• From self-help to benzodiazepines: the lucrative business of dissatisfaction in Spain

Spain is the country in the world with the highest consumption of benzodiazepines, a drug included in the group of hypnosedants that is often prescribed for better sleep for its anxiolytic, hypnotic and muscle relaxant effect, according to data from the International Narcotics Control Board (INCB).

It is estimated that in 2020 almost 110 daily doses per 1,000 inhabitants were consumed in Spain. Only Belgium (84 daily doses) and Portugal (80) are close to the figures of Spain, from which geographically close countries such as Germany (0.04 daily doses) are very far away.

In addition, more recent data from the EDADEs 2022 survey have shown that 9.7 percent of the Spanish population had consumed hypnosedants with or without a prescription in the last 30 days, while 7.2 percent of the population admits to consuming these drugs daily.

"We live in a competitive and stressful society in which we must maintain routines that require staying at the limit of performance without anguish and without giving up. In this context, many find it difficult to face everyday problems and turn to chemistry to disconnect, mitigate anxiety or sleep. At the end of the day, to escape from an overwhelming daily reality, "said the psychiatrist of the Canalejas Mental Health Unit of Las Palmas de Gran Canaria, Mónica Florido, during the III Conference on Dual Pathology and Addictions in the Canary Islands, organized by the Spanish Society of Dual Pathology (SEPD), the Canary Islands Health Service and the Government of the Canary Islands.

This medicalization of life, he continues, has caused that many circumstances that are not pathological, but vital situations or daily life that are wrongly labeled as anxiety disorders or insomnia, end up being treated with psychotropic drugs "instead of resorting to a non-pharmacological intervention such as health education or some psychological intervention, which is an erroneous practice and with iatrogenic potential.

In that sense, the psychiatrist recalled that the clinical guidelines "are clear on this point" and indicate benzodiazepines, in mental health, for the symptomatic and temporary treatment of anxiety disorders and insomnia as a sleep disorder that accompanies another psychiatric disorder such as depression.

"They shouldn't be the first choice"

"It is important to note that benzodiazepines should not be the treatment of first choice in these cases, but an alternative treatment for specific cases. In any case, the approach to a clinical picture and the prescription of benzodiazepines must be preceded by a correct diagnosis and its use, in any of the situations, should be in the short term, "warned the expert.

That said, he recalled the adverse effects of these drugs, including tolerance, long-term dependence and other effects due to prolonged use such as traffic, domestic or work accidents, as well as other behavioral and behavioral alterations.

According to Florido, most of the hypnosedants consumed in Spain are prescribed by doctors, which complicates addressing their control, unlike what happens with other illegal substances. In this sense,the psychiatrist has highlighted the importance of doctors carrying out their work in accordance with the responsibility that entails, both professional and ethical.

In relation to medical liability, Florido has spoken of the importance of informed consent. "We are probably not informing patients correctly, although the guidelines are clear, both by scientific knowledge and by legal mandates and ethical standards, we do not always adjust clinical practice," he said.

According to The Trust Project criteria

Learn more