On the Use of Sleeping Pills 7th July 2001

“Tranquilizers”　　　　　　　　　 16th June 2001
Hazards Increasing Anxiety by Anti-Anxiety Agents

By HAMA, Rokuro
Chairman: NPO Japan Institute of Pharmacovigilance

　Very sad murders have happened in Osaka in which more than ten of elementary-school children were killed and wounded. Today, I would like to write on the tranquilizers that were one of the issues in this case.

　As it seems denied that tranquilizer was used immediately before the murder, I cannot say whether the drug affected the case or not. But I could say that it is true that tranquilizers are easily abused, although there are many people who truly need tranquilizers. Almost one third of patients are using this group of drugs.

　For example, sleeping pills are one of these groups. There are many people who became paradoxically anxious and unstable by tranquillizers.

　One group of tranquilizers is “neuroleptics” for psychotic diseases such as schizophrenia and the other is anti-anxiety drug for neurosis with extreme anxiety.

　The former was formerly called as major tranquillizer that is very strong not only in efficacy but also in adverse effects. On the other hand the latter was formerly called as minor tranquilizer. But it is not merely gentle or tender. Some of them are very strong for sleeping pills with very rapid action. Their harm is sometimes big.

　For example, Triazolam (Brand name is Halcion etc.) is a drug of social issue about ten years ago. It acts well with rapidly falling asleep and easily getting awake initially. So it is easily abused. It is underground-marketed with high price.

　But the duration of action is only about 3 hours. One tends to get awake at midnight and to get difficult to re-sleep. One tends to be dependent on the drug if one habitually uses it. Ability for judge and for memory in daytime may decrease; one may tend to be irritable, anxious or agitated. Elderly person may have dementia-like symptom with this drug. Dependent person may be convulsed or hallucinated with withdrawal symptom when one stopped taking it suddenly. It is very similar to alcohol in many respects.

　One may be unable to remember what he or she did if one take the drug and get up at night even though he or she apparently behave normal as if deep drunken may loose his memory. This phenomenon is called antegrade amnesia.

　A murder case by a dependent person happened in the United States. The drug was banned in UK and in the Netherlands but it is a very commonly prescribed drug in Japan.

It should be recognized that the drug hazards by anti-anxiety drugs might threaten the society.