of benzodiazepines and related drugs in Manitoba: a population-based study

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