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

The misuse of benzodiazepines is sparking concern in Quebec and prompting the college of physicians to increase its scrutiny of doctors who overprescribe 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, especially when misused. 

“These medications are intended for short-term use for insomnia or anxiety,” said Camille Gagnon, a pharmacist and associate director of the Canadian Network for Appropriate Medication Use and Deprescription.  

“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.”  

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.

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

So he stopped taking the drugs, but then the withdrawal symptoms hit. 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 addicted to benzos without knowing what he was taking. 

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

“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 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. 

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.