Sedative Hypnotic Use in Alberta

By Kassam, Aliya; Carter, Brian et al. | Canadian Journal of Psychiatry, April 2006 | Go to article overview

Sedative Hypnotic Use in Alberta


Kassam, Aliya, Carter, Brian, Patten, Scott B., Canadian Journal of Psychiatry


Objective: Benzodiazepines and similar sedative-hypnotics (BDZ-SSHs) are associated with both beneficial and adverse effects. Pharmacoepidemiologic data describing the use of these medications in contemporary Canadian populations has not been readily available. Our objective was to examine the hypothesis that increasing use of antidepressant medications for anxiety and mood disorders during the past decade led to less frequent use of BDZ-SSH medications.

Method: We used data from an Alberta Mental Health Survey to describe the pattern of BDZ-SSH use and to estimate provincial and health region frequencies of use. We supplemented the data with pharmacy dispensing data from IMS Health.

Results: The frequency of use was comparable to that reported in previous studies. Unexpectedly, in the survey data, we observed trends suggesting regional variation both in the frequency and pattern of use. Examination of prescription dispensing data confirmed this pattern. Clinical factors, including the use of other psychotropic medications and psychiatric diagnoses, were strongly associated with BDZ-SSH use. Among the drugs examined, zopiclone had the highest frequency of use. Prescription dispensing data confirmed that the frequency of zopiclone use in Alberta is higher than that in most other provinces.

Conclusions: This descriptive study generates several new research questions and provides benchmarks for future pharmacoepidemiologic monitoring.

(Can J Psychiatry 2006;51:287-294)

Clinical Implications

* Regional differences exist within Alberta and across Canadian provinces in the use of BDZ-SSH drugs.

* The frequency of BDZ-SSH use increases with age.

* In Alberta, zopiclone is now the most frequently used hypnotic drug.

Limitations

* The survey component of this study relied on self-reported drug use data.

* The survey component of this study used random digit dialing, which results in underrepresentation of institutionalized and homeless individuals.

* Prescription dispensing data cannot confirm that purchased drugs were actually consumed.

Key Words: epidemiology, cross-sectional studies, sedative-hypnotic medications, mood disorders, anxiety disorders, population studies.

Pharmacoepidemiology is the study of medication use in real world populations. Pharmacoepidemiologic studies provide an opportunity to monitor therapeutic trends. Durring the past 2 decades, antidepressant medication use has increased in Canada (1) and other countries (2-5). Hypothetically, more effective treatment of mood and anxiety disorders could lead to a reduction in the use of sedative-hypnotic medications as symptomatic treatments for insomnia and anxiety. Further, the pattern of use in different population subgroups may change over time. In Alberta, the AMHS was conceived as a vehicle to monitor mental disorder prevalence as well as the frequency and adequacy of pharmacotherapy for mental disorders in the population. Data from this survey are useful in addressing key questions: What is the frequency of use of various classes of medication in the population? What factors are associated with a higher or lower frequency of use? This analysis presents estimates from the AMHS, supplemented by additional drug sales data from IMS Health Canada (www.imshealthcanada.com).

BDZ-SSHs are frequently prescribed. Collectively, these medications have a broad range of activity that includes anxiolytic, hypnotic, sedative, and anticonvulsant properties, with indications that vary by product, including anxiety disorders, insomnia, alcohol withdrawal, and skeletal muscle spasticity. In addition to their therapeutic properties, BDZ-SSHs are associated with adverse effects, including drowsiness, an increased risk of falls in the elderly, an increased frequency of motor vehicle accidents, dependence, and abuse (6-9).

The pharmacoepidemiology of BDZ-SSH use in contemporary Canadian populations has been inadequately described. …

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