Heavy use of addictive drugs among disabled
People receiving disability benefits in Norway use a lot of habit-forming sleeping pills and sedatives and continue using them over a long time.
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Benzodiazepines (BZD) are a psychoactive drug used in sleeping pills, sedatives and medications for epileptics.
We know them by their brand names such as Vival, Valium, Sobril or Flunipan (formerly Rohypnol).
These medications are habit-forming and health authorities advise against their long-term use.
Every other day
A recent study shows that 15-20 percent of all persons receiving disablement benefits in Norway are long-term users of BZD.
In other words they continue to renew prescriptions for these drugs year after year. Researchers have studied the data for prescription sales in the period 2004-2007.
In addition to using the drugs long-term, they also use a lot of them. Half of all the long-term users ran through their prescriptions at a rate equating to use every other day or more, year round.
“This is a pretty large percentage, no doubt about it. We were surprised when we saw it,” says researcher Ingeborg Hartz at the Norwegian Institute of Public Health and Hedmark University College.
More than one out of every ten Norwegian men and women receive disability benefits.
Also the young
The biggest BZD consumers are women on disability in the age group 44-49. A fourth of them are long-term users. This share is one fifth among disabled men in the same age bracket.
Use is fairly heavy among young people too, according to Hartz.
From 11-13 percent of the youngest people on disability are long-term users.
The researchers point out that this use is often combined with other addictive pharmaceutics.
In segments of the population not on disability a maximum of 6 percent use BZD long-term. The usage rate of 6 percent was women in the oldest age group.
“You could counter that one of the major causes of disability is mental health problems, but these medications are not recommended for use over periods of several years. This is because they can have side-effects,” says Hartz.
According to Hartz, use can lead to physical dependence and these pills can be hard to quit. Some of these drugs dull the senses and there’s a risk of a day-after effect, which can reduce functionality in daily life all the more.
A high share of long-term use among the youngest people on disability should probably rouse the most alarm:
“Once the use of BZD is established, there’s a high probability that it will continue,” says Hartz.
Medicated out of the work force?
She thinks the high numbers among disabled persons could be an expression of the difficulties people encounter when they don’t have jobs to go to.
The authorities have focused on trying to get people back into jobs.
Hartz thinks that many persons clearly need to be on disability, but there are surely many of them who could gain from participation in working life if given a work routine tailored to their capabilities.
“Work is a vital arena in our lives. If you lose it you can also lose your health as well,” says Hartz.
The researcher thinks it would be very interesting to find out whether people are being medicated out of a working life.
"With the data we have access to in Norway we have the opportunity to conduct studies of such issues,” she says.
Hartz stresses that the new study only describes a user pattern and it doesn’t provide an answer to whether long-term use of BZD is counterproductive to job rehabilitation.
Nevertheless, the researcher thinks that more emphasis on the ensuring proper use of potentially habit-forming prescription drugs among people receiving disability benefits might be one of many measures that could get people back into jobs.
Not long-term solution
What about the doctors who prescribe all these drugs?
“Doctors know that once a patient starts to use such medications there’s a big risk they’ll continue. But what do you do when people aren’t well? When they want something that enables them to sleep, calm down or feel comforted?
“It’s not easy being a doctor in such cases, when there are no alternatives at hand,” says Hartz.
Would you say that these drugs are being overly prescribed?
“Plenty of people react when they see these figures. But the medical profession is divided on the issue,” says Hartz.
She adds that some think it’s natural that the figures are so high, because this is a segment of the population with a lot of mental problems.
“My thought is this: Okay, but is using these medications year after year a good solution? Should something else be done?”
Hartz hopes the new figures will trigger more debate between the health authorities and the physicians who prescribe such drugs.
Does this pose a challenge for our public mental health care agencies?
“I believe so, absolutely. Such medications shouldn’t be a long-term solution.”
Hartz thinks that treatment traditions are an important factor.
Passed on to new generations
She says it would be a thrill to link directly up with people who are on disability. What have they experienced when their health failed? How much support have they received to find suitable employment?
“This applies to the young people too. They could potentially have long work careers ahead of them. Perhaps the medications they take are one of several factors consolidating their disability situation,” says Hartz.
She is currently working on another study centring on how the use of habit-forming prescription drugs can carry over from one generation to the next.
“This use is propagated from mother to child. If a mother is on disability, that’s a risk factor for the use of addictive pharmaceutics among her children. So it doesn’t stop with the figures we see now. It will pass on to the next generation,” says Hartz.
The study of persons receiving disability insurance and use of BZD included over 2.2 million persons aged 25-61 who were registered in the national census of 2001 and were still alive in 2007.
Nearly 150,000 of these people were registered as receiving disability benefits.
Information about disability status was coupled with information from the Norwegian Prescription Database for the period 2004-2007.
“What’s unique about this study is the use of complete national registries of prescription drugs and persons receiving disability insurance,” says Hartz.
In Norway there are entire registries like this that can be coupled, based on individual National Insurance (Social Security) numbers. In the USA, for instance, this is impossible, according to the researcher.
“So we don’t have any way of comparing Norway to other countries regarding this type of prescription drug use and disability status,” says Hartz.
Translated by: Glenn Ostling