June 30, 2009

Benzodiazepine Use Up Dramatically, Drugs' Addictive Properties Criticized

I know so many people with various mental disorder diagnoses who have taken a benzodiazepine in addition to whatever other medication they were on (and often they were getting a benzo for side effects of, say, anti-depressants) over the years and I've seen many of these people run into very severe withdrawal and addiction problems as a result. The usual suspects are Klonopin, Xanax, and Ativan (there are others of course). Sales of Xanax last year hit $350 million, up almost 50 percent since 2003 and 85 million prescriptions were filled for the top 20 benzos in 2008, an increase of 10 million scrips over 2004, according to this article on anti-anxiety drugs and their problems in today's Washington Post.

Their problems are legendary.

"The ordeal of withdrawing from benzodiazepines can rival that of kicking a heroin habit, according to some who have had success. Abrupt withdrawal can result in hallucinations, seizures and even death, experts say.

"Last year, after jail officials in Cleveland denied R&B singer Sean Levert's repeated requests for his Xanax, he hallucinated for hours and ultimately died from the effects of withdrawal, according to the coroner's report cited in court records. His widow sued the corrections center and medical staff. The suit is pending."

The article certainly serves as a reminder to me of how commonly these drugs are used--85 million scrips could easily translate into more than 10 million people taking benzos--and how their use has boomed, despite all the bad things doctors know about the drugs, during this very anxious decade.

I've not experienced benzo addiction or withdrawal personally, but I know it's utter hell and I'll try to pay more attention to these issues. I think some docs are prescribing these drugs far too casually and for too long a period of time.

During my 18 years in the mental health system, I was only ever prescribed Ativan at 1 mg. a day to take as need to, drum roll, treat agitation I was experiencing from Seroquel and Lamictal. My then-psychiatrist and I worked out a deal where he would only write me a scrip for 15 pills every two or three months and would only renew the scrip in person instead of over the phone or by fax. He said he wanted to make damn sure I didn't get hooked on the drug and I'm thankful he took that approach, even though I'd been waved away from benzos by other docs and patients for many years at that point.

Ativan was a nice enough drug for me, but then I never took it for more than a day or two at a time.

A friend once gave me a Xanax--I forget which dosage--and it knocked me out so hard that I fell asleep on my usual bus and missed my regular stop by one mile. Not so nice.

Posted by Philip Dawdy at June 30, 2009 12:03 AM
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Dear (((Phil))) -Please feel free2edit my post-Iam dyslexic so it may need tidying up-gutting-thanks


I look forward too reading others voices on this-interested if the same pattern is emerging in USA- England-The Poly use of different benzos with a tag line of anti-psychotics’.


-In NZ they are scripting out benzos O so loosely again-at one point I has a tee-shirt with -stop bashing the benzos-scribbled across it becos they were damm near demonised - the new anti-psychotics were seen as--cleaner-LOL-

. Here when the new anti-psychotics hit town the psychiatrists started too script them for Every-thing and dished out very few tranx. What Iam bearing witness too the past 18 months is the alarming rise of benzo use with in the mental health services again-as the psychiatrists have started 2listen too their patients about the uglies -side effects of anti-psychotics.

Most psychiatric patients I know though have had the benzo added on and r still on anti-psychotics-the major benzo given out is now- lorazepam -called Ativan in USA. -becos of the short life of Ativan and the horrific withdraws -most doctors damm dear stopped writing them in NZ for 2 decades-they also stopped prescribing Rohypnol as well-I was heavily medicated with Rohypnol while a committed patient in the early 1980’s-the trend then changed 2wards Valium becos of the-long ½ life.-but what 2 too-?-

If some one Needs a benzo becos of extreme anxiety disorders-well for me the class of drugs that work best are the benzos- I still get valium each week but space it out-only get 2mgs tables etc I do my best 2 keep it low. I would like too think that there is a middle ground-?-

I did have a period of 8 years not using any benzos or any Doctor sedatives but was self-medicating with alcohol-hence the stuck betweens and what too do”s-?

-When your PTSD-OCD-what ever is harsh-what’s a women 2do- I was given Klonopin--in NZ its called- clonazepam during my last psychiatric hospital stay->-I was told it was not as addictive as other benzos- Liars. I was also told it was-good-as an anti-psychotic. I live in low level supported accommodation below are the meds a couple of my neighbours are on-changed names of course.

Heres Susan’s daily meds-this is usual now-
Hell of a breakfast hey-one that goes on threw the day.

2 Effexor- 6 lorazepam -2 temazepam -sleepers- 10 mgs olanzapine during the day - also 4 low dose Klonopin pills available as required.

Debbie”s -3 Effexor -6 klonopin a day-2 benzo sleeping pills at night-10mgs olanzapine - 1 pill a day of an old anti-depressant - she is also taking xenical 2 try and loss the weight she put on with the anti-psychotics-

Its truee madness Now-!!

I don’t know the answer-what I do know is that therapy helped me save myself-2 sessions a week with a psychologist at the anxiety disorder unit-I was very lucky -I got 2 do trauma work-CBT-DBT-also Schema Therapy-I was with Ron the T for 6 years-

My motto now is-Ya cant drug Trauma- but as we know therapy costs big money-cheaper too drug ppls with Muppet drugs. My therapy was all paid through central government-Iam so very blessed 2 have been given the opportunity 2 address my childhood sexual abuse and sexual-physical abuse with in psy hospital in the early 1980”s.


I did notice that Evelyn Pringle posted here re- Michael Jackson --she is a journalist for the largest on line news out-let in NZ- I hope she can chip in on this subject-I would love 2 hear what she has 2 say about the benzo issue in NZ and hear her thoughts on the Poly-drugging-

Also I personally see a connection with the rise of SSRI”s and NZ”s astonishing rise of the murder rate of children-the under 5”s in main and would be interested 2 hear if she is going to do an article around this-?-God I hope so-

Again Phil big kudos for your work-

Posted by: poodles at June 30, 2009 05:55 AM

In the clinical trials for Prozac, back in the 1980's, the protocol called for using benzodiazepines for those who became agitated on the drug.

Just thought this might be of interest, historically.

Posted by: Rosie at June 30, 2009 07:05 AM

Personaly I am very lucky that whenever I have been on a benzo long term and then for some reason had to quit cold turkey the only WDs I have ever had was a few days of transient anxiety irritability and trouble sleeping. None of the long term WD problems and none of the life threatening stuff. Then again the WAY I use benzos probably means I become minimaly physiologicaly addicted. I generaly only take them once a day, at night (and they've always been the ones with short half lives so its out of my system by morning), and rarely will also take one pill durring the day for at most three of four days at a time. Personaly I think benzos should be used on an as needed basis and if they are going to be used for sleep or some other once a day use they should be ones with short half lives so it gets out of your system quickly enough that your brain and body aren't being exposed to the effects of the drug 24/7. Its 24/7 exposure that leads to the worst physiological addiction to anything.

I think it is reprehensible when doctors deny patients access to benzos for things like panic attacks, episodes of irritability etc, instead choosing to put them on a daily med like an ssri (which is more likely to cause physiological dependance than a benzo used as needed on a not even daily basis for anxiety or panic or any other problem that is not a daily problem).
You shouldn't be forced to become physicaly dependant on any medication in order to treat there problems out of fear they *might* find a way to abuse their limited script to a benzo and somehow become physical dependant on only 15 pills a month. At least with benzos the WDs are understood and admitted and people are warned, with the alternatives which are usually ssris of atypical antidepressants like effexor, patients are not warned and the WDs can be just as bad in the case of someone taking high doses of a benzo a couple times a day for months at a time, or much worse in the case of someone taking a benzo as needed and then quitting it.

If we lived in world that had a sane system of healthcare benzos would rarely be used because people with the type of disorders that use these meds the most - anxiety disorders- would have access to the VERY effective therapy treatments for these disorders instead of the only choice being meds or no treatment for 6 months due to a lack of access thru insurance to therapists.

If I had ever had the type of WDs from benzos that some go thru I never would have gotten back on them, I would avoid them like the plague the same way I avoid antidepressants (WORSE WDs than opiates). I think benzos are actually pretty safe as long as the dr rxing them understands how the physical dependance on them happens (daily high dose or multiple dose or use of benzos with long half lives like valium) and avoids giving their patients dosing instructions that lead them to have the benzo in their system more of the time than not and thus the body and brain become dependant. Drs SHOULD know how to do this if they take 10 minutes out of their lives to look at the very plentiful data available on benzo dependance and effects, and half lives etc. It seems though from what I have seen from the way benzos have been rxd to people I know that about 1/3rd of doctors don't bother educating themselves and rx these things in the most risky ways, even though there is enough knowledge out there that there is no reason anyone should become physicaly dependant on a benzo as per drs rxing and dosing orders/schedule unless a benzo with a long half life or taken many times a day is the ONLY thing that will work for them. If the patient abuses the med that's a different story, but that's not always the cause for physical dependance, it is often ignorant drs bad rxing practices.

Posted by: katielou82 at June 30, 2009 09:40 AM

PCP gave me Xanax to "take the edge off" from being freaked out that my daughter was in a psych ward--10 years ago.

I'm now down to the last .5 mg of that addictive drug, thanks to my psychiatrist who is over-seeing (and supporting)the removal of the drug, as my quest to be drug-free and not medicalize my emotions and life events moves forward.

One of the worst parts of the withdrawal so far was a year ago when I went from the name brand Xanax XR (extended release)to generic alprazolam.

I typically swell up, get the shakes, headaches and diarhea. Not once did the PCP ever stop renewing that rx and would give several months refills.

Find a better way to cope is my advice!

Posted by: Stephany at June 30, 2009 09:42 AM

Agreed with katielou82, the benzos are actually good for some things (I'd take them -illegally, yes- to sleep or to relax going onto a film shoot or whatever), and moving away from the "daily med" to, once again, an "as needed" model is good.

That said, Xanax is the worst of them all (half-life issues and its chemistry makes it more addictive than, say, Valium or Klonopin)

Posted by: A Groupie at June 30, 2009 11:10 AM

Took lorazepam (ativan)-'to help me focus' while starting fluoxetine. Had night sweats and tremors for a week after stopping. And that was after only taking it for two weeks. But I do take them on and off and I like being able to use them that way. I've never experienced any other trouble using them intermittently.

Posted by: richey at June 30, 2009 06:14 PM

Klonopin nearly killed me. I came within a hair's breadth of dying.

Posted by: Sherry at June 30, 2009 06:28 PM

Excellent article - thank you! Yes, benzodiazepine withdrawal is dangerous, especially when one quits "cold-turkey." Although I tapered off klonopin (prescribed for a facial tic) there were times when I was convinced I was dying. I had more than 60 withdrawal symptoms, some of which were very severe and frightening. Thankfully, I am now recovered but I would discourage anyone who can find an effective alternative from using benzos long-term.

Baylissa
Author, Benzo-Wise: A Recovery Companion

Posted by: Baylissa at July 1, 2009 12:05 AM

phil:please delete that first post of mine just previous to this one, I misread this paragraph. my bad. I will exercise more discretion in the future.

I think it is reprehensible when doctors deny patients access to benzos for things like panic attacks, episodes of irritability etc, instead choosing to put them on a daily med like an ssri (which is more likely to cause physiological dependance than a benzo used as needed on a not even daily basis for anxiety or panic or any other problem that is not a daily problem).

Posted by: Knowledge Junkie at July 1, 2009 03:47 AM

Rosie has a good point about benzos vs. SSRI's -- what is the chicken and what is the egg? Two different SSRI-type medications GAVE me panic attacks almost instantly.

Benzos seem to be one of those medications people have either very good or very bad experiences with. (Google "Stevie Nicks" and "Klonopin" for an example of the latter.)

For myself, I take Klonopin in a low enough dose (and less than prescribed, except on a particularly stressful day; and NEVER more than prescribed) to not be physically addicted -- but probably, since I have taken it daily for years, I am now psychologically dependent on the drug in some way.

But it does help my severe anxiety -- tremendously. And there are many other medications that people take for legitimate reasons for non-mental health conditions that they could be considered dependent on.

As a matter for public concern among psych meds, IMO benzos rank a distant third behind anti-psychotics and SSRI's. Unless, of course, you want to ban psych meds altogether.

Posted by: Larry at July 1, 2009 07:24 AM

I've lived with nearly constant terror ever since I can remember, due to severe child abuse. I've been on lots and lots of drug, nearly died from klonopin.

About three weeks ago, after 30 years of being in therapy off and on, I had a break through with a woman I've seen--mostly off, some on, but running into her often because we live in a rural area. I have come to trust this woman completely and I'm sorry it took me three decades to do so but my abuse was quite systematically designed to ensure lifelong isolation.

Anyway. I have been terror free for the past three weeks. Somehow in that session I was able to "go back in time" and make a new decision about what to believe about what was happening to me. This seems to have made a profound and permanent (and unexpected after all these decades) change in my hopelessly impaired, biochemically defective system. Who knew? Certainly not the drug-pushing psychiatrists who nearly killed me.

I just bring this up to support the notion often found here that psychotherapy can sometimes do what drugs cannot. I was not expecting this turn of events. My life hasn't become suddenly rosy, just livable now that I'm no longer cringing in terror a goodly portion of my nights and mornings.

Posted by: Sherry at July 1, 2009 10:38 AM
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