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Home > Use of sedatives or tranquillisers and anti-depressants in Ireland.

Horgan, Justine and Long, Jean (2013) Use of sedatives or tranquillisers and anti-depressants in Ireland. Drugnet Ireland, Issue 44, Winter 2012, pp. 1-3.

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 The National Advisory Committee on Drugs (NACD) recently published Bulletin 6 in the series of reports on the 2010/11 general population survey on drug use in Ireland and Northern Ireland.1 The bulletin reports the prevalence of sedative or tranquilliser and anti-depressant use among adults aged 15–64 years.  

This article summarises, in separate sections, the 2010/11 survey findings on sedative or tranquilliser use and on anti-depressant use in terms of lifetime (ever), last-year (recent) and-last month (current) use, and compares them with the 2006/7 survey results.
 
 
Sedatives or tranquillisers
‘Sedatives’ and ‘tranquillisers’ are commonly used terms for a group of medicines which depress brain and central nervous system activity.2 Benzodiazepines are the most common type of drug in this group; the ‘Z-drugs’, such as zolpidem and zopiclone, are also included in this group and have the same effect. Medically, sedatives or tranquillisers are often referred to as hypnotics (which treat insomnia) or anxiolytics (which relieve anxiety). The same drug can be used as a hypnotic or as an anti-anxiety agent depending on the dosage used and on the time of day that it is consumed.  
 
Key findings: sedatives or tranquillisers
  • Prevalence rates were 14% for lifetime use, 7% for last-year use and 3% for last-month use. There were statistically significant increases in the lifetime rate (up by 32%) and the last-year rate (up by 38%) since the last survey. 
  • The prevalence rates for women were somewhat higher than those for men on all three measures: lifetime use (16% vs 12%), last-year use (7% vs 6%) and last-month use (3% vs 2%). 
  • The lifetime prevalence rate for men increased by 55% since the last survey, while the rate for women increased by 17%. The last-year prevalence rate for men increased by 54%, while the rate for women increased by 28%. Overall, the gap between men and women in terms of lifetime and last-year rates has narrowed.
  • Prevalence rates were higher among older adults (aged 35–64) than younger adults (aged 15–34) on all three measures: lifetime use (17% vs 10%), last-year use (8% vs 5%) and last-month use (4% vs 1%). Lifetime and last-year rates increased in both age groups since the last survey, but the increases were substantially larger for the younger adult group. Lifetime rates for young adults increased by 71%, compared to 16% for older adults; last-year rates increased by 92%, compared to 20% for older adults. As a consequence, the gap between the older and younger age groups in terms of lifetime and last-year use has narrowed. 
  • The median age at first use was 30 years, and was lower among men (28 years) than women (30 years).   
  • More than half (53%) of current users of sedatives or tranquillisers had taken them on 20 or more of the 30 days prior to the survey. Almost all (95%) said they had got the medicines on prescription from a doctor.  
  • Rates of use of sedatives or tranquillisers were highest at both ends of the social spectrum (among professionals and managers and among those who were dependent on long-term social assistance).  
  • Prevalence rates were higher among people who were separated, divorced or widowed than among married or co-habiting people.  
Discussion: sedatives or tranquillisers
The misuse of certain prescribed medicines, including sedatives or tranquillisers, is of increasing concern in Europe,3 and is reported as a growing health problem globally.4 Such medicines can be more easily obtained than illicit drugs, and the potential for their misuse is widespread. In Ireland, these medicines are legally and appropriately prescribed to patients to treat medical conditions, including some mental health illnesses (such as anxiety, depression and other mood disorders). Their use for short periods of time is recommended to allow doctors or other health professionals and patients deal with or stabilise an underlying condition.
 
The NACD survey is an important source of information to establish the extent and nature of use of these prescription medicines in the general population in Ireland and to identify which population groups are more likely to be prescribed such drugs. The 2010/11 NACD survey highlights several issues for attention.
 
The results show that the proportion of people using sedatives or tranquillisers has grown in recent years in Ireland. The reasons for this are not clear. Prevalence rates increased among the groups traditionally associated with these medicines (that is, women and the older population). However, the largest increases were in the rates of use by men and by young people. It is important to continue monitoring use of these drugs and to develop a better understanding of the patterns of use in sub-populations.5  
 
The survey also raises questions about the safety of the pattern of sedative or tranquilliser use in the general population. Clinical guidelines6,7 recommend that, particularly with regard to anxiety-related conditions, many of these medicines should be prescribed for short-term (2–4 weeks) relief and taken for the shortest duration of time, with the least frequency possible, so as to avoid tolerance, drug dependence and the adverse effects of long-term use. However, the survey shows that over half (53%) of all current users reported daily or almost daily use; the proportion rose to 63% in the older adult group. It is important to note that current users in Ireland are engaging in this frequency of use for periods of longer than one month and many may be at risk of experiencing a range of side effects, including dependence. Clinicians can play a critical role in identifying patients who may be at risk of overuse.
 
The NACD surveys show that social class plays a role in sedative or tranquilliser use. Key indicators of socio-economic deprivation, such as being unemployed, having low educational attainment or fewer years in education, and living in social housing, were associated with higher prevalence for sedative use in the 2002/3 and 2006/7 surveys. Results from the 2010/11 survey, however, show a departure from this general pattern in that prevalence rates are now highest among those who are unemployed/without employment, followed by those in managerial or professional occupations. An explanation offered for this new pattern is that it reflects a response to the stress of deteriorating economic conditions in Ireland. However, the fall-out from the recession will have impacted all occupational groups and it is difficult to see why managers and higher professionals would have resorted to sedatives or tranquillisers more than other social groups.
 
General practitioners everywhere need to be aware that the medicine they prescribe may be over used or diverted from the intended patient and fall into the wrong hands.4 A more considered approach by health care professionals to alternative (and complementary) treatments where appropriate, as well as efforts to inform the general population on the safe and effective use of sedatives or tranquillisers and on the viability of other treatments, may be effective in reducing their use in the future. 
 
Alex White TD, Minister of State at the Department of Health with responsibility for primary care, is considering imposing additional controls on the main sedatives and tranquillisers, such as benzodiazepines and ‘Z-drugs’. The legislative amendments being considered include the introduction of an offence of unauthorised possession, as well as controls on the import and export, of such drugs.8 It is also proposed to tighten the prescribing and dispensing rules applying to these drugs. One of the main challenges in formulating policy to reduce the misuse or over-use of these medicines is doing so in a way that does not interfere with appropriate use.  
 
Anti-depressants
An anti-depressant is a prescribed medicine used to alleviate medical conditions known as mood disorders (which include major depression, chronic depression and anxiety disorders). Two examples of anti-depressants are serotonin re-uptake inhibitors (SSRIs) and serotonin and noradrenaline re-uptake inhibitors (SNRIs). The former are used as a first-line treatment for depression, while the latter are used to treat patients who do not respond to first-line treatment.
 
Key findings: anti-depressants
  • In 2010/11 the prevalence rates among adults (aged 15–64 years) were 10% for lifetime use, 5% for last-year use and 4% for last-month use. The rate for last-month use increased by 29% since the 2006/7 survey.
  • Prevalence rates for women were higher than those for men on all three measures: lifetime use (13% vs 8%), last-year use (6% vs 4%) and last-month use (5% vs 2%).
  • The lifetime rate for men increased by 41% since the last survey, while the rate for women was unchanged. The last-year prevalence rate for men increased by 33%, and the rate for women was unchanged. Overall, the gap between men and women in terms of lifetime and last-year rates has narrowed.
  • Lifetime rates for older adults increased by 21%, from 11% in 2006/7 to 13% in 2010/11. No statistically significant changes were found over time among young adults. 
  • The median age at first use was 30 years, two years earlier than the median age reported in 2006/7, and was lower for women (30 years) than for men (34 years).
  • The vast majority (92%) of current users reported taking anti-depressants on 20 or more days in the month before the survey, and 99% reported getting the medicine on prescription from a doctor.
  • Prevalence rates were highest for those who were dependent long-term on social assistance, and lowest for professionals and managers.
  • Prevalence rates were higher for people who were separated, divorced or widowed than for married or co-habiting people. 
1. NACD and PHIRB (2012) Drug use in Ireland and Northern Ireland. 2010/11 Drug Prevalence Survey: sedatives or tranquillisers and anti-depressants results. Bulletin 6. Dublin: NACD & PHIRB.www.drugsandalcohol.ie/18660
2. Phillis JW and Wu PH (1982) The effect of various centrally active drugs on adenosine uptake by the central nervous system. Comparative Biochemistry and Physiology, 72(2): 179–187.
3. Casati A, Sedefov R and Pfeiffer-Gerschel T (2012) Misuse of medicines in the European Union: a systematic review of the literature. Addiction Research, 18(5): 228–245. www.ncbi.nlm.nih.gov/pubmed/22572594
4. United Nations Office on Drugs and Crime (2011) The non-medical use of prescription drugs: policy direction issues. Discussion paper. Vienna: United Nations Office on Drugs and Crime.
5. McLarnon M, Monaghan T, Stewart S and Barrett SP (2011) Drug misuse and diversion in adults prescribed anxiolytics and sedatives. Pharmacotherapy, 31(3): 262–272 www.ncbi.nlm.nih.gov/pubmed/21361736
6. Department of Health and Children (2002) Benzodiazepines: good practice guidelines for clinicians. Dublin: Department of Health and Children. www.drugsandalcohol.ie/5349
7. Health Service Executive and Irish College of General Practitioners (2006) Guidelines for the management of depression and anxiety disorders in primary care. Dublin: HSE. http://lenus.ie/hse/handle/10147/45510
8. Department of Health (2012, 23 October) Launch of research findings on the use of sedatives, tranquillisers and anti-depressants. Press release issued by the Department of Health on publication of NACD survey results. http://health.gov.ie/blog/press-release/the-nacda-launched-the-drug-use-in-ireland-and-northern-ireland-20102011-drug-prevalence-survey-polydrug-use-bulletin/

 

Item Type
Article
Publication Type
Irish-related, Open Access, Article
Drug Type
CNS depressants / Sedatives, Prescription/Over the counter
Intervention Type
Screening / Assessment
Issue Title
Issue 44, Winter 2012
Date
January 2013
Page Range
pp. 1-3
Publisher
Health Research Board
Volume
Issue 44, Winter 2012
EndNote
Accession Number
HRB (Electronic Only)

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