Sex and Gender-based Analysis of this topic
Definition
Women’s use of benzodiazepines and sleeping pills has been identified as a critical health issue for many years. Benzodiazepines are some of the most commonly prescribed, including drugs like Xanax and Ativan, and are used to treat anxiety, tension, and insomnia by slowing down the nervous system. It is estimated that 1 in 10 Canadians report using a benzodiazepine at least once a year and continue using them for at least one year [1].
Addiction to benzodiazepines usually occurs within one month, while tolerance to the sleeping effect of benzodiazepines and sleeping pills can occur within 7 days of initial use. Reducing the medication often results in a long withdrawal and recovery period that may last up to one year, including symptoms of insomnia, anxiety/panic, and depression, to name a few. Surprisingly, these withdrawal symptoms can begin while the person is taking the medication, which may result in the person being prescribed more medication to deal with these symptoms [2].
Sex Issues
Women process drugs differently at the molecular level due to lower body weights and organ sizes and a higher percentage of body fat, resulting in differences in the way women react to the medication. Monthly hormone cycles may also affect the way that benzodiazepines or antidepressants are absorbed, distributed, and eliminated from the body. As well, women may be less sensitive to the effect of anesthesia and thus, may be more likely to be awake during surgery and take longer to return to pre-operative health status, suggesting that sex hormones may affect anesthetics [3].
Gender Issues
Women are more likely to be prescribed benzodiazepines when presenting to the doctor for non-medical symptoms, such as stress and grief or life changes, such as childbirth and menopause. Women are also more likely to be prescribed benzodiazepines for longer periods of time compared to men, contrary to the general consensus in the research community advocating only short-term benzodiazepine use [4]. Women may be more likely to abuse prescription drugs because they are more likely to have a regular doctor than men. Additionally, women take more over-the-counter medications, herbal remedies, and vitamins, putting them at risk of adverse drug reactions [5]. A survey of BC high school students found that girls were more likely to use prescription pills without a doctor’s consent compared to boys, 11% versus 7%, respectively [6].
Diversity
Women, specifically elderly women, are the most vulnerable to the side effects of benzodiazepine use. The long-term use of benzodiazepines and sleeping pills among elderly women increases with age and has been linked to an increased risk of falls and hip and femur fractures [7]. Indo-Canadian women are vulnerable to depression due to their social isolation, loss of extended family support, and domestic violence. These risks put them in danger of being over-prescribed benzodiazepines and anti-depressants [8].
Rates of benzodiazepine and sleeping pill use are high among both Aboriginal men and women, with Aboriginal women twice as likely as Aboriginal men to receive benzodiazepine prescriptions [9]. Some researchers suggest that rates may be high in the Aboriginal community because the medication may be used to numb the physical and mental pain in relation to living in poverty.
Critique
More information is needed in terms of benzodiazepine and sleeping pill prescribing, including the patterns of use among specific subpopulations of women. For example, more research is needed to determine why rates of benzodiazepine use among Aboriginal women are so high when less addictive medications like anti-depressants could be used. More comprehensive surveillance systems are needed to monitor the effects of long-term benzodiazepine and sleeping pill use and to determine the specific effects that these drugs have on women long-term.