The government needs to take action to stop prescription drugs, including opioids and slimming tablets, being obtained from online pharmacies that can avoid regulation.
Health chiefs are failing to investigate a clear pattern of worsening health outcomes
Within the first seven weeks of 2018, some 93 990 people died in England and Wales.1 Over the same weeks in the previous five years, an average of 83 615 people died.1 This rise of 12.4%, or 10 375 additional deaths, was not due to the ageing of the population. Ageing is a slow process and leads to slow, not sudden, rises in mortality.2 An additional person died every seven minutes during the first 49 days of 2018 compared with what had been usual in the previous five years. Why?
Not the weather or flu
The weather was unusually mild during the initial weeks of this year—very cold weather did not arrive until late February. The mean temperature was 4.1°C across the UK in January 2018, almost half a degree above the average for this time of year.
Harriet Williamson Wednesday 19 Sep 2018 8:12 am Last November, Christina Craig died after taking a fake Valium pill. The tablets were known as ‘Blue Plague’. She was the fourth in a group of six friends in Glasgow to lose her life to what she believed to be Valium.
Scottish police estimate that there could be millions of fake Valium pills on the streets. Why is there a thriving market for the drug? Why aren’t users getting it on prescription?
Valium, also known as Diazepam, is part of a group of drugs called benzodiazepines. It’s a sedative recommended for short-term treatment only because it can quickly become addictive.
Valium isn’t usually prescribed for longer than two to four weeks at a time, and some GPs are uncomfortable prescribing it at all. The NHS lists the side effects of benzodiazepines as including drowsiness, difficulty concentrating, vertigo, low sex drive, headaches and the development of a tremor.
After four weeks of use, benzodiazepines may start to lose their efficiency, meaning that you need a higher dose to get the same effect. The way Valium loses potency and the potential for addiction are two reasons why GPs don’t regularly prescribe the drug for long-term conditions like anxiety, as they did when it was first released. Valium was created by Leo Sternbach and released in 1963. It became one of the most frequently prescribed medications in the world, and between 1968 and 1982, it was the highest selling medication in the US. More than two billion tablets were sold in 1978 alone.
Anxiety and insomnia had previously been treated with barbiturates, which caused extreme withdrawal symptoms, were highly addictive and easy to overdose with. Benzodiazepines like Valium seemed like the safer and more effective option, and they became the prescription solution for every problem.
The drug was particularly associated with women, and in 1966, the Rolling Stones even wrote a song about it, entitled ‘Mother’s Little Helper’. It took a long time for the addictive nature and negative side-effects of benzodiazepines to be recognised, despite research in the 1980s linking the long-term use of this drug group to brain damage and calling the drug ‘more difficult to withdraw people from than heroin’.
The NHS is now supposed to prescribe benzodiazepines for a maximum of four weeks to curb the potential for addiction. However, some doctors are failing to stick to guidelines published more than 20 years ago.
What are benzodiazepines, and how do they work?
Benzodiazepines are a class of drugs primarily used for treating anxiety, but they also are effective in treating several other conditions. The exact mechanism of action of benzodiazepines is not known, but they appear to work by affecting neurotransmitters in the brain, chemicals that nerves release in order to communicate with other nearby nerves. One of these neurotransmitters is gamma-aminobutyric acid (GABA), a neurotransmitter that suppresses the activity of nerves. Scientists believe that excessive activity of nerves may be the cause of anxiety and other psychological disorders, and benzodiazepines reduce the activity of nerves in the brain and spinal cord by enhancing the effects of GABA.
For what conditions are benzodiazepines used?
Benzodiazepines are used for treating:
anxiety and panic
seizures (convulsions), and
insomnia or trouble sleeping.
They also are used for:
sedation prior to surgery or diagnostic procedures,
alcohol withdrawal and drug associated agitation,
nausea and vomiting,
Alprazolam (Xanax), chlordiazepoxide (Librium), chlorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan), and midazolam are used for anxiety disorders.
Clonazepam (Klonopin), clorazepate (Tranxene), lorazepam (Ativan), clobazam (Onfi), and diazepam (Valium) are used for seizure disorders.
Estazolam (Prosom), flurazepam (Dalmane), quazepam (Doral), temazepam (Restoril), and triazolam (Halcion) are used for insomnia or trouble sleeping.
Midazolam (Versed), lorazepam (Ativan), and diazepam (Valium) are used in anesthesia.
Diazepam (Valium) also is used for muscle relaxation.
Chlordiazepoxide (Librium) is used for alcohol withdrawal.
unsteadiness (especially in older people, who may have falls and injure themselves as a result)
nausea (feeling sick)
low blood pressure
increased saliva production
sight problems (such as double vision)
changes in sexual desire
incontinence (loss of bladder control)
jaundice (yellow skin)
breast development in men
“….identified a new process in the brain that is responsible for the delayed stress response and the long-term effects of stress…”
“…The potential for a threat from outside might also be protracted, thus requiring the body to adopt not only an immediate but also a prolonged state of alertness…”
“…..Within fractions of a second, a direct neural connection is made to the prefrontal cortex and this determines our behaviour…”
(Vienna, 13 September 2018)
In an international collaboration between MedUni Vienna, Semmelweis University in Budapest, the Karolinska Institute in Stockholm and Yale University in the USA, researchers have identified a new process in the brain that is responsible for the delayed stress response and the long-term effects of stress: with a delay of 10 minutes after the “danger”, the area of the brain that reacts to stress and responsible for further action is activated via the cerebral fluid. The findings could open up new perspectives for understanding the neuronal processes at play in post-traumatic stress disorder, chronic stress and burnout.
“Hitherto we were aware of two main stress mechanisms in the brain”, explains Tibor Harkany from the Division of Molecular Neurosciences at MedUni Vienna’s Center for Brain Research: “A group of neurons located in the hypothalamus is responsible for triggering both mechanisms. The one process is a hormonal pathway, which leads to hormones being released from the adrenal glands into the bloodstream within a few seconds of the stress event. The other process is the nerve pathway, which is even quicker. Within fractions of a second, a direct neural connection is made to the prefrontal cortex and this determines our behaviour.”
Third stress mechanism identified in brain
In the recent investigations led by Alán Alpár (Semmelweis University), Tamás Horváth (Yale), Tomas Hökfelt (Karolinska Institute) and Tibor Harkany (MedUni Vienna), it has now been discovered that these same neurons are also capable of triggering a stress response in a third way, the effect of which occurs slightly later and is sustained.
The completely new mechanism that has now been described proceeds via the cerebrospinal fluid. This also involves a molecule that is important for the development and maintenance of the nervous system, the so-called ciliary neurotrophic factor (CNTF), reaches the stress centre by travelling in the cerebrospinal fluid.
Since this is a mechanism that spreads with the cerebrospinal fluid, it is much slower than the process that occurs via the bloodstream. The substance is diluted more slowly and can therefore have a longer-lasting effect. Conversely, CNTF molecules in the cerebrospinal fluid constantly bombard the neurons of the stress centre, keeping the prefrontal cortex on permanent alert. This means that the nervous system remains in a heightened state of alert with greater reactivity.
According to lead author Alán Alpár from Semmelweis University in Budapest, it is very probable that all three known mechanisms are deployed in the event of severe stress. This third type of process identified by the researchers plays a major role in producing the delayed, and hence lasting effect.
“We know from the work of the world-famous Hungarian-born stress researcher, János Selye, which areas of the brain are responsible for responses to external stressors. He also described what happens in a stress situation, how the hypothalamus activates the pituitary gland, and this in turn activates the adrenal glands,” explains Tomas Hökfelt from the Karolinska Institute in Stockholm. However, stress is a longer-lasting process. The potential for a threat from outside might also be protracted, thus requiring the body to adopt not only an immediate but also a prolonged state of alertness.
Better understanding of neuronal processes
According to the research team, the discovery of the new process can also open up new perspectives for understanding the development of post-traumatic stress disorder. The fact that acute stress can metamorphose into chronic stress, manifesting itself in burnout, for example, represents a serious challenge to today’s society. “Understanding the neural processes that lead to it can open up new options for treating this neuropsychiatric condition, particularly since we identified several molecular steps that might become targets for pharmacological development in the future” emphasises Tibor Harkany.
British Medical Association
“Prescribing of psychoactive drugs is a major clinical activity and a key therapeutic tool for influencing the health of patients. But often their use can lead to a patient becoming dependent or suffering withdrawal symptoms.
Clinic set up for teenagers sees high number of adults seeking treatment after illicitly buying drugs such as Xanax to treat anxiety
A pioneering clinic set up to help teenagers addicted to Xanax and other prescription drugs is being sought out by adults who use pills purchased illicitly on the internet.
At the beginning of the year Dr Owen Bowden-Jones opened the Addiction to Online Medicine (Atom) service in London, a free, easy-to-access NHS clinic run by Central North West London NHS Foundation Trust that offers one-to-one meetings and group mindfulness sessions.
The clinic, thought to be the first of its kind in the UK, was established in response to the growing problem of teenagers addicted to prescription drugs, particularly Xanax, bought illegally on the web.
What has surprised Bowden-Jones is that a third of current referrals are over 20. “When we established the clinic we were at the peak in terms of interest in Xanax and we were seeing a lot of young people using it,” he says. “But one of the cohorts we have seen are people in their 20s and 30s – people who are prescribed a medicine and then they seek it online, either because the dose they have is not enough or the medicine is stopped by their GP .”
He adds: “Teenagers tend to use [prescription drugs] for the intoxicating effect, to get giddy and drunk, but older people tend to use it to treat symptoms, particularly anxiety. We have had a number of patients with traumatic experiences and for them these medicines are being used to anaesthetise themselves.”
The adult group tend to use benzodiazepines to treat anxiety and tend to be women, he says. They have a job, have a partner, friends and a social network, “but have a secret that they have been buying drugs online and not telling people. They are often quite ashamed about it, but they found they cannot cope without prescription medicines.”
Benzodiazepines are currently prescribed on the NHS but are only supposed to be used in the short term. Research shows around four in every 10 people who take them every day for more than six weeks become addicted.
In the UK, alprazolam is not available on the NHS and can only be obtained on a private prescription. Tranquillisers are controlled under Class C of the Misuse of Drugs Act and possession without a prescription could lead to a prison sentence of up to 2 years and an unlimited fine.
Without dopamine, we wouldn’t be able to feel driven and motivated. Dopamine increases attention, improves cognitive function, and stimulates our creativity. It makes us more social and extroverted and helps us form romantic and parental bonds. However, dopamine, when too high, can also have its drawbacks. Many people seek out artificial sources of dopamine, which can lead to addiction. Dopamine can increase weight gain and aggression. Read this post to learn more about the pros and cons of dopamine and dopamine genetics.
Dopamine is a neurotransmitter, which is a chemical released by neurons (nerve cells) to send signals to other nerve cells (R).
Many areas of the brain produce dopamine. It is produced in the ventral tegmental area (VTA in the image above) of the midbrain, the substantia nigra pars compacta, and the arcuate nucleus of the hypothalamus (R).
The most important dopamine pathway in the brain controls reward-motivated behavior (R).
Most types of rewards, such as new experiences or accomplishment, can increase dopamine levels in the brain. In addition, most addictive drugs and behavioral addictions can increase dopamine (R).
In addition, dopamine has many other important roles in humans, including movement, memory, attention, learning, sleep, and mood (R).
Dysfunctions of the dopamine system contribute to Parkinson’s disease, schizophrenia, restless legs syndrome, and attention-deficit hyperactivity disorder (ADHD) (R).
Jamie Hancock continues his column with a discussion about his experiences of taking antidepressants at Cambridge
I was scared to try medication. I think that a lot of people are. For some, to take medication seems to be an admission of weakness – an acceptance that their ways of coping are not working. For others, they associate it with a fear that by taking something which affects your brain, you might lose who you are. Many people are afraid of the impact that side effects might have on their lives. I experienced all of these worries and more.
Any doctor will tell you that, in general, antidepressants and similar therapeutic medications are not intended for permanent use. They are part of a toolset, used alongside various therapies. The aim is for you to become well enough that you no longer need them.
I’ve collected the stories of several friends to illustrate the diversity of experiences that come under ‘taking medication’ beyond my own. Every case is different. Several of them have had to try multiple medications before they discovered one which worked best for them. Several, like me, have experienced a range of adverse side effects. Some are taking just one type of medication, be that an antidepressant SSRI (selective serotonin re-uptake inhibitors), a beta-blocker or mood stabiliser (for bipolar disorder). Some are taking several, to treat a variety of issues.