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Comment by Alex3917 | Hacker News Reader

Still happening today with sedative hypnotics (e.g. xanax, ambien), where a recent study estimated that these drugs were killing 300,000 - 500,000 Americans each year:

http://www.medicaldaily.com/news/20120228/9190/sleeping-pill...

This is despite the fact that the government recommends against prescribing them for longterm use since all the research shows that these drugs have zero efficacy (in fact negative efficacy) after the first ten days or so. And yet most doctors hand out longterm prescriptions for these drugs like candy since they either have no idea about this research or simply don't care. In fact they are some of the most widely prescribed drugs in the US.

(Note that it's not entirely clear that they really are killing 300 - 500k Americans each year, as other studies find no excess deaths, but what is clear is that the longterm use of them is terrible for you and that they have zero longterm efficacy in the first place.)

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The world health organisation has some information about the Z drugs.

People in France steal prescription pads - zopiclone is in the top ten list for medications that are obtained with stolen pads.

Dublin drug and alcohol clinics are reporting more people having trouble with zopiclone. People suggest that zopiclone is as addictive as diazepam (valium).

"Addiction" is a technical term, and zopiclone doesn't meet that definition, but people should be a bit careful when taking these meds. Especially if they're taking them long term.

Sleep hygiene is important, and even though there's plenty of information about it anecdote suggests people aren't often given that information.

Also, unfortunately, the best (evidence based) treatment for most insomnia -cognitive behaviour therapy (tailored for insomnia)- is hard to find.

Just over 2.4 million Americans died in 2010 (source: http://www.cdc.gov/nchs/fastats/deaths.htm).

So basically, this study is making the claim that prescription sleeping pills are responsible for 12-20% of all deaths in the U.S.

That sounds like a rather extraordinary, and probably exaggerated, claim.

  > a recent study estimated that these drugs were killing 
  > 300,000 - 500,000 Americans each year

Looks like sloppy epidemiology to me. The only way to nail a claim like that down would be to establish a control group with very similar life stressors, something you couldn't do from medical records. People take sleeping pills because they're under stress bad enough to keep them from sleeping, and that has an impact on survival rates.

  > what is clear is that the longterm use of them is terrible
  > for you and that they have zero longterm efficacy in the
  > first place.)

This is interesting. What's the evidence?

> This is interesting. What's the evidence?

I'd be interested to see the evidence for "terrible for you".

Hypnotics just make you sleep - they don't treat the cause of the insomnia. (For some people they're great at kicking you back into a routine.) There's evidence that long term use can create rebound insomnia.

Here's a guide for general public stating the need for using the meds short term:-

(http://www.nice.org.uk/nicemedia/pdf/TA077publicinfoenglish....)

Here's a slightly more technical document with links to the evidence that they used:

(http://www.nice.org.uk/nicemedia/pdf/TA077fullguidance.pdf)

Here's a guide aimed at clinicians with many links to good evidence:

(http://www.cks.nhs.uk/insomnia/evidence)

"This is interesting. What's the evidence?"

http://www.madinamerica.com/2011/11/anxiety/

The actual book (Anatomy of an Epidemic) explains it better, but those are just some quick links. They're also vastly more addictive than heroin. While the worst of heroin withdrawals are over in less than a week, benzo withdrawals can literally last over a year, with people unable to sleep and in severe pain that entire time:

http://en.wikipedia.org/wiki/Benzodiazepine_withdrawal_syndr...

This cannot be stressed enough. Benzodiazepines are insidious because people get used to taking them when they have trouble sleeping, and when they try to stop, they cannot sleep properly for a very long time. I have seen this happen with two of my friends, and it is painful just to watch. Not being able to sleep is a crippling enough horror that people go right back to consuming. To paraphrase Fight Club: NO, what you NEED is some exercise, good food, and to relax.

... and chew valerian root :) Fight Club is full of useful information, by the way (the book, too).

The Z drugs are not benzos.

To claim that the Z drugs are "vastly more addictive than heroin" is, frankly, ridiculous.

Rebound insomnia is nasty; and the Z drugs should be treated with respect; and sleep hygiene should be tried first; but it's stupid to scare people with nonsense like "addictive as heroin".

Epidemiology specifically does not and can not nail down claims, but rather provides probabilities of possible causal relationships.

It is a collection of statistical methods based on interpretation of available data, usually from public health records.

Anyone who complains that it doesn't prove anything outright has no idea of what it is, how it works or what it tries to achieve.

they either have no idea about this research or simply don't care

Alternatively, perhaps their patients have no idea about the research (or simply don't care)? Of course, a doctor does not have to bend to his patients' demands, but perhaps if they are pestered enough...

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