Research investigates wrongful use of anxiolytics among women

The majority of women who use anxiolytics incorrectly buy them with a prescription but, despite being under a doctor’s care, are not given appropriate information on the risks of prolonged use of this type of drug.

By Karina Toledo

Agência FAPESP – The majority of women who use anxiolytics incorrectly buy them with a prescription but, despite being under a doctor’s care, are not given appropriate information on the risks of prolonged use of this type of drug.

These conclusions have been published in an article by researchers from Universidade Federal de São Paulo (Unifesp) in the magazine Ciência & Saúde Coletiva.

The qualitative study, which was financed by FAPESP and coordinated by Ana Regina Noto, was conducted to understand the patterns of the incorrect use of benzodiazepines and involved interviews of 33 women aged 18 to 60. This class of medicine is principally prescribed to treat anxiety and insomnia. Their use for more than four weeks, however, is not recommended given the risk of dependence.

In Unifesp’s study, cases that were defined as wrongful included patients who obtained the medication with a prescription and who consumed the drug in greater quantities or over longer periods than recommended.

“Epidemiological research has frequently indicated abuse of benzodiazepines, and we decided to investigate this phenomenon more deeply. We opted for women because the population of these studies indicates higher consumption,” explains Noto.

Of the 33 women interviewed, 24 said they were under a doctor’s care, and 30 affirmed buying the medicine with the appropriate prescription. Nevertheless, only five of those interviewed could cite the main instructions that should be given to anyone consuming benzodiazepines, such as avoiding usage with alcohol, not driving under the influence of the drug and the associated risk of dependence from prolonged use.

“Benzodiazepines are depressants of the central nervous system, and if consumed with alcohol, this effect is potentially increased. This reduces motor coordination and increases chances that a patient will be involved in several types of accidents. This is an important cause of falls in the elderly,” affirms the researcher.

The majority of those interviewed confirm having used the drugs for longer than the recommended time period. The time periods mentioned vary from 50 days to 37 years, with an average of 7 years.  Despite this fact, only 16 women recognized their dependence on the drug, and the majority stated that they prefer to assume the risks of chronic use to maintain the benefits of the drug.

“Some studies suggest that the use of benzodiazepines over many years can cause cognitive losses, principally affecting memory. However, dependence in itself is a major problem because it makes the patient lose his/her autonomy and the capacity to control his or her own behavior,” comments Noto. 

In the article, some patients admitted feeling desperation and anxiety upon realizing that their pills were running out and that they would have to be without the medicine. Some said that they feel irritation and difficulty sleeping when they are without the drug.

According to Noto, the majority of scientific research focuses on the consumption of illegal drugs, such as crack, cocaine and marijuana, but research should also examine the use of psychotropic drugs sold as medicine.

“The abuse of this type of drug is not as valued in society, but it happens. Dependency exists and is not identified. Notification is underreported,” Noto says.

Patients’ stories indicate that a fraction of doctors are aware of their abusive use and that doctors provide access to the medicine. “We had a hypothesis that these women acquired medicine in a clandestine manner, but this was not observed. The majority go through a doctor and get a prescription,” says the researcher.

The patients, she adds, have developed long-term strategies to guarantee access to the drug. “They change doctors or seek out a professional who will prescribe the medicine. They learn to make a complaint. They know that with the right words, they will obtain a prescription.”

When questioned about why they continue to prescribe the drug in these cases, the researcher says that doctors claim there are no alternatives in the public health system to manage their patients’ anxiety and insomnia.

“It would involve affording access to activities such as yoga, meditation and other relaxation techniques. Furthermore, it is necessary to raise the awareness of doctors to adequately guide patients,” Noto says.

The article, “Contexts and patterns of undue use of benzodiazepines among women,” is the result of a master’s thesis by Ana Rosa Lines de Souza, a FAPESP fellow who was mentored by Ana Regina Noto. The content can be accessed at www.cienciaesaudecoletiva.com.br/artigos/artigo_int.php?id_artigo=9703.