Benzodiazepines: Our Other Prescription Drug Problem
journalistsresource.org
journalistsresource.org
Taking an SSRI has helped a lot, but there are times where I can feel a panic attack coming and know the only way to stop it is with a Xanax.
I regard benzodiazepines with a lot of respect. Their power is a blessing and a curse. Used responsibly, I believe they can be a very effective and safe tool to live a normal life free of panic attacks.
At this point, I rarely take them - one dose every month or two at most. But the knowledge that I have a tool to quell a panic attack, should I need it, has actually done more for me than the pills themselves. Knowing I’m not powerless gives me the strength to overcome the panic attacks on my own.
Recently, I’ve noticed doctors becoming more and more apprehensive about prescribing benzodiazepines. This is definitely a good thing - I think they should be reserved for severe cases as a last resort. But I also worry about a future where people who could have benefited greatly from them without abuse are denied a prescription.
There are times where I would've likely made poor decisions during an acute panic attack that was aborted quickly by benzos. The ability to say "stop now" -- hell, even the security of know there's a way to say "stop now" -- is important to coping with anxiety.
I took them infrequently at the beginning, like you now, 1 or 2 a month max and the past few years, I haven't taken any. I didn't even realize the connection to "Benzos" until ~6 month ago when a construction worker friend said all his coworkers were on it and I connected the dots.
Just having access to the pills for me is enough to keep my anxiety in check, hopefully something I can stop relying on some day. My doctor is moving, so I need to find another one who will be just my 3rd doctor in my 32 years of life. I hadn't thought about it until just now, but I am hope my new doctor will be as facilitating.
While techniques like CBT, meditation, diet have helped me a lot to fight my fears, there have been situations which I had to rely on meds to power thru - I call it going nuclear.
So yeah, this stuff is serious. And of course, my Lorazepam was prescribed legally, by a responsible, well regarded psychiatrist, with very little warning regarding how quickly one builds both tolerance and physiological dependence on this chemical.
Sorry to hear that. Mine told me to take at most 1mg no more than once a week for that reason. Seeing what that quantity does to me, I can't imagine dosing at that quantity or frequency (obviously you acquire a tolerance, but still).
In my case, I busted a gasket in my twenties. I went from the most capable person in the room, to the trembling guy who could barely leave his room. I can honestly say it ruined my life.
I was given a benzo with a long half life. It worked a bit, but I never fully recovered. I think we all know the drug. 40 hour half life.
I tried all kinds of medications over the years, and nothing worked except benzodiazepines , and alcohol. Yes--alcohol hits so many different parts of the brain, but is horrid on the body. I really tried to avoid alcohol, but some days the anxiety susptoms we just unbearable.
I've been on the long half life benzodiazepine for decades. I take the same dose low dose, and try not to drink.
I've never even asked my doctor, but he knows my low dose isn't going to cause physical problems. They are better than alcohol, if you're self-medicating. I belive his thinking is I need the drug. I've been on it forever. Why put him through a misserable detox, at this stage of the game?
There are a few big studies done on patients whom were on opiates, and benzodiazepines for long periods of time. They didn't necessarily need to increase their dosages. I believe the studies were done on rest home geriatric patients.
I feel at my age, what's the point of a long withdrawal. It's easy to say for myself because my doctor has reasonable rates. He is getting close to retirement, and that has me very worried. The last thing I want is a long misserable detox.
I don't like the way this drug problem is playing out. I don't like blaming doctors. All their patients are very different.
My wish is we let, especially Psychiatrists, make these hard calls concerning what's best for their patients. That's what they went to school for.
I don't know why we are even discussing it here.
I don't want to live in a world where doctors send their patients home a mess because they are afaird of being accused of some sinister reason for keeping a patient on a addictive drug.
In all reality, so many doctors just don't prescribe certain drugs. Probally, one of the main reasons why former patients go to the streets, or liquor stores.
(I would further like to see a governmental bill that would allow patients, whom have been on addictive drugs for years, the ability to authorize their own scripts. The Same dose, and any increase would require a doctor's visit. At this point my office visits are pointless. There is a bill that is in congress now I believe, but it's for drugs that aren't addictive. I doubt the AMA will ever let it pass though.)
The problem is that you look like someone who has done their research, is knowledgeable and self aware, and trying to (seemingly successfully) address a problem.
Lots and lots of people are nothing like that. They just want to get high. Escape reality at all costs, no matter the damage to themselves or others.
This isn't the drugs' problem or fault, obviously. Those people will use alcohol and other means to get fucked up and they will obtain the drugs they want illegaly anyway.
THE THING IS: While it's illegal to get those drugs, society can demonise those people and politicians can run with that as their platform.
Should drugs be made legal, all it will take is one idiot killing themselves or others while on drugs and suddenly it's the drugs' fault again, and the next politician running with a 'tough on drugs' stance will win.
People will look for blame and they will not do so rationally.
Self-driving cars will be dragged through the press for every accident there is, even if they are 10,000x less likely to crash. People are afraid of flying. Videogames are the reason for killing sprees, etc. etc.
I have friends and family members with chronic pain and, through them and their communities, have become aware of many people who use opiods on a long-term, occasional basis to manage their pain. A family member of mine who suffers from chronic migraine lives in fear that she won't be able to get an opiod which she uses as a last-ditch rescue treatment before she ends up at the ER (not to mention that she gets treated like a drug seeker when she does end up there).
I don't really see an alternative for acute intense pain; likewise an alternative for acute, intense anxiety. Meanwhile the crackdowns on these drugs also create a chilling effect for physicians. What do we do for people who fall in those categories?
(Edit: not to claim that abuse of these drugs is not a problem... It just seems like the people these drugs are inteded to help are being sidelined in the dialog on the topic.)
Benzos generally require you to taper off them, as I believe the withdrawal side-effects include seizures. You cannot safely "cold turkey" them.... so I hope they don't get all heavy-handed with them like they are for people who rely on opiods to treat chronic pain.
Actually the two really serve different purposes. Benzos are commonly prescribed as a way to manage panic attacks or other acute occurrences of anxiety. SSRIs can help reduce your anxiety over time, but take a long time to build up in your system. Often people are prescribed both simultaneously.
That's how they're supposed to be prescribed, but in this threaad we see a few people who take a daily benzo and have done for several months.
I actually broke free of the "have to carry Xanax on me at all times" chain that anyone with panic disorder can relate to by constantly reminding myself while driving that there is a convenience store or bar around the next corner (being stuck in traffic or a crowd sets mine off).
That being said, I am not advocating using alcohol over benzos it's health impact is far more devastating, but it is an effective tool for breaking the mental chain of having to carry benzos on you at all times, by knowing that you can end one with it if you need to. As the fear of having panic attacks in and of itself is just as debilitating.
As I mentioned in another response, I think marijuana is probably promising in this area as well but it will take a long time for us to derive treatment from it.
The longer lasting part is IMO better too, I have bad anxiety (and potentially on the spectrum), and knowing that I can take .25 or .5 (I'm prescribed .5) and get through the stress of something new or any other activity without a full on panic attack helps me out a lot. Just as an example, the idea of going shopping at the mall with a new friend (I'm in college btw) is already making me anxious as I write this(And this is just an example!).
Xanax seems like it'd be less helpful if I'm going to be hanging out for a while.
The "broad spectrum" products that have multiple active components are far more variable, clearly.
Imagine that marijuana is (at a minimum) federally rescheduled to schedule 2 in the US. How long will it take to research canniboid-based painkillers once drug companies can legally do so? How pong for FDA approval?
It will be a long time until there is an alternative that is taken seriously by anyone other than the most progressive physicians in the realm of cannabis, unfortunately.
Opioids are a more difficult problem. Some patients do need opioids, but we're not sure which. There is some evidence to suggest that opioids may worsen the long-term prognosis for many chronic pain patients. We need more research and better availability of psychosocial interventions and physiotherapy.
Etizolam is one such drug. It's prescribed in Japan and India, but not really anywhere else as far as I can tell. It has a lower potential for dependance than classical benzodiazepines and tolerance builds up a lot slower. Anecdotally from people I know who've taken it, its acute effects feel much more mild than Xanax or Valium. In my limited experience, Valium feels like you've been lobotomised, and Etizolam feels like you've been given a big hug.
If you look around the world, what is the solution there? The US is unique in the prescription of these drugs, but also unique in its reluctance to look around and say "what's everyone else doing that's working"?
I think here the answer is that it's fundamentally a different view on chronic pain (Acute pain is a different story- you don't prescribe a ton of opiates to someone who needs to keep it for emergencies).
The US is in no way unique for prescribing anxiolytics, benzos or otherwise
"In 2008, approximately 5.2% of US adults aged 18 to 80 years used benzodiazepines." [1]
Here "used" means filled at least one prescription during the year. This to me looks like an extremely high number, but I can't find a good number for comparable countries. I'd be very surpised if the rest of the OECD had a figure of even 1%
[1] https://www.researchgate.net/publication/269766767_Benzodiaz...
It seems like there's a problem in the general case though, if you have doctors that are a little too quick to prescribe benzos and refer the prescribing of antidepressants to a specialist. For those that live in an area with a shortage of mental health professionals, it might take a month or two to see a psychiatrist (and then maybe only after talking to a therapist or something first), and then maybe a few weeks more before the antidepressants start working, which is longer than anyone ought to be on benzos if they can at all help it.
This is the correct way to use opioids for long term pain, but it's only useful for a small number of people.
https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-awar...
"A small proportion of patients may obtain good pain relief with opioids in the long term if the dose can be kept low and especially if their use is intermittent (however it is difficult to identify these people at the point of opioid initiation".
This "small proportion" is in the UK context, where we are already prescribing much less opioids.
The mistake people make is to think that opioids are effective to treat long term pain. For most people they do not work to treat long term pain. The patient develops tolerance, needs increasing doses, and eventually they're taking dangerously high doses and also not getting pain relief.
We need to understand that there are limited treatments for chronic pain. Some people will need to lose weight and exercise. Some people may find a psychological treatment useful to either treat the pain or come to terms to live with the pain.
https://www.rcoa.ac.uk/node/21134
"Chronic pain can cause low mood, irritability, poor sleep and reduced ability to move around. Unlike acute pain, chronic pain is difficult to treat with most types of treatment helping less than a third of patients. Most treatments aim to help you self-manage your pain and improve what you can do. Different treatments work for different people. Medicines generally and opioids in particular are often not very effective for chronic pain. Other non-medicine treatments may be used such as electrical stimulating techniques (TENS machine), acupuncture, advice about activity and increasing physical fitness, and psychological treatments such as Cognitive Behaviour Therapy and meditation techniques such as mindfulness. Helping you understand about chronic pain is important and in particular helping you understand that physical activity does not usually cause further injury and is therefore safe. It is important that you understand that treatments tend not to be very effective and that the aim is to support you in functioning as well as possible."
"Neuropathic pain is a type of chronic pain associated with injury to nerves or the nervous system. Types of neuropathic pain include, sciatica following disc prolapse, nerve injury following spinal surgery, pain after infection such as shingles or HIV/AIDS, pain associated with diabetes, pain after amputation (phantom limb pain or stump pain) and pain associated with multiple sclerosis or stroke. Neuropathic pain is usually severe and unpleasant. Medicines may be used to treat neuropathic pain but are usually not very effective and work for a small proportion of people. You may not benefit from the first drug tried so you may need to try more than one drug to try and improve symptoms."
I get the feeling that you're not aware of the scale of over-prescribing in the US. The US prescribes hugely more opioids than other countries. For example, for a while the US was using 99% of the world supply of hydrocodone.
The US could correctly treat the small number of people who'd get benefit from occasionaly tightly controlled opioid prescribing while also massively reducing the total number of opioidprescriptions.
And for anxiety the story is similar. The evidence for efficacy of benzos isn't great.
https://www.nice.org.uk/guidance/cg113/chapter/Key-prioritie...
You need a stepped approach:
individual non-facilited self help
individual guided self help
psycho-educational groups (for one example see Recovery Colleges https://www.health.org.uk/recovery-college
If these don't work you offer a high intensity psychological intervention, or a medication.
Notice that for medication they say "Do not offer a benzodiazepine for the treatment of GAD in primary or secondary care except as a short-term measure during crises. Follow the advice in the 'British national formulary' on the use of a benzodiazepine in this context."
Every time the patient collects their benzos from the pharmacy there will be a patient information leaflet. Here's an example for diazepam: https://www.medicines.org.uk/emc/medicine/18061
I get the feeling that benzos are far more readily prescribed in the US, and for long times.
And this is a "journalist's resource," one associated with the Harvard Kennedy School? No wonder journalism is garbage these days.
In the first link in the article >the quantity of benzodiazepines they obtained more than tripled during that period, from 1.1-kg to 3.6-kg lorazepam-equivalents per 100,000 adults.
Presumably we can agree that a world in which prescriptions for methamphetamine have tripled might be a cause for concern, right? It's debatable whether this class of drugs has the same abuse and health risks, but based on my own reading and anecdotal experiences, I think they're pretty comparable.
[1] https://resobscura.blogspot.com/2012/06/from-quacks-to-quaal...
Luckily I am generally skeptical of pharmaceuticals, at least to the extent that I try to educate myself about them. So I did my own reading up about it. But even then, while online sources did indicate that benzos could be habit-forming, I did not see the strong language and terrible stories that are coming out now about benzo addiction.
So hopefully that illustrates the newsworthy issue: a lot of doctors, and even online medical info sites, did not adequately appreciate the risks of benzos, or warn people about those risks.
And since we're LSD as a potential therapeutic tool, as always I'm going to tack on this disclaimer: if using psychedelics as a therapeutic tool, make sure to take them in a positive environment (which your house might not be) with people you like and ensure that you have somebody with experience in psychedelics to guide you and assist you.
It is a very powerful tool for healing though. I know people who have used it (with the above precautions) to essentially overwrite negative memories and experiences. As always though, everybody has a different experience and it isn't as effective for some as for others, and people should be always careful with anything that fucks with your psyche in such a powerful way.
It also seems that, like opiates, it can vary a lot from person to person.
I've been fortunate, and the few times I've had occasion to try taking benzos for a non-hospital interval, they didn't do anything for me - positive, negative, or otherwise, without any sort of visible withdrawal effects when we stopped.
Conversely, there are people I know who have reported nasty side effects and dependency issues rather rapidly (in my own family, even).
I really think the way to move forward and minimize this see-sawing of public opinion on necessary evil versus unnecessary tool will be gaining better insight into people's personal response profiles to these things before and after giving them the drugs, so you can try to notice "huh, that's a lot higher concentration of those metabolites than I expect, I guess they process it fast" or "well that opioid sure is lighting up the reward parts of the brain, guess they're at decent risk for addiction."
(Unfortunately, I'd speculate we're at least 20y out from anything like that being ubiquitous/useful, so ...)
In the case of alcohol, it often takes years for addicts to reach a point where withdrawal becomes lethal. In the case of short acting benzodiazepines/barbiturates, this point can be reached in less than a month.
Of course, benzodiazepines are in schedule IV, which means they are viewed as being rather benign with no/low potential for abuse. In the eyes of the federal government, alprazolam (xanax) is far less dangerous than marijuana/the traditional psychedelics.
Just another data point demonstrating the utter absurdity of US drug legislation and regulation.
https://www.dea.gov/drug-scheduling
There's no planet where Ritalin has a higher potential for abuse and addiction than Xanax. Not to mention all the lower-risk drugs that have been categorized schedule I for political reasons.
Under the current system rohypnol is schedule IV but has special date rape laws passed to make possession of it punishable like a schedule I drug as a workaround.
Most of the prescription opiates such as Hydromorphone, Oxycodone, etc are schedule II as well.
>Not to mention all the lower-risk drugs that have been categorized schedule I for political reasons.
Not just for political reasons (clonazolam would be FAR superior than anything currently scheduled as a 'date-rape' drug, thanks for keeping us safe politicians), but also anything 'new' is often placed in schedule I by default, without any consideration as to the actual properties of the drug.
A great recent example of this is whenever the DEA moved to schedule kratom as schedule I. Kratom. The DEA, in an age where it gets constant flack for classifying marijuana as a schedule 1 drug, attempted to classify kratom as having more potential for abuse than Hydromorphone.
It's an absolute fucking sham, but goodluck seeking a political career while being seen as anything other than 'TOUGH ON DRUGS!'.
Omeprazole is not a controlled substance and is OTC in the United States.
You're right, the website that had showed up in google that I had used for my prilosec example is either incorrect or using some non-DEA scheduling sytem. I'll use another comparatively ridiculous example and re-edit my comments with the correction.
Said pathways have also given me the privilege of being able to quit cold turkey (in the se se that I suffered no crippling withdrawal symptoms or rebound effects, but man is it difficult to break the habit).
I count myself amongst the very lucky.
One should note that "three of them" is (probably) a lot. Even half a pill is often sufficient to quell panic attacks.
Half-life of Xanax varies between 6 and 29 hours, averaging 11.5 hours. A “pill” is an arbitrary amount and that’s not what I’m referring to. It’s the proportion that still affects you hours later and how long it lasts that matters, including that dosages can overlap.
It’s also important to note that tolerance develops of these drugs. Half a pill to you might be two for someone who is taking them every day for years. Tolerance to various effects develops to different extents, and perceived, subjective tolerance to dosages and impairment may be exceeded by measurable motor skill and judgment reduction.
If you take half a pill, you’re still on more than a quarter of a pill when you wake up the next day. If you take another half pill, you will be on more than a half pill.
Bad stuff unless you must have it.
Benzos are a respiratory depressant, and when combined with Methadone it amplifies it to the point where you stop breathing in your sleep and never wake up from respiratory failure, lack of oxygen to the brain, or your body freaks out and has a coronary episode, etc. it's really really risky -- no joke & no exaggeration. If alcohol is in the mix too then it's even worse.
And I'm not going to pretend like it's not enjoyable -- because it is. It's a great fuckin' buzz if downers are your thing. IMO it's better than heroin (no 'rush' to it, but the effects hit you like a ton of bricks and it lasts all night long. And it's a cheap buzz too), but it's also asking for your life to end.
methadone clinics know this and every one that I've ever seen, heard of, or been to personally Benzos are their one big 'no-no' [as in: if we find it in your Whiz Quiz we kick you out, some won't even give you a second chance and most clinics have mandatory urine screening twice a month, some every week]. You can test positive for damn near anything else -- and they expect you to test positive for opiates -- but if you have benzos in there then you kick rocks.
And it was explained to me at 3 different clinics in 3 different areas of the country that it was really about #1) liability -- particularly at clinics that accepted insurance for payment but not exclusively, there were cash-only ones with the same rule: No Benzos full-stop. If you had a legit prescription for xanax or ativan then they would send a letter to the prescribing doctor and would not dose you until they got an affirmative, positive response -- and to a somewhat lesser extent #2) they know it has the real potential to be fatal, and they're not monsters they don't want to kill all the junkies. Despite what you might think, some of them actually do give a shit and got into substance abuse medicine trying to help. Sure, for some it's just a job, and if you own the clinic it's a gold-shitting goose, but there are a lot of them who are genuinely trying to do good.
> It's almost as if they think of methadone patients as less than human, creatures whose lives are not of value.
This is 100% what one friend who's going through methadone treatment says. They don't even want to get them off of methadone either. He had to fight to even begin going down, and he was on it at 2 years at this point. He'll be in "rehab" for 5 years early next year, and the dose is about 1/3 what it was when he started.
GABAergenics in general are pretty much the sole class of popular recreational drug which have a very real possibility of lethal withdrawals.
In the case of alcohol, it often takes years for addicts to reach a point where withdrawal becomes lethal. In the case of short acting benzodiazepines/barbiturates, this point can be reached in less than a month.
Of course, benzodiazepines are in schedule IV, which means they are viewed as being rather benign with no/low potential for abuse. In the eyes of the federal government, alprazolam (xanax) is far less dangerous than marijuana/the traditional psychedelics.
Just another data point demonstrating the utter absurdity of US drug legislation and regulation.
That's what I had heard, but I was uncomfortable making a stronger statement without more knowledge.
If one wishes to cease benzodiazepine usage, they effectively are forced to slowly taper over time period that can potentially take years. If one were to "cold turkey" after a multi-year long period of heavy benzodiazepine use, assuming they survived with no other long term damage, their severe-moderate withdrawal symptoms would still be apparent after several months. These include, but not limited to, constant paranoia/panic attacks, constant visible parkinson-like shaking, SEVERE unceasing insomnia, etc.
I've only elaborated on the withdrawal aspect of benzodiazepines as well. They are capable of causing far more harm than simply their lethal withdrawals. User behavior, synergistic effects on respiratory depression, etc.