'Concerning' Rate of Benzo/Z-Drug Use in IBD

Megan Brooks

September 15, 2022

Patients with inflammatory bowel disease (IBD) are 70% more likely to use benzodiazepines and "Z-drugs" than are the general population, a large study from Canada suggests. 

Mood/anxiety disorders and sleep disorders are common in patients with IBD, but few studies have looked at use of benzodiazepine and Z-drugs (such as zolpidem, zaleplon, and eszopiclone) in this patient population.

The results are "concerning, and especially as the IBD population ages, these drugs are associated with health risks, including something as simple as falls," first author Charles Bernstein, MD, University of Manitoba IBD Clinical and Research Centre, Winnipeg, told Medscape Medical News.

"Clinicians need to find better strategies to deal with anxiety disorders and sleep disorders in the IBD population," Bernstein said.

The study was published online in The American Journal of Gastroenterology.

High Burden of Use

Using administrative data from Manitoba, Bernstein and colleagues identified 5741 patients with IBD (2381 with Crohn's disease and 3360 with ulcerative colitis) and matched them (1:5) to 28,661 population controls without IBD.

Over a 20-year period (1997-2017), there was a "high burden" of benzodiazepine and Z-drug use in the IBD population. In 2017, roughly 20% of Manitobans with IBD were using benzodiazepines, and 20% were using Z-drugs, the study team reports.

The benzodiazepine use rate (per 1000) was 28.06 in the IBD cohort vs 16.83 in the non-IBD population (adjusted rate ratio [RR], 1.67). The use rate for Z-drugs was 21.07 in the IBD cohort vs 11.26 in the non-IBD population (adjusted RR, 1.87).

Benzodiazepine use declined from 1997 to 2016, but it remained at least 50% higher in patients with IBD than in the general population over this period, the researchers found. The rate of Z-drug use also was higher in the IBD population than in the general population but remained stable over the 20-year study period.

Regardless of age, men and women had similarly high use rates for benzodiazepines, Z-drugs, and joint use of benzodiazepines and Z-drugs. The highest incidence rates for joint benzodiazepine and Z-drug use were in young adults (age 18-44 years), and these rates were similar among men and women.

Patients with IBD and a mood/anxiety disorder also were more likely to use benzodiazepines and Z-drugs and to be continuous users than were those without a mood/anxiety disorder.

Mental Health and IBD Go Hand-in-Hand

"The results are not very surprising, but they highlight the importance of mental health and mood disturbances in patients with IBD," Ashwin Ananthakrishnan, MBBS, MPH, with Massachusetts General Hospital and Harvard Medical School in Boston, who wasn't involved in the study, told Medscape Medical News.

"It is important for treating physicians to be aware of the important mental health implications of IBD diagnosis and disease activity, to screen patients for these disturbances, and to institute early effective interventions," Ananthakrishnan said.

Also offering perspective, Laurie Keefer, PhD, academic health psychologist and director of psychobehavioral research within the Division of Gastroenterology, Mount Sinai Health System, New York City, said that she is "concerned but not surprised" by the results of this study.

"One in three patients with IBD meets criteria for an anxiety disorder," Keefer told Medscape Medical News.

And with the ongoing mental health crisis and shortage of mental health providers, "gastroenterologists are, unfortunately, in the position where they may have to manage these issues," she said.

Keefer noted that when patients are first diagnosed with IBD, they will likely be on prednisone, and "an antidote" for the side effects of prednisone are benzodiazepines and sleeping medications because prednisone itself causes insomnia. "However, that's really just a band-aid," she said.

A major concern, said Keefer, is that young men and women who are diagnosed with IBD in their 20s may start using these drugs and become reliant on them.

"People do build up a tolerance to these drugs, so they need more and more to receive the same effect," she said.

A better approach is to figure out why patients are so anxious and teach them skills to manage their anxiety and sleep problems so that they're not dependent on these drugs, Keefer said.

"There are behavioral strategies that can help. These are harder to do, and they're not a quick fix. However, they are skills you can learn in your 20s and so when you have an IBD flare at 50, you have the skills to deal with it," she said.

"We just have to be a little more proactive in really encouraging patients to learn disease management skills," Keefer added.

The study was funded by the Canadian Institutes of Health Researc h and Crohn's and Colitis Canada. Bernstein has disclosed relationships with AbbVie Canada, Amgen Canada, Bristol-Myers Squibb Canada, Roche Canada, Janssen Canada, Sandoz Canada, Takeda and Takeda Canada, Pfizer Canada, Mylan Pharmaceuticals, and Medtronic Canada. Ananthakrishnan and Keefer report no relevant financial relationships.

Am J Gastroenterol. Published online August 22, 2022. Abstract

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