Drugs Most Often Prescribed for Insomnia
, Ohio Nearly one out of two visits to a doctor's office for
help with a sleep disorder result in the prescription of potentially
addictive medications, a 2005 study reported.
visits by older patients and those with publicly funded health insurance
plans were nearly twice as likely to result in the prescription of
these kinds of medications.
called benzodiazepines, are often a cheaper alternative to some newer
types of medicines that don't have the same potentially addictive
side effects, said Rajesh Balkrishnan, the study's lead author and
the Merrell Dow professor of pharmacy at Ohio State University .
of the most vulnerable populations in the United States are at greater
risk of receiving prescription sleep medication with a high abuse
potential," he said.
which appears in the current issue of the journal Sleep, includes
data from 94.6 million office visits in the United States over a six-year
period. Patients included in the data set sought help for sleep-related
difficulties in outpatient physician offices.
and his colleagues gathered six years of outpatient office visit data
from 1996 to 2001 from the National Ambulatory Medical
Care Survey (NAMCS). The NAMCS includes information on patient demographics,
the reason for a visit, a patient's diagnosis, the medication prescribed
and the therapeutic and preventive services recommended during that
visit. The majority of patients went to family practice physicians,
internal medicine providers or psychiatrists.
information from the NAMCS, the researchers analyzed the treatment
patterns of patients 18 and older who reported sleep problems.
two-thirds of those visits resulted in medication prescriptions for
a person's sleep difficulties, and three-quarters of those prescriptions
were for a benzodiazepine. (Five of the 13 kinds of benzodiazepines
on the market in the United States are indicated for treating insomnia.)
25 percent of patient visits for sleep disorders ended with prescriptions
for non-benzodiazepine medications.
were widely prescribed for anxiety and other stress-related problems
in the 1960s and 1970s. These drugs, which have a calming effect on
the nervous system, are still prescribed as muscle relaxants and tranquilizers.
(Valium is one example of a benzodiazepine, although it is not recommended
for treating insomnia in the United States.)
are usually effective for just a few weeks when used to treat insomnia.
But addiction can develop relatively quickly", Balkrishnan
person can develop a strong psychological and physical dependence
on these drugs in a short time, and experience severe withdrawal-like
symptoms once he stops taking the medication," he said.
visits by people 50 and older were about 5 times as likely to result
in a drug treatment for sleep problems as were visits by 18- to 34-year-olds.
65 and older were twice as likely as the 18- to 34-year-olds to receive
prescriptions for benzodiazepines. Visits by patients with Medicare
or Medicaid the federally subsidized health insurance plans
were also twice as likely to result in benzodiazepine prescriptions
as visits by patients with private health insurance.
were four times as likely to prescribe newer non-benzodiazepine drugs
during patient visits compared to family practice and internal medicine
may be more informed than other kinds of doctors about newer, non-benzodiazepine
drugs," Balkrishnan said. "Or psychiatrists may see patients
with more complex problems in whom other therapies such as over-the-counter
medications have failed.
the study suggests that some physicians do consider other options
before jumping to prescribe a drug to treat sleep problems,"
health care providers don't take public health insurance, Balkrishnan
said. This means that these patients, regardless of their age, are
more likely to receive cheaper benzodiazepines as treatments for their
people, 65 and older, with private health insurance were more likely
to receive benzodiazepines.
need to understand the reasons for these disparities in order to
stop this trend," Balkrishnan said. "There needs to be
a move toward a more uniform prescription system at least
for certain types of medications.
possibility is to create guidelines that say let's reserve the most
addictive benzodiazepines for patients for whom every other kind
of treatment has been unsuccessful."
the study did not look at the types of non-drug treatments prescribed
to treat sleep disorders, such as behavioral therapy, the researchers
found that nearly half (48 percent) of patient visits resulted in
a drug prescription, while 14 percent of the office visits resulted
in a combined prescription of medication and behavioral therapy. Just
five percent of patient visits resulted in prescribed behavioral therapy
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