Posted by on Oct 20, 2020 in Uncategorized |

Sleeping pills in Ireland

 

According to an article published in the Irish Examiner on 19 September 2019:

“Doctors have six months to change how they prescribe anxiety and sleeping medicine to avoid disciplinary action by the Medical Council. The council has warned doctors that they could face an investigation if found to be over-prescribing benzodiazepines, z-drugs and pregabalin.”

The same day, RTE News published an article on the same subject titled ‘Doctors warned to reduce overprescribing of anxiety and sleeping medications’. In referring to the Medical Council, the article also stated:

“It has pointed in particular to benzodiazepines, which are used to treat severe anxiety or sleeping problems. Benzodiazepines are not for long-term use and can be dangerous when a patient develops an overreliance, or dependency, on such drugs. Medical Council President Dr Rita Doyle said the impact of inappropriate prescribing of certain drugs is having a significant impact on patient safety and well-being. The medicines of concern to the council, along with benzodiazepines, are a class of medicines called Z-drugs for insomnia …….”

Links to the above articles:

https://www.irishexaminer.com/breakingnews/ireland/doctors-warned-about-over-prescribing-anxiety-and-sleeping-medicine-951836.html

https://www.rte.ie/news/2019/0919/1076825-benzodiazepines/

In 2018, the Health Service Executive (HSE) Medicines Management Programme published a document titled ‘Guidance on appropriate prescribing of benzodiazepines and z-drugs (BZRA) in the treatment of anxiety and insomnia.’

The Irish guidance document cites the American College of Physicians (ACP) and states:

“The American College of Physicians (ACP) recommends that all adult patients receive CBT for insomnia (Cognitive Behavioural Therapy for Insomnia) as the initial treatment for chronic insomnia disorder. CBT for insomnia consists of a combination of treatments that include cognitive therapy around sleep, education (e.g. sleep hygiene) and behavioural interventions (e.g. sleep restriction and stimulus control). These nonpharmacological measures should be trialled before prescribing hypnotics.”

See page 14, section 7.2 of the guidance (see link below).

The Irish guidance document uses the term benzodiazepine receptor agonist (BZRA) in referring to benzodiazepine and z-drugs. Both of these drug types are used to treat insomnia. The document highlights the fact that there are various problems associated with the use of benzodiazepines. It lists these as including the following

  • Misuse
  • Dependency
  • Diversion
  • Morbidity & mortality related to overdose & withdrawal
  • Tolerance
  • Driving impairment

The document also notes that older people are more vulnerable to the adverse effects of benzodiazepines and their use in this group has been associated will falls, cognitive impairment and dementia. In addition, the document highlights the fact that dependence on benzodiazepines is recognised as a significant risk in patients receiving treatment for longer than one month.

In relation to Z-drugs, the Irish guidance document points out that although Z-drugs are structurally different from benzodiazepines they have the same pharmacological properties. Also, although they were developed with the intention of overcoming some of the disadvantages of benzodiazepines, such as next day sedation, dependence and withdrawal, there is no clear evidence of differences in effects between z-drugs and short-acting benzodiazepines. In common with the benzodiazepines, their sedative effects may persist the day after they are taken, and tolerance, dependence and withdrawal symptoms can also occur. (see pages 2 to 5 of the link below).

https://www.hse.ie/eng/about/who/cspd/ncps/medicines-management/bzra-for-anxiety-insomnia/bzraguidancemmpfeb18.pdf

For excellent information on sleeping pills and so-called “natural” sleep supplements, please visit the link below. Please note that this link is to an American site and some drug trade names mentioned may be different in Ireland. Also, some of the sleep supplements mentioned may not be available in Ireland or may need a prescription.

https://www.helpguide.org/articles/sleep/sleeping-pills-and-natural-sleep-aids.htm