On December 14, 2017, a school bus was hit by a train to Millas, in the Pyrénées-Orientales. The record is dramatic: six children lose their lives. A crucial question remains: why did the driver get on the train track as it approached? On April 4, we learn that she had been taking for seven years a hypnotic, the zopiclone (Imovane), with which the conduct is disadvised.
Immediately, family lawyers rush into the breach. "I will fight so that the doctors who follow her are also pursued", declares in September 2018 Me Jehanne Collard, lawyer of three families of victims. "For us, it would be appropriate [le médecin] be indicted for prescribing a medicine, incompatible with driving, to a woman whose job is to transport children ", she supports the 4 April 2019 after the announcement of these new elements.
If the zopiclone was recognized as having led to the accident, the medical responsibility, in particular of the prescriber could indeed be committed. "She drives a bus, it's a security post: the occupational doctor is also responsible for surveillance"explains Dr. Roy Didi, psychiatrist, court expert. "Moreover, at the prefecture, the medical commission of the driving license authorizes or not to drive, every five years. But if the driver failed to say that she was taking zopiclone, she could be held responsible. "
"Warning danger: do not drive." The logo on the back of each zopiclone box warns patients. This medicine can indeed impair alertness and therefore driving. "But that does not mean, as all media say, that driving is not allowed when you take this medicine. You just have to get the go-ahead from your doctor, " says Dr. Charles Mercier-Guyon, expert at Road Safety.
But it is also the duration of taking that seems excessive: seven years for a drug whose initial prescription is limited to twenty-eight days. The drug class of which zopiclone is a member – benzodiazepines and related – is highly addictive and, taken over the long term, can lead to dependence that is difficult to wean off. Beyond the questions of responsibility, this case recalls a public health problem: the overconsumption of benzodiazepines in connection with the trivialization of this extremely common disorder that is insomnia.
Extremely important figures
Molecules such as zopiclone are effective for treating acute and transient insomnia, as well as anxiety disorders. But when the durations get longer – sometimes for several years sometimes – it is not uncommon that the person can no longer pick up. In order to limit this prescription addiction, the prescription of benzodiazepines is limited to three months for anxiety disorders and twenty-eight days for insomnia, so that disorders are re-evaluated by the prescriber. Yet nothing prevents a doctor from renewing an order if he deems it necessary. "For this type of sleeping pills, hypnotic benzodiazepines, the doctor can prescribe for a month and then renew the prescription with the aim of controlling the need for taking the drug", explains Dr. Roy Didi.
Despite this re-evaluation, the figures for benzodiazepine consumption in France remain extremely important. In 2015, 16 million boxes of zopiclone were sold for a total of approximately 46.1 million boxes of benzodiazepines for hypnotic purposes. If we note a slight decrease in recent years, a large part of the population continues to regularly consume these molecules.
"The six benzodiazepines most consumed by psychoactive substance-dependent patients have remained the same since 2012."
About 13% of the French population take it at least once a year. Consumption is higher among women (16.6%) than men (9.7%). And this consumption increases with age: one-third of women over 65 consume a benzodiazepine anxiolytic and 18% a benzodiazepine hypnotic. Even more than 38% of women aged 80 and older are found. With the risk of turning insomniacs into real junkies.
Since 2017, zopidem (Stilnox) -molecule similar to zopiclone- requires a secure prescription such as morphine, Subutex or methadone. The National Agency for Health and Medicine (ANSM) warns against long-term use, misuse for recreational purposes and even notes an increase in cases of chemical submission with this molecule. "The six benzodiazepines reported to be the most consumed by psychoactive substance-dependent patients […] remain the same since 2012 ", observes the agency. Zopiclone is one of them.
Other, even more drastic restrictions had led to reductions in certain types of consumption, such as clonazepam (Rivotril), whose prescription had been limited in 2012 to only neurologists and pediatricians. Consumption fell by 84% between 2010 and 2015.
Hypnotics, it's not automatic
If the use of this type of sleeping aid is so common, it is that insomnia is an extremely widespread and very badly experienced by people who suffer from it. According to Inserm, 15 to 20% of French people suffer from insomnia, half of them in a severe form.
Faced with this demand, the use of sleeping pills is often the easy way: general practitioners – who are in the front line – prescribe 90% of benzodiazepines. In addition, the renewal of the prescription is all too often the result of an express request from the patients and an automatism of the doctors. Thus, it is not uncommon to see people – like the bus driver – taking these drugs for years, even decades.
However, many other causes are sources of insomnia: disorders of sleep hygiene bad habits through anxiety, depression or pain. With, for each cause, a specific management that often allows to do without benzodiazepine.
To limit these prescriptions and to treat this real public health problem, insomnia would benefit to be taken care of specifically, whether by the attending physician or by a specialist sleep doctor.