News · Brain & Mental Health
Loneliness went with starting sedatives and opioids, in 29,976 middle-aged and older Canadians
Loneliness is tied to poorer health in many ways. In a large Canadian study, lonely adults were about twice as likely to start a benzodiazepine sedative, and more likely to start an opioid, over about three years.
- An observational study of 29,976 Canadians aged 45 to 85, tracked from 2011-2015 to 2015-2018.
- About 11% said they felt lonely at least occasionally when the study began.
- Lonely adults started a benzodiazepine sedative at about twice the rate of others, 2.8% against 1.3%.
- Opioid starts were also higher, 2.2% against 1.2%, but that link faded after accounting for mood and anxiety.
- Medicines were recorded by interviewers, but the study could not tell whether each prescription was justified.
Loneliness is often discussed as a feeling, but it can travel with anxiety, low mood and poor sleep. Those are also the complaints that can lead to a prescription for a sedative or a painkiller, medicines that carry real risks in later life.
A study in the journal Age and Ageing followed nearly 30,000 Canadians aged 45 to 85. Lonely adults were about twice as likely to start a benzodiazepine sedative over about three years, and more likely to start an opioid painkiller.
Why sedatives and opioids deserve caution
Benzodiazepines are sedative medicines prescribed for anxiety and sleep problems, and opioids are strong painkillers. MedlinePlus lists the prescription medicines most often misused, and notes that these include opioids, sedatives, tranquilizers, and stimulants. It adds that prescription drug misuse can affect anyone at any age, including teenagers and older adults.
Misuse is not the only concern. The authors note that a higher cumulative dose is associated with higher rates of falls and mortality, meaning death. Previously, the association between loneliness and incident use of benzodiazepines and opioids, meaning starting them for the first time, was unknown.
How the loneliness and medicines study worked
The data came from the Canadian Longitudinal Study on Aging, which enrolled 51 338 community-dwelling Canadian adults aged 45 to 85 years between 2011 and 2015 and checked in again between 2015 and 2018. At each visit, participants were asked to show the trained interviewer all regularly or occasionally used medications, rather than relying on memory alone.
The analysis included 29,976 people. Anyone already taking these medicines at the start was set aside when counting new use. Loneliness was measured with a question from a widely used depression questionnaire, and 10.8% were lonely (all the time or occasionally) at baseline. Lonely participants were slightly older, more often women, and more than twice as likely to live alone.
What happened to sedative and opioid prescriptions
Lonely adults were more likely to start both kinds of medicine. Lonely participants had a higher rate of incident use of benzodiazepines, 2.8% against 1.3%, and of opioids, 2.2% against 1.2%. After adjusting for other differences, the odds of starting a benzodiazepine were about twice as high, and of starting an opioid about 40% higher.
Mood made a difference to the picture. Loneliness remained significantly associated with use of benzodiazepines, but not opioids, after adjusting for mood and anxiety disorders. So the opioid link may run largely through depression and anxiety. The sedative link does not fully go away. Among lonely participants, women and non-white participants were more likely to start a benzodiazepine, and immigrants less likely.
Why the loneliness link matters for prescribing
A lonely person may see a doctor about poor sleep or anxiety. They may leave with a sedative, while the loneliness goes unaddressed. The authors suggest that multimodal interventions to deprescribe these medications in lonely individuals and decrease symptoms of loneliness could reduce the harms that follow. Deprescribing means carefully reducing or stopping medicines that may no longer be helping.
For doctors, the finding is a prompt to ask about loneliness when someone asks for help with sleep, anxiety or pain. For health systems, it adds to the case for social programs that tackle loneliness directly.
What an observational loneliness study cannot prove
This study shows a link, not that loneliness caused the prescriptions. Lonely people may differ in health and life circumstances in ways the analysis could not fully capture. Loneliness was measured with items from a depression scale, which are less well validated than some dedicated loneliness scales.
A medicine recorded by an interviewer does not prove it was taken, and the study could not measure doses or whether pills were taken only as needed. Some prescriptions will have been entirely appropriate, such as opioids for cancer pain or at the end of life, and the data could not tell which. Other sleep medicines with similar risks were not included.
What this changes for adults facing loneliness
For people who feel lonely, it is worth raising loneliness itself with a doctor, not only the sleeplessness or worry that comes with it. Community groups, volunteering, talking therapies and social prescribing programs may help with the root problem.
For anyone already taking a benzodiazepine or opioid, the answer is not to stop suddenly, which can be risky. A doctor or pharmacist can review whether the medicine is still needed and help reduce it safely if not.
People also ask
What did the study find?
Lonely participants had a higher rate of new benzodiazepine use (2.8% vs 1.3%; adjusted odds ratio 1.94) and new opioid use (2.2% vs 1.2%; adjusted odds ratio 1.43) than those who were not lonely. After adjusting for mood and anxiety disorders, loneliness remained linked to benzodiazepine use but not to opioid use.
What are benzodiazepines?
A group of sedative medicines, such as diazepam, lorazepam and alprazolam, prescribed for anxiety, sleep problems and some other conditions. In older adults they are linked to falls, confusion and dependence, especially at higher doses and with long-term use.
How was loneliness measured?
Participants answered a question from a widely used depression questionnaire about how often they felt lonely. Those who felt lonely all the time or occasionally were counted as lonely.
Why might loneliness lead to these prescriptions?
The study did not test reasons. Loneliness often comes with anxiety, low mood, poor sleep and pain, all of which can lead to a prescription, and the link to opioids faded once mood and anxiety were accounted for.
Does this mean lonely people are misusing medicines?
No. The study measured new use of these medicines, not misuse, and some prescriptions will have been entirely appropriate, such as pain relief for cancer or at the end of life.
What can someone do if they feel lonely?
Talk to a doctor about loneliness itself, not only about sleep or anxiety. Social contact, community programs and talking therapies may help, and a doctor can review any sedatives or painkillers. This is general information rather than medical advice.