With melatonin supplement use on the rise, experts ask if it should be prescription-only

As the number of people using over-the-counter melatonin supplements rises, Canadian sleep experts warn that many are using it incorrectly. A spokesperson for the Canadian Sleep Society even suggests that it should be only available with a prescription. A study published in JAMA in February 2022 found melatonin use increased from 0.4% of people surveyed in 1999-2000 to 2.1% in 2017-2018. More than 55,000 American adults took part in the survey. Sleep experts have spotted a similar trend in Canada. “Although we don’t have the same evaluation, many of my colleagues and myself have noticed the same thing where people are speaking about melatonin and using melatonin more often,” Mina Tadrous, a drug safety expert and assistant professor in the University of Toronto’s Leslie Dan faculty of pharmacy, told Radio Canada in February. “The problem is that sleep is a very complicated issue, and it’s sometimes correlated with other clinical factors,” said Tadrous. “So one of the concerns is that if people are just using melatonin as a Band-Aid, they might not be addressing an underlying issue.” Many patients are using melatonin as a treatment for insomnia, when it’s usually indicated for circadian rhythm disorder. “These are completely different disorders,” explained Jonathan Charest, a behavioural sleep medicine specialist and adjunct professor in the department of kinesiology at the University of Calgary and in the department of psychology at Université Laval. “The problem with melatonin is the misconception around it,” Charest said. “Melatonin is not a sleep inducer, it’s a time shifter.” Indeed, melatonin supplements are sometimes used to treat jet lag, or help patients get accustomed to shift work. Charest gave the example of the proper use of melatonin supplements to help a night owl become an earlier riser. The patient would work with a sleep expert to develop a plan of action, which may include taking 1 mg to 1.5 mg melatonin before bed, combined with other lifestyle interventions. Once the patient’s sleep-wake cycle is successfully shifted, melatonin would be discontinued. “Melatonin has never been intended to be used long-term but rather for a very specific manner and very specific timing to shift someone,” Charest said. Health Canada stressed in a 2015 safety review that melatonin should not be used for longer than four weeks without consulting a medical professional. Read: Study aims to encourage non-pharmacological treatment for insomnia in seniors Charest said those who use melatonin supplements to help them sleep could get stuck in a loop of poor sleep. Melatonin sends a signal to the brain that it’s time to sleep, but if patients are looking at a screen, they're stimulating their brains with the light. This means the melatonin lasts longer in the morning and leaves patients feeling groggy, so they reach for the supplements again the following night. He called misuse of melatonin supplements a “Trojan Horse” leading to prescription medication to help with sleep. “It should be behind the counter with a prescription,” Charest said. “It should not be available to everyone.” In the U.K., Melatonin is available only with a prescription, usually given as 2 mg slow-release tablets. In Australia, melatonin pills were only available with a prescription until June 2021, when people over age 55 were allowed to access them from pharmacies without a prescription. CADTH, Canada's drug and health technology agency, conducted a review of melatonin supplements for insomnia in 2019 and noted there was a need for Canadian guidelines on the use of melatonin supplements for sleep disorders. The lack of guidelines may be due to the lack of clear data surrounding melatonin’s effectiveness for insomnia. Read: Atlantic Canada's pharmacists want more responsibilities to ease burden on hospitals While melatonin supplements are considered safe, adverse events have been reported, including rare neurological side effects in children that sparked the 2015 safety review from Health Canada. The review concluded parents and caregivers should consult with a healthcare professional before giving melatonin to a child or adolescent. Health Canada has licensed more than 500 products containing melatonin through the Natural Health Products Regulations. A 2017 University of Guelph study found that the amount of melatonin in various products differed widely. The researchers analyzed 31 supplements and found that 71% of the supplements had a melatonin content that deviated by 10% of the labeled amount. Also, 26% of supplements were found to contain serotonin, a controlled substance. “There should be oversight to ensure that if people are buying melatonin that they’re actually getting what they thought they’re getting on the label,” Dr. Michael Mak, a psychiatrist at Toronto's Centre for Addiction and Mental Health and a sleep medicine specialist, told CBC News in February. Good sleep hygiene and stimulus control is a better option to help with insomnia. Charest noted that research suggests behavioural modifications are twice as likely to be successful as medications in helping with insomnia. “There’s no such thing as a quick fix, even though we want to believe it.” Read: New site aims to raise awareness around medication safety

With melatonin supplement use on the rise, experts ask if it should be prescription-only

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