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.
There exists a large, mostly-underground, growing community consisting of those iatrogenically harmed by benzodiazepines. Guilty only of following doctors orders, these patients are marginalized and misunderstood. This has been enabled, at least in part, by poor terminology………
Physical dependence and addiction are not synonymous (see: patient education materials that accompany some benzodiazepine prescriptions). Yes, physical dependence can manifest from both abuse and compliant use. But physical dependence can stand alone. Signs of its development — tolerance, interdose withdrawal, and/or withdrawal symptoms with dose reduction — are not an accurate indicator that addiction is co-occurring. So then why are terms like “addictive,” “addicted,” and “hooked” utilized by many experts and media outlets to describe what is actually prescribed physical dependence? I believe the answer is two-fold: (1) confusion (lingering from a history of bastardized language) or a lack of education; and (2) the media’s desire for a sensational headline. The latter alienates the as-prescribed population and comes at the expense of accurate reporting.
When examined objectively, it is obvious that this terminology approach is illogical.
It also has considerable cost in the following ways:
1. By providing a false sense of security to the prescribed physically-dependent population. Drug abusers know they are at risk of harm. Patients compliantly taking benzodiazepines, long-term (>2-4 weeks), often do not. Stories encountered about “benzodiazepine addiction” are dismissed as irrelevant and fall on deaf ears. Instead of an informed warning, patients and their prescribers are left incorrectly reassured that any problems with benzodiazepines lie solely with the user’s behavior as opposed to being inherent to the drug class itself.
2. It results in misdiagnosis and dangerous mistreatment. Physically dependent patients who do accurately identify symptoms as originating from their benzodiazepine may seek out or be referred to addiction-based “treatments,” like rehab or “detox,” if they are left under the impression that they are “addicted.” At such facilities, the “law of the instrument” often manifests when all patients are universally “treated” under the “addiction model,” consisting of abrupt discontinuation of any drug deemed “addictive,” irrespective of abuse history. This practice defies all respected benzodiazepine withdrawal guidelines (calling for slow, patient-guided tapers). The result is often disastrous, increasing the risk of severe symptoms (seizures, psychosis, suicidality, akathisia, etc.) and protracted neurological insult.
Similarly, in the outpatient setting, physically dependent patients mistaken for “addicts” are sometimes “fired” or have their prescription “cut off” by misinformed prescribers. For best outcomes, patients require understanding, patience, and withdrawal guidance that facilitates slow tapering, usually over many months and years.
3. It causes displaced blame. Compliant patients are too often on the receiving end of misdirected blame when they are mistakenly believed to be “addicted” to benzodiazepines. This literally adds insult to injury. Worse, it enables the problem to persist because fault is directed away from actual causes like prescribing practices which ignore well-documented long-term risks and harms, inadequate pharmacovigilance, lack of truly informed consent, etc. Since fault is assigned solely to patients, there is no impetus for change.
To tackle this terminology hurdle effectively, clinicians, educators, the media, etc. need to present benzodiazepine issues in a way that makes clear there are four distinct problems: (A) adverse effects; (B) iatrogenic physical dependence (including tolerance and interdose withdrawal) and subsequent withdrawal reactions; (C) post-withdrawal (protracted) neurological insult; and (D) addiction/misuse.
Collectively, these encompass all potential complications but each has individual problems deserving of their own platforms. Prescribed harm advocates are attempting to spotlight the first three (A-C), those being the most common yet most unrecognized and overlooked. Doing so proves difficult, however, because there is a lack of meaningful discussion as a consequence of the language of condition D eclipsing everything. The dominant narrative is that everything falls under the addiction umbrella, regardless of whether that narrative applies. Case in point: cardiologist Dr. Christy Huff recently told her story of prescribed physical dependence to Xanax on “NBC Nightly News with Lester Holt” (the news story referenced in the above tweets). Her story is a cut-and-dry case of elements A (adverse effects appearing after only a few weeks) and B (physical dependence that developed, as could be pharmacologically expected, shortly after being prescribed Xanax for insomnia), with no trace of D. Much to the chagrin of everyone championing for accurate benzodiazepine safety information, the newscast was riddled with addiction terminology. The narrator misrepresented Dr. Huff’s story, proclaiming she was “hooked” on the longer-acting Valium she’s using to taper. Meanwhile, the following caption trailed beneath her on-screen image: “Doctors warn of addiction risk from anti-anxiety drugs.” More inaccurate information. More false security. More misplaced blame.
Unfortunately, public commentary beneath the news segment on social media consisted largely of finger-pointing at the “addicts” for “ruining it for everyone else who takes them appropriately!” Another missed opportunity to warn the public with the message that Dr. Huff set out to convey — that anyone who takes benzodiazepines, even exactly as prescribed, is at risk for potentially severe adverse outcomes (physical dependence, painful and/or lengthy withdrawal, protracted neurological insult, etc.)
A popular children’s rhyme concludes, “… words will never hurt me.” But this isn’t just a case of hurt feelings over a botched news story or labeling people addicts when they aren’t. It’s much more serious than that. In this case, misapplied words do grave harm. Many people’s lives and health hang in the balance. By taking great care with the terms we use to discuss benzodiazepines, we can alleviate unnecessary suffering, provide the information needed for consent to be truly informed, and save as many patient lives as possible.
Nicole Lamberson is a physician assistant and serves on the medical advisory board, Benzodiazepine Information Coalition.
Overdose awareness Day!
Heath Ledger, Prescription drugs and overdose.
‘It was  years ago … but to me it’s like it was yesterday.’
These are the words of Kim Ledger as he recalled the loss of his son Heath to an opioid overdose in January 2008.
The 28-year-old actor had been caught up in a punishing production schedule, flying between three different countries and filming scenes at night in the bitter cold. He contracted a chest infection that developed into pneumonia, and experienced insomnia.
Heath visited a variety of doctors on his travels to help deal with these problems, collecting a veritable cornucopia of prescription medications, including opioids and sleeping pills.
In combination, the opioids, sleeping pills and the chest infection itself had a depressing effect on Heath’s respiratory system, causing it to shut down. This made him a high-profile casualty of what was emerging as a prescription opioid epidemic, which includes the use of legal drugs such as codeine, fentanyl and oxycodone.
This phenomenon has claimed thousands of lives in Australia and around the world.
While Heath’s death was the result of a medication mix he didn’t realise would exact such a heavy toll, other opioid users have a more long-term relationship with these types of drugs, often becoming unexpectedly addicted after using them as a treatment for chronic non-malignant pain.
‘The accidental addict. In a very short space of time, people can become addicted to oxycodone and products like that,’ Kim said.
Such was the case of 30-year-old nurse and mother of two, Katie Howman, found dead following a fentanyl overdose in her Toowoomba home just before Christmas in 2013. Investigations revealed she had visited 20 different doctors and 15 different pharmacies over the previous 13 months in her search for opioids.
Opioids – a category that includes pharmaceuticals such as oxycodone and fentanyl, as well as illicit versions such as heroin – remain the main cause of accidental overdose death in Australia. Opioid-related deaths hovered at around 450 per year at the turn of the century, but these numbers have risen sharply since 2006 to hit over 1100 per year since 2014.
What has led us to this epidemic, and what can GPs do to help curb it?
Too good to be true
In the late 1990s, prescription opioids seemed like an ideal answer to the often-difficult problem of chronic, non-malignant pain.
‘There was an increased demand to treat chronic pain. There were very few options and very little research that had been done on this problem,’ Dr Evan Ackermann, a GP with a special interest in opioids, told the RACGP.
‘This was mixed with a situation of some fairly aggressive drug company marketing of opioids and a change of clinical attitude towards pain. Normally, pain would be part of the healing process, but people started to say we should be looking at pain as the “fifth sign” and treating it aggressively.
‘It was a cultural shift across the healthcare sector, across the board, from pharmacy right through to general practice, specialists and hospitals.’…………….
‘There is a sense out there sometimes that it’s just people choosing to do this, that there’s a dichotomy between the genuine-pain patient and the bad drug user,’ she said. ‘My experience is that they’re the same group of people.
‘Opioids interact with us as a species in a particular way; all of us are at risk of side-effects and one of those major side-effects is dependency and addiction.’
Antidepressant Withdrawal – What we Know and Don’t Know
My Doctor/Psychiatrist told me that I have to take an antidepressant to correct a
chemical imbalance in my brain, is this true?
No, it is a myth, we cannot test or measure the state of neurotransmitters in your brain, the
American Psychiatric Association disavowed this myth in 2011(1). It is a pharmaceutical
company invention (2).
How many people experience withdrawal effects?
It varies according to which drug is used, at what dosage, and for how long. Recent
studies (3) are showing the number affected to be greater than 50% of those taking the
drugs. The UK Royal College of Psychiatrists did their own survey (4) (now removed) which
showed that 63% reported withdrawal effects.
Why does my doctor/psychiatrist keep saying ‘discontinuation syndrome’ when I
Discontinuation syndrome is an invented term (5) which minimises the role of the drug in the
harm caused and steers users away from addiction terminology. While dependence and
withdrawal have some features in common with addiction, they are not accurately
described using just this approach. What you are experiencing is an effect of withdrawing
from a drug, not of discontinuing treatment.
Why does my doctor insist that ‘once the drug is out of my system’ I will be fine?
Because not all doctors understand the effects of antidepressant drugs on the brain (6). A
heavy drinker or smoker may suddenly stop drinking/smoking, but the effects on their brain
and nervous system continue to be felt long after they have quit. Antidepressant drugs
change the brain in ways we don’t currently understand. These adaptations (7) to the drug
are responsible for withdrawal effects.
What does withdrawal feel like?
It’s a highly variable experience ranging from mild symptoms which pass quickly, to
profound symptoms that sometimes persist for many years. In a 2017 survey (8), 46% of
those reporting withdrawal symptoms described them as ‘severe’. Most common reported
symptoms (9) are insomnia, dizziness, fatigue, digestive problems, anxiety, panic,
depression, agitation. Withdrawal symptoms can sometimes mimic depressive or anxious states but should not be confused with relapse (10).
I am worried about dependence, what should I do?
The most important thing is never stop your drugs suddenly, this can be dangerous. Talk to
your doctor but be prepared as many doctors do not have the information to be able to
help. Withdrawal is a unique experience, with no fixed rules.
There are some excellent and
reliable online sources for help including:
www.jfmoore.co.uk August, 2018
Antidepressant Withdrawal – What we Know and Don’t Know
References (to read these online visit www.jfmoore.co.uk/ltw.html)
4. RCPsych survey (now deleted)
www.jfmoore.co.uk August, 2018
An interesting article found at
To fight a rising tide of depression and suicide, psychiatrists need to do more than just fill patients up with pills
The New York Times recently published an important investigative report shining a long-overdue light on the painful, sometimes disabling experience of withdrawing from antidepressants – drugs that millions of Americans have been taking, sometimes for decades
The recent deaths of Kate Spade and Anthony Bourdain threw into stark relief the human toll that depression can take. But the problem is complex, with multiple factors. We are seeing a striking increase in the number of Americans diagnosed with depression, and an accompanying increase in suicides. This is coupled with the promiscuous and sharply increasing prescription of antidepressants to 34.4 million Americans in 2013-2014, up from 13.4 million just 15 years earlier. And this pervasive prescribing continues despite the lack of proof of the drugs’ long-term effectiveness; their mixed results even with short-term treatment; the frequent side-effects – weight gain, gastrointestinal problems and sexual dysfunction – that are themselves depressing. Meanwhile, we are paying the prohibitive financial costs of depression – an estimated annual average of $210.5bn in treatment and lost productivity.
These numbers raise critical questions: why are so many Americans becoming depressed? Why do rates of suicide, depression’s dire and irreversible consequence, continue to increase – by 25% since 1999 according to a recent Centers for Disease Control and Prevention report? Why are we treating vast numbers of these depressed and suicidal people with drugs that are of limited effectiveness? How can we do better?
Depression is characterized by low energy and despondency, negative self-esteem, pervasive pessimism, difficulties with eating, sleeping and sexual functioning, and helplessness and hopelessness. It is caused by biological, psychological, social and economic and spiritual challenges which are increasing in number and severity and often compound one another. These include decreases in social support and the loneliness that follows; high levels of stress about the economy, and the future; the hyper-competitiveness and hypercritical self-assessments of youth; sedentary lifestyles and poor diet; and our addiction to our digital devices.
The prevailing psychopharmacological treatment is based on the theory that depression is a neurotransmitter disorder. Pharmaceutical manufacturers and physicians are fond of making an analogy between depression and type-1 diabetes. The bodies of type 1 diabetics do not produce enough insulin, so diabetics receive insulin by injection. Depressed people, the analogy goes, are incapable of producing adequate amounts of neurotransmitters and must be prescribed drugs to increase them.
This is incomplete and misleading. Some depressed people may have lower levels of serotonin or norepinephrine. But no one knows how many, and doctors rarely measure these levels before prescribing drugs. A variety of emotional, social, nutritional and environmental factors affect a person’s fluctuating neurotransmitter levels, which in turn affect how a person functions. In other words, low levels are likely to be the symptoms, not the cause, of depression. Unfortunately, the prevalent view of depression as a “Prozac deficiency disease” prevents many Americans from seeking out a more comprehensive, safe and effective approach, grounded in self-care and group support.
Meditation is fundamental to this approach. Slow, deep breathing relaxes our body, quiets our mind, and lowers the stress which often precipitates depression. It quiets activity in the amygdala, a portion of the emotional brain responsible for fear and anger, and enhances activity in the hippocampus, which mediates stress and memory and is damaged by depression. Meditation thereby promotes functioning and increases tissue mass in the frontal part of the cerebral cortex, where depression has inhibited judgment, self-awareness and compassion. Meditation also makes it easier for us to connect with others who may provide comfort, intimacy and support. It gives us perspective – helping us see that what seemed insurmountable is manageable. It promotes compassion, and facilitates finding mood- and life-enhancing meaning and purpose.
Physical activity complements meditation. As a depressed person moves, she overcomes her inertia, releases tension and reclaims and enjoys a body that seemed alien, even hostile. Jogging, tai chi, yoga and dance all lower stress and stress hormones, may help rebuild the hippocampus and enhance activity in the frontal cortex. Exercise by itself can be at least as effective as drugs in relieving depression.
These self-care tools enhance the production of the neurotransmitters that drugs are aimed at – serotonin, dopamine and norepinephrine – without damaging side-effects. And the active engagement that self-care requires may itself be the most effective antidote to depression’s hallmark symptoms of hopelessness and helplessness.
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.
Pharmaceutical drugs pushed by the mainstream medical establishment are notorious for causing countless side-effects leading to even more problems. In fact, the average drug label contains 70 negative side-effects on average, with many drugs reaching the 100’s. Helping to make up the outrageous amount of side-effects caused by pharmaceutical drugs are brain-related side-effects, known to be causing serious damage to many prescription drug users.
Top Pharma Drugs Linked to Cognitive Damage
Collecting data from the FDA Adverse Event Reporting System, a company known as AdverseEvents, Inc. conducted a survey of pharmaceutical drugs potentially causing brain-related side-effects. In their quest, the company found more than 50,000 individual adverse event case reports linking to “common brain-related side-effect categories” such as:
- Memory loss (amnesia)
- Loss of libido
- Compulsive behaviors
After analyzing the data collected, the company found which top drug culprits cause the greatest adverse impact on the brain. Used by thousands of individuals to ‘treat’ insomnia, a drug known as Ambien CR was the top drug linked to memory loss-related side-effects. Interestingly enough, it was recently reported that consuming sleep medication not only completely ignores the underlying problem of what is causing sleep issues, but also leads to an increased risk of cancer and premature death.
With about 41 percent of adults diagnosed with insomnia turning to prescription drugs, it is imperative to pass along this information. The top drug shown to lead to the most side-effects, causing inhibition of libido and more, is a hair loss medication known as Propecia. Other drugs making the top 25 count were commonly used antidepressants. Ingested by more than 1 in 10 Americans, antidepressants have also been shown to cause your arteries to thicken 400 percent more than aging.
These pharmaceuticals, as shocking as it may sound, have even been shown to worsen depression and cause suicidal thoughts. As for causing the greatest amount of side-effects related to compulsive behavior, a Parkinson’s medication called Mirapex won the gold trophy. Instead of resorting to this medication, brain exercises have been shown to provide significant relief to Parkinson’s patients. In addition, tai chi can improve balance and lower the risk of fallsin those suffering from mild or moderate Parkinson’s disease……