More addictive than heroin, yet prescribed to one in four adults. Benzodiazepines can ruin lives...
Sunday Express Magazine
Report by Cherrill Hicks
When Barry Haslam tried to come off drugs, he went through hell on earth. "I was physically sick, and incontinent," he recalls. "I would spend hours staring at the walls, curled up in the foetal position. I was severely depressed; I couldn't stop sweating and I had hallucinations. I must have lost three or four stone."
Barry Haslam wasn't hooked on heroin, or any other illegal drug. For the previous ten years he had bean taking Ativan a so-called "minor" tranquilliser in doses prescribed by his doctor.
Ativan belongs to a group of drugs called benzodiazepines more commonly known by brand names such as Valium, Librium and Mogadon. Used to treat anxiety and insomnia, they can be highly addictive and, as Haslam discovered, withdrawal from them can be agony more difficult than with heroin. Described by one doctor as the opium of the masses, they have, it is claimed, ruined careers; marriages, families and lives. Yet benzos, as they are known, are also among the most widely prescribed drugs in Britain, with millions of prescriptions made out for them every year. An estimated one in four adults has used one of these drugs.
"A lot of people have been damaged by the overprescribing of benzodiazepines", says Robert Kerwin, Professor of Psychopharmacology at the Maudsley Hospital, London. "They get repeat prescriptions and then they get stuck on them."
Developed in the early Sixties by big drug companies, such as Roche and Wyeth, the benzodiazepines work by increasing the effectiveness of the chemical messenger that dampens down activity in the brain. Highly effective for acute anxiety, they were also thought to be safer than their predecessors, the barbiturates, which were known to be dangerous at overdose. Benzos soon became the new wonder drugs. GPs began to dish them out to anyone. But before long some doctors started to express concern about patients becoming dependent on the new drugs. Professor Malcolm Lader, consultant at the Institute of Psychiatry, was one of the first to blow the whistle on the potential dangers.
"We found that patients who had been put on Valium were getting withdrawal symptoms when it was stopped," he says. "Some of these were similar to alcohol withdrawal. They included mild delirium tremens [a state of confusion accompanied by trembling and hallucinations,] sleeplessness, jumpiness, everything seeming loud and bright some people said they felt as though they were going mad." Ironically some of the withdrawal symptoms produced by benzodiazepines resemble the very condition they are supposed to be treating: "Symptoms include intense anxiety, panic attacks and sleeplessness," says Kerwin. "But if a patient got these, doctors just put it down to their disorder and re-prescribed benzodiazepines. What they are being used for is not the original condition but just preventing the withdrawal syndrome."
Despite the warnings from people such as Lader prescriptions for benzodiazepines reached 31 million in 1979 and they continued to stay high in the Eighties. Not surprisingly, an estimated 1.2 million patients have become dependent on these drugs with many taking them regularly for 20 or 30 years.
Some long-term users report side-effects of benzodiazepines that are every bit as devastating as the withdrawal symptoms. Side-effects can include memory loss, lack of confidence, feelings of unreality, loss of concentration, irritability, depression, aggression and emotional anaesthesia the inability to feel pleasure or pain. "Users go through life semi-tranquillised in a state of hypnosis." says Kerwin.
"One common feeling among long-term users is that they have spent years in a kind of daze," adds Heather Ashton, Professor of Clinical Psychopharmacology at the University of Newcastle upon Tyne. "Many cannot remember their children growing up and this is one of their most bitter regrets."
Those who struggle to get off the drugs can find it very difficult and sometimes dangerous. Abrupt withdrawal can lead to fits, as well as other severe symptoms such as muscle pain and tinnitus.
"These drugs dampen down everything in the brain so when you come off them you get this rebound state," says Ashton. "You're very sensitive to physical stimuli. In some cases this never settles down."
A sizeable minority of users develop "post-withdrawal syndrome", which may linger for months or even years. "As yet we have no hard evidence that benzos cause permanent damage," says Ashton, "but there are suggestions that cognitive performance may be reduced for a long time after."
The government's Committee on Safety of Medicines warned in 1988 that withdrawal symptoms from benzodiazepines can occur after taking them for a very short time. It advised they should be prescribed only for severe, disabling anxiety or insomnia, and then only in the lowest possible dose for periods of two to four weeks.
But despite these guidelines and advice from doctors' own professional bodies GPs currently make out an estimated 16 million prescriptions a year to patients in the UK for anti-anxiety drugs, mostly benzodiazepines. "They're still being doled out without much thought," says Professor Kerwin. "GPs are very busy and have very little time and if people want them, it's easy to write a prescription. It's a bit like antibiotics doctors tend to become careless in prescribing them."
Malcolm Lader agrees. "Some older doctors just don't want to change, and they're still giving out repeat prescriptions," he says. "Some GPs also deny the drugs' effects, arguing that their patients have addictive personalities," he adds. "Yet one of the most common benzodiazepines, diazepam (brand name Valium), is also used in patients with sports injuries as a muscle relaxant. We found that people without any psychiatric condition at all have the same withdrawal problem."
One alternative to the benzodiazepines are the newer anti-depressant drugs, such as Prozac, which are highly effective for some anxiety states. But, as Lader points out, these tend to be more expensive to prescribe. The benzos, by contrast, have become extremely cheap since drug company licences have expired. Diazepam, for example, costs the NHS 6p for twenty 2mg tablets (with a daily dose between 6mg and 30mg) while Prozac costs £20.77 for thirty 20mg capsules (the average dose being one a day). Not everyone agrees that GPs should be criticised for overprescribing. "These days most prescriptions are for acute anxiety, and will be short term, covering days rather than weeks," says James Kennedy, a practising GP and member of the Royal College of General Practitioners' prescribing committee. GPs also have to prescribe for many long-term users, he adds, "where all that can be hoped for is a gradual reduction in dose".
The RCGP, says Kennedy, has campaigned successfully to promote more responsible prescribing, although he admits that "some doctors are still not following the best prescribing practice."
The drug companies have always argued that if prescribed correctly, the benzodiazepines cause few problems. According to Roche, they play "an essential role in modern clinical practice" and are "remarkably safe". Legal action for compensation involving 17,000 "benzo" users has failed so far, although some patients are still pressing on with their own cases through the European Court, as well as demanding a government inquiry into benzodiazepines.
Inevitably, over the past few years, benzodiazepines have found their way on to the street. Known as "benzos" or "vallies", and more recently including the "date rape" drug Rohypnol, they are being used in vast numbers, in combination with hard drugs such as heroin.
"One of the biggest problems with drug abusers is not heroin or ecstasy but addiction to benzos, which have found their way on to the street through lax prescribing," says Professor Kerwin. "Some people might be picking up repeat prescriptions, then using half and selling half."
Most doctors agree that, used appropriately in cases of extreme anxiety, benzodiazepines are useful drugs. Diazepam can be lifesaving for an emergency condition called status epilepticus, or repeated seizures.
But their use should be far more restricted, and GPs need to be educated further about alternative treatments for anxiety disorders such as counselling and psychotherapy, argues Kerwin. As well as newer drugs for depression-related anxiety, there are also safer, shorter-acting tablets available for insomnia, adds Lader.
Barry Haslam, meanwhile, has been off benzodiazepines for 13 years. Now 55 and on disability benefits, he says he has permanent damage from the drugs, including nerve pains in his legs, hearing problems, mood swings, fatigue and cognitive defects.
"I was on those drugs for 10 years and I don't remember any of it," he says. "When I finally got off, it was like waking up. What happened to me was horrendous and it has affected my whole family. I'm still living with the effects."
"I was very frightened. I couldn't leave the house."
Ann Tallentyre was first prescribed benzodiazepines 32 years ago and has been taking them ever since. "I do not live: I exist," she says. "I can't go out because I have agoraphobia. I am totally dependent on others my daughter has to do the shopping."
Now aged 54, she was first prescribed Valium for panic attacks when she was 22 and the mother of two small children. "I was in a horrendous marriage, pregnant with my third child and feeling dreadful." she recalls. "The doctor said I could have as much as I wanted there were no limits. It was a case of take one whenever you need to and lust phone in for a repeat prescription.
The tablets seemed to help at first. "Suddenly I didn't feel as though I had any problems I was too zonked." But after only three weeks, Ann became agoraphobic· "It was very frightening," she says. "I just couldn't leave the house. I thought I was going mad. The doctor said It was to do with hormone levels in pregnancy.
"I also started to have mood swings high as a kite one minute and suicidal the next."
After the birth, her new son was in special care far six weeks: he was floppy, wouldn't wake up to feed and had projectile vomiting. "At home, he used to sleep 24 hours at a time " Four years later, while still on benzodiazepines she had a daughter, who also spent three weeks in special care. "I don't remember much about bringing them up a friend helped out a lot," she says.
"Over the next few years I was put on half a dozen different benzos including Librium and Ativan. I had to be admitted to psychiatric units several times with depression I now realise that I was having withdrawal symptoms.
"Every time I tried to stop the benzos, I went into withdrawal, so they would just put me back on them.
"Another thing I've suffered is memory loss. And I get terrified of the daylight sometimes I'll hide under a blanket. The slightest sound makes me panic."
Although Ann has worked on and off as a cook in old people's homes, she is currently on disability benefits for agoraphobia. A few years ago, she was involved in a collective legal action against the drug manufacturers which collapsed.
The GP who first prescribed them is now dead, she says. "I used to think doctors knew best but he didn't know enough about them to prescribe them."
The doctor she has now is "more supportive"; he has helped her get down to a maintenance dose of 6mg daily.
"I'm coming off them very very slowly" she says. "Every day I get a nail file and file a tiny bit off. That's how difficult it is."
"I stopped taking them and thought I was dying."
Andrew was prescribed diazepam early last year for muscle spasm, after he suffered whiplash injury from a fall. "It started at 2mg three times a day, then went up to 15mg a day because I was still in pain," he says.
"I'd been taking them for almost five months. When I realised the pain had gone I stopped taking them and thought I was dying. I had severe panic attacks, heart palpitations, blackouts and tinnitus [ringing in the ears]. I ended up in Accident and Emergency five times."
"That was where I found out what was happening. One young doctor asked if I'd been taking any drugs and so I told him. He said I was suffering abrupt withdrawal syndrome. I hadn't been warned about their effects and I'd picked up a lot of repeat prescriptions."
"It was then I started a withdrawal programme. I had my GP's support but I also saw a doctor privately who specialises in withdrawal techniques."
"You have to reduce dosage extremely slowly. First of all I stabilised on 6mg of diazepam a day and I have to reduce this by an eighth of the total dose every two weeks. To do it like this you need it in liquid form. It's been very difficult. I reduced the dose too fast at one point, and I was almost admitted to a psychiatric ward. I couldn't stop grinding my jaw, I was hypersensitive to noise, my arms and legs and all my joints ached and I got very depressed. It was absolutely terrible. I had to start taking more again."
"Now I've managed to get down to quarter of a mg once a day, but I still have some way to go. Then I'll probably get what's called post-withdrawal syndrome, because the body has to recover from the damage. It has greatly affected my life. At the moment I don't have a job I used to work for an architectural company. I had to end my relationship because I've been so irrational and paranoid."
"Some people can come off benzos very quickly without any problem but others, like me, are very sensitive and the experience has been horrible."
In pregnancy, the benzodiazepines are known to cross the placenta, causing addiction in the unborn child. Once born, these babies go into withdrawal developing a condition known as "floppy baby syndrome".
Although doctors warned against prescribing the drugs during pregnancy, an estimated 20-30,000 babies every year are born with benzodiazepine addiction, many of them to drug-abusing mothers. There are also claims that benzodiazepines are still being prescribed by GPs to women of child-bearing age without warning of the dangers.
Dr James Robertson, a paediatrician at Arrowe Park Hospital, Liverpool, says that benzo babies' withdrawal symptoms are worse and longer lasting than those suffered by the babies of heroin addicts. "They include colic, sneezing, diarrhoea, inability to suck, jitteriness and a very distinct cry," he says. "Many babies will need intensive care." Benzodiazepine use in pregnancy has also been linked to foetal malformations such as cleft palate, and to developmental difficulties later.
Commonly prescribed benzodiazepines include:
Chlordiazepoxide (original trade name Librium)
Diazepam (original trade name Valium)
Lorazepam (original trade name Ativan)
Nitrazepam (original trade names Mogadon or Somnite)