Montreal

Quebec doctors to face increased scrutiny for overprescription of anti-anxiety medication

The overprescription of benzodiazepines is sparking concern in Quebec and prompting the college of physicians to increase its scrutiny of doctors who prescribe them. 

College of Physicians says it will educate doctors who overprescribe benzos

Orange pills marked 'Clonazepam' and '0.5', meant to represent generic drugs.
Clonazepam, a benzodiazepine drug, is among those that experts warn doctors are prescribing too freely and not warning people of the possible side effects and dependency issues. (Joe O'Connal/Canadian Press)

The overprescription of benzodiazepines is sparking concern in Quebec and prompting the college of physicians to increase its scrutiny of doctors who prescribe them. 

Benzos, as they are colloquially called, are a class of drugs prescribed to treat anxiety, among other disorders. They include brand name drugs like Valium, Xanax and Ativan.

But experts say they can have dangerous side effects and can be habit-forming. 

"These medications are intended for short-term use for insomnia or anxiety," said Camille Gagnon, a pharmacist and associate director of the Canadian Medication Appropriateness and Deprescribing Network.  

"What we're concerned about is that most people do not use them for short term, in fact they use them for months or years."  

woman sitting
Camille Gagnon, a pharmacist and associate director of the Canadian Network for Appropriate Medication Use and Deprescription, says benzodiazepines should only be prescribed for short periods of time. (Radio-Canada)

Gagnon said about one in 10 people in Canada have a prescription for benzodiazepines. 

Twelve people who spoke to Radio-Canada's Enquête said they were prescribed the drugs by a doctor, but most said they were not warned about side effects, including life-altering withdrawal symptoms.

"There were no warnings about long-term hazards, the dangers of discontinuing treatment," said Jérémie Morin, a supervisor in a water treatment plant who turned to benzodiazepines to cope with the difficulty of alternating day and night shifts. 

His doctor gave him a prescription for 0.5-milligram tablets of lorazepam, a benzodiazepine drug used to treat anxiety disorders, that he could take, and renew, as much as he wanted.

man in plaid
Jérémie Morin, a supervisor in a water treatment plant, turned to benzos to cope with the difficulty of alternating day and night shifts. (Radio-Canada)

But he quickly became physically dependent. His personality changed; he became anxious, worried and afraid of open spaces. 

So he stopped taking the drugs cold turkey, which can be dangerous and even fatal. He says his doctors had never warned him about those risks, nor about the possibility of withdrawal symptoms. As the days went on, he felt constantly panicked and afraid.

"There was no way to relax, no way to unwind," he said. Without his partner's support, he would surely have died by suicide, he said. "I'd even given her the keys to my gun safe, because I'd reached that point."

James-Dean Trepanier said he became physically dependant on benzos without knowing what he was taking. 

After a gallbladder operation, he said his doctor offered him what he described as a muscle relaxant.

WATCH | Why benzos can be dangerous even if they're prescribed often: 

Quebec doctors need to warn patients about risks of using benzos, experts say

2 months ago
Duration 1:36
Benzodiazepines are often prescribed to treat anxiety, among other disorders. However, there are concerns that doctors in Quebec could be overprescribing and not doing enough to inform the patients about the serious risks.

"They told me it was a muscle relaxant and to take it when I had pain and it would relieve me," said Trepanier. "Never was I told that it was a benzodiazepine." 

It was only after eight years of taking the drug that he realized he had developed a physical dependency and tried to wean himself. But he, too, went into deep withdrawal.

His balance was off. He was anxious, sensitive to noise and to light. "I had to wear sunglasses indoors," he said. 

man sitting
James-Dean Trepanier said he got hooked on benzos without knowing it. It was only when he was coming off the drugs that he realized he was having withdrawal symptoms. (CBC)

But he said it was the unwillingness of several doctors to take his situation seriously that really bothered him. 

"If somebody goes to you and speaks to you about being unwell for any symptom, please believe them," he said. "If I would have had that support I would have been okay."

Trepanier said he doesn't blame the doctor who prescribed him the benzodiazepine because he believes they didn't know how dangerous the drugs could be despite the fact that the drug manufacturers' product monographs are very clear and detailed about the dangers and the side-effects these medications can have on some users.

Now, Quebec's College of Physicians says it will increase scrutiny of doctors who heavily prescribe benzodiazepines. The college announced in January that it would reach out to doctors who are among the highest prescribers of the drug.

RAMQ, which administers the public health insurance program in Quebec, will flag doctors who prescribe them and the college will follow up with individual doctors to ensure they are aware of the dangers the drugs pose.

In other provinces, medical associations are ahead of Quebec and already impose clear limits on benzodiazepine prescriptions. Alberta, for example, limits initial benzodiazepine prescriptions to seven doses and Nova Scotia, where benzodiazepine use is highest in Canada, limits dosage to two to four weeks.

ABOUT THE AUTHOR

Matthew Lapierre is a digital journalist at CBC Montreal. He previously worked for the Montreal Gazette and the Globe and Mail. You can reach him at matthew.lapierre@cbc.ca.

With files from Brigitte Noel, Alison Northcott and Steve Rukavina

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