Tens of thousands of Israeli adults, including five percent of people 65 and over, use certain tranquilizers or sleeping pills too often, meaning at least once a day.
The figure comes from a report, issued by the Health Ministry Tuesday, on public health in Israel. Among member states of the Organization for Economic Cooperation and Development, only in Ireland and Portugal is there greater use of the class of drugs known as benzodiazepines.
Prescribed for conditions including anxiety, insomnia, panic disorders and seizures, the group includes Valium, Clonex (Clonazepam, Klonopin), Lorivan (Lorazepam, Ativan), Bondormin (Brotizolam), Xanax, Vaben (Oxazepam, Serepax) and Ambien.
Benzodiazepines work by slowing down the brain and the central nervous system, and are considered effective. But they are supposed to be used for a few weeks only, in order to avoid dependence and side effects that can include drowsiness, memory loss, loss of concentration and balance problems.
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Most of the people using these drugs are older women, because insomnia, anxiety and depression are all more common among postmenopausal women. According to the ministry’s report, the proportion of women over age 65 who overuse these drugs is 1.5 times higher than the proportion of men the same age — about six percent of women compared to only four percent of men.
Additionally, overuse of these drugs is twice as common among well-off women as it is among poor women, and the dosage tends to rise with age.
The report also found that postmenopausal women are often prescribed drugs whose prolonged use is bad for the elderly. About 2.5 percent of such women receive drugs defined as “long-lasting,” like Diazepam, Clorazepate and Nitrazepam. These slow-release drugs, when combined with elderly people’s slower metabolisms, lead to the drug accumulating in the body. They are therefore on the list of medications that the American Geriatrics Society doesn’t recommend for use by the elderly.
“Many international organizations recommend avoiding use of these drugs in general, and especially long-term, given their negative effects — memory problems, instability, falls and more,” said Dr. Carmil Azran, a pharmacist who heads Herzliya Medical Center’s department of quality control, safety and infection prevention.
Nevertheless, she added, use of these drugs is widespread among the elderly. “We’ve seen a great many cases of patients who take one drug for anxiety during the day and another at night. Many of them haven’t heard about other techniques for improving sleep quality, of concepts like ‘sleep hygiene’ or drugs from other families, like melatonin.”
Both in Israel and other Western countries, the fact that doctors prescribe anxiety and sleeping pills in large quantities has been widely criticized for years. Use of these drugs is very common in the West, and it is increasing due to rising life expectancies.
A 2016 study by the Mayo Clinic in California found that more than 10 percent of American women aged 65 to 80 and six percent of men the same age filled at least one prescription for benzodiazepines over the course of a year. About a third of them received the drugs for more than 120 days a year.
Another class of drugs that is widely overused is antibiotics, whose waning effectiveness as bacteria develop resistance is one of the most burning issues on today’s medical agenda. Unnecessary use of broad-spectrum antibiotics, which enable large groups of bacteria to develop resistance, has been one of the factors contributing to the spread of such bacteria.
Compared to other OECD countries, Israel makes widespread use of two categories of broad-spectrum antibiotics, cyclosporines and quinolones, said Prof. Ronit Calderon-Margalit. She argued that a national plan is needed to reduce the use of antibiotics.
Of all the antibiotics prescribed by community clinics, 22 percent are broad-spectrum, compared to an OECD average of 18 percent. And in most Western European countries, the rates are much lower — six percent in Sweden, four percent in Britain and three percent in Denmark.
On another issue, the ministry’s report found that 62 percent of Israeli men aged 20 to 64 and 53 percent of women the same age are overweight or obese.
But for the first time, it also showed a decline in the proportion of the population with diabetes, to 9.6 percent. In addition, it found that the proportion of diabetics whose situation has stabilized has risen sharply since 2013.
On the down side, however, it found that the proportion of diabetics experiencing kidney failure — a complication that can necessitate dialysis treatment and can be fatal — is rising. There are currently some 600,000 people with diabetes in Israel and 600,000 more who are prediabetic.