The opioid epidemic, despite still being underreported and having its causes and development misunderstood by many, seems to remain in the public consciousness as the face of the issue, the type of medicine abuse that comes to mind first when one is reminded of prescription misuse. However, the focus on prescription opioids, whereas certainly justified by the data and various personal testimonies presented earlier, cannot remain the only focal point when trying to discuss and understand prescription abuse.
Opioids, as sedatives, are one of many types of the substances the misuse of which can produce effects desired by the abuser. The British charity organisation, Mind, provides a general list of the types of mind-altering drugs; one can differentiate between:
⦁ stimulants (e.g. methamphetamine; causing excitement, alertness, and insomnia – also responsible for inducing psychosis, albeit of a different type than opiates, as the state begins when the effects of the drug are still present, instead of being the result of a withdrawal),
⦁ depressants (e.g. benzodiazepines; provoking the state of relaxation and drowsiness – however, in larger doses, are able to induce aggressive behaviour and anxiety),
⦁ opium-based painkillers (e.g. OxyContin; described in detail in the previous chapter),
⦁ hallucinogens (e.g. psilocybin; leading to complex visual, auditory, and sensory hallucinations, detachment from one's surroundings, illusion of a spiritual or religious experience, and rapid mood swings).
To provide the reader with the most detailed and comprehensive analysis of the problem, based on adequate sources, as well as create necessary and thorough comparisons between and references to the data introduced earlier, the present chapter will only focus on one type of the listed kinds of substances, depressants. The certain type was chosen in order to keep the rhetoric of the thesis consistent – to still aim the attention at drugs with sedative purposes – and to introduce the reader to yet another prescription medicine widely abused in The United States.
The category of depressants examined in the chapter is benzodiazepines – in particular, the prescription medication Xanax.
RxList defines benzodiazepines as:
“A class of drugs primarily used for treating anxiety, but also effective in treating several other conditions. (...) They 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. (...) 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.”
As with any other class of drugs, benzodiazepines comprise of numerous constituents. Alprazolam is the certain benzodiazepine used in production of Xanax; as stated by MedicineNet, Alprazolam is a “benzodiazepine sedative that causes dose-related depression of the central nervous system. Alprazolam is useful in treating anxiety, panic attacks, insomnia, and muscle spasms.”
Although they are classified as different families of substances, with distinct chemical properties, as well as used in treatment of divergent conditions, benzodiazepines can be called and treated as the “opioids of antidepressants” - because despite the differences in their core nature, the external factors contributing to their abuse and the circumstances surrounding it bear noticeable similarities that can be recognised even by those affected by neither of the issues analysed in the thesis.
In her recent (2018) article for CNBC, Ashleigh Garrison allows the reader to attain general understanding of various aspects of the abuse of Xanax, but also other benzodiazepine-based medicines. The thesis, basing on additional sources, will detail each point and refer to its equivalent from the previous chapter.
However, before the examination of the elements included in the article can begin, one should be able to sense the actual scale of the issue, depicted in the graph below:
Even in the graph, a certain similarity can be recorded. The increase in providing prescriptions for benzodiazepines began at the beginning of the 21st century, correspondingly with the time of the rise of opioid painkillers being prescribed. The deaths caused by prescription benzodiazepine abuse (marked by “x”) also started to increase around the aforementioned time – interestingly, lethal cases of the misuse were not recognised before.
Garrison's article begins with data concerning the number of people in The United States officially diagnosed with anxiety disorder – which surpasses forty millions, meaning nearly one out of ten Americans has been affected by the problem. The most recent statistics provided in chapter two reveal that the ratio of opioids being prescribed causes one out of six people being catered with the drug. Although the latter number is one third less than the former, both surpass the half of the considered group (nevertheless, it is important to acknowledge, that not every person suffering with anxiety disorder is treated with benzodiazepines – while the latter number does, in fact, portray the number of those who used opioids).
Next, Garrison presents more detailed numbers of fatal benzodiazepine overdoses. Similarly to opioid-related deaths, the cases have been rising in numbers in the same period of time. While in 1999, there were 1135 reported cases of fatal overdose, the number increased several times during less than twenty years, reaching 8791 deaths in 2015. The prescriptions filled by the patients account for over 13 millions – the author reports that the number equals for 67 percent increase in the sale of the medicines.
Garrison's thought-provoking side remark to the data states:
“Like opioids, there’s plenty of money to be made in the general anxiety-disorder drug market, which includes antidepressants, benzodiazepines and buspirone. In 2014 this sector was valued at more than $3.3 billion in the United States. It’s expected to reach about $3.8 billion by 2020.”
When trying to understand the roots of the high demand for benzodiazepine-based antidepressants, the author quotes the finding of San Diego psychologist, Justin LaPilusa. According to the specialist, most patients develop anxiety disorder in their early twenties, the reason for that being the stress and responsibilities connected to the beginning of adulthood – namely work and social pressure of various origin. LaPilusa reminds the reader that even though the described age group is considered to be adults, they still do not have the necessary mental capability to successfully cope with such tension, therefore falling victim to the plethora of their personal concerns that, in most cases, can only be treated with professional medical help.
The statement is proven correct by the entry published by Substance Abuse and Mental Health Service Administration (SAMHSA) (2012). In their report, Admissions Reporting Benzodiazepine and Narcotic Pain Reliever Abuse at Treatment Entry, SAMHSA divides the number of American patients admitted to several addiction treatment centers by age:
As presented in the graph, young adults make up to over a half of all admissions. The number not only explains that this certain age group is at the highest risk of abusing benzodiazepines and developing addiction – it also leads one to the conclusion that such kind of medicines can be highly addictive, if those that begin to use it the most frequently, are also admitted to addiction recovery centers at such rate.
The mentioned root causes leading to being prescribed benzodiazepines for the first time match, in general understanding, the reasons the interviewees in the film Oxyana provided for their abuse of opioids – the stress related to work (or lack of thereof), social factors (being considered “hillbillies” and thus not receiving sufficient attention to the issue), and lack of better ways of help (caused mostly by internal factors in benzodiazepine abuse, and external in opioid crisis).
The next section of Garrison's research deals with the probability of developing dependence. The author bases her findings on the account of yet another professional, Dr Anna Lembke.
According to Lembke, the physical nature of benzodiazepine addiction does not differ considerably from other cases of substance dependence if the chemical properties of the given class of drugs are considered. Since the benzodiazepine-based medicine alters the actions of gamma-aminobutyric acid (GABA), a neurotransmitter responsible for alleviating the intensity of a person's current emotional state, by strengthening the activity of the acid, the patient can cease to experience anxiety and psychological tension much quicker.
However, prolonged or regular use of such drugs, as Lembke remarks, puts the user at risk of their brain becoming “lazy”. As, during the use, the function of GABA does not rely solely on a natural process anymore, but is instead controlled by an external determinant, the neurotransmitters get used to their purpose having become redundant. Consequently, when the usage of the medicine stops, the reduced or completely erased activity of GABA deprives the patient of the ability correctly manage emotions, thus putting them at risk of panic (due to the sudden lack of the natural reponse they expect) and mental anguish.
Such mechanism creates an unfortunate circle of behavioural pattern – the affected person is aware of the treatment causing chemical imbalance and interfering with the innate agency crucial in maintaining emotional stability, yet is reluctant to quit the therapy due to the distress provoked by the absence of the medicine in the system.
The described process is clearly analogous to the general concept of addiction, including opioid dependence. Nonetheless, in case of the discussed kind of anxiety-management medicines, the addicted individual does not usually seek the recreational properties of the medicine, but rather desires to retain the otherwise natural capability of healthy emotion management. Still, it is important to recognise that recreational use of benzodiazepines does exist and is, in fact, the major component of benzodiazepine (Xanax) epidemic; the issue is going to be analysed in greater detail later in the chapter.
The consequences of the failure of the typical actions of GABA are, however, not the only factors that contribute to the development of benzodiazepine dependence. Similarly to opioid withdrawal, the phenomenon is present in this sort of prescription abuse as well. Corinne O’Keefe Osborn (2018) of Very Well Mind lists the most common symptoms of benzodiazepine withdrawal, along with describing its possible results.
The withdrawal syndrome comprises of:
⦁ nausea
⦁ insomnia
⦁ grand mal seizures
⦁ general muscle pain and spasms
⦁ the feeling of being detached from one's surroundings
⦁ panic attacks, anxiety, the risk of becoming clinically depressed
Whereas many of the symptoms are comparable to the signs of opioid painkillers withdrawal, the most detrimental result in the latter case was paranoia – a purely psychological manifestation. The untreated, prolonged benzodiazepine withdrawal, however, is likely to generate discomfort of more physical nature (but not without being accompanied by some psychological aspects as well). As stated by Osborn:
“Benzodiazepine withdrawal can be dangerous when not handled properly. There is a risk that people who quit benzos without a taper [to taper – to narrow gradually] may experience a life-threatening grand mal seizure. If you go into withdrawal without tapering, you also risk experiencing delirium and hallucinations that cause you to lose touch with reality—a terrifying and dangerous experience.”
Although opioid withdrawal and benzodiazepine withdrawal, when extended in time, are constituted mainly by opposite kinds of symptoms, similarities between can yet again be found - they can both lead to a potentially lethal outcome. The story of Kurt's family in the film Oxyana depicts a case of paranoia that motivated a murder-suicide; likewise, Osborn's statement presented above reveals the possibility of life-threatening seizures appearing.
As stated previously in chapter two, exploring one's personal experience is the most fruitful approach in confirming and supporting official research. Quoted below is the account of Tessa Torgesson, provided by Healthine (2018), a former prescription addict, who suffered from benzodiazepine withdrawal syndrome:
“After a few years of using benzos and then heroin, I got to a place where I was able to make the decision to detox. The doctors told me that I would no longer be prescribed benzos and I went into instant withdrawals. (...) I had increased anxiety, insomnia, irritability, and ringing in my ears.”
Garrison names the last part of her CNBC piece What's leading the charge in benzo Rx? Before the author's findings can be further evaluated and supported by external testimonies and input to answer the leading question, it is necessary to familiarise the reader with the general overview of numbers and demographics pertaining to Xanax and other benzodiazepine abuse. By acknowledging the scale of the problem and the groups that are and the highest risk of falling victim to the abuse (as in the analysis of the opioid epidemic) one is more likely to properly understand the roots of the issue and recognise the factors prone to propel it.
The official site of DrugAbuse – An American Addiction Centers Resource submits a summary of the statistics regarding benzodiazepine misuse which states the following:
⦁ those addicted to benzodiazepines were first introduced to the drug or drugs by being prescribed a benzodiazepine-based medicine for medical and/or therapeutic reasons (similarly to the cases of opioid abuse),
⦁ the most popular names among the benzodiazepines that the patients filled a prescription for are Xanax (Alprazolam), Valium (Diazepam), Ativan (Lorazepam), and Klonopin (Clonazepam),
⦁ the substances are most frequently prescribed to people of Caucasian descent (up to 85% of all admissions), males (over 50%), and those over 18 but under 35 years old (over 50%) (the data yet again shows parrarels between benzodiazepine and opioid misuse),
⦁ a benzodiazepine medicine is rarely the only or the main substance that the patient abuses; in most cases the drug is an accompaniment to another, usually an opioid, or marijuana (a literal connection between the two discussed kinds of prescription abuse).
The Resource's Mike Loverde further illustrates the provided data by creating a diagram out of the medical records related to benzodiazepine abuse:
Once more, the evidence supports the notion that the beginning of the 21st century marked the sudden and steady escalation of benzodiazepine use, inevitably leading not only to the popularisation of said type of treatment, but also to bolstering the number of addicted individuals.
One of the most recognisable characteristics of the opioid epidemic was its connection to certain demographics (Caucasians, eastern United States). In case of benzodiazepine abuse, no link exists that would be as distinctive as in the previously discussed issue; however, the problem does seem to affect a particular area slightly more often than the rest of the country.
A KUTV reporter, Jim Spiewak (2019), reports his findings concerning benzodiazepine addiction in a piece called Addicted Utah. As the title suggests, this specified state met the problem of prescription abuse on a scale big enough to be noticed by mainstream media.
Nevertheless, before studying Spiewak's article, the reader should be introduced to brief facts, relevant to the reviewed question, regarding the state.
Utah is located in the south west of the US; it does not overlap with the areas mentioned in the previous chapter that are affected by the opioid epidemic on the highest scale. The most important data, however, pertains to the racial composition of the state.
Caucasians (non-Hispanic) make up to over 85% of the overall (3,162,000) population – which suggests that the race aspect is likely to play an important role when considering the risk factors of falling victim to benzodiazepine addiction. No ancestry other than European exceeds 3%. Such relation has not been mentioned in Spiewak's report; nonetheless, it should be taken into consideration due to the clear association with the opioid epidemic.
Instead, the article presents a more official information. In just three years (2016-2019) The University of Utah Health provided over 205,000 prescriptions for benzodiazepines, roughly suggesting that 1 out of 15 Utahns use or used some branch of the medicines. Psychiatrist Ky Dorsey, on the work of whom the report is based, states that he believes such high number of prescriptions distributed is unnecessary. He also confirms the threat benzodiazepine withdrawal possesses for the affected:
“When I see patients come in and they've been on them for 10, 15, 20 years and never had the discussion with a doctor previously about coming off of them, that tells me that there is an issue here. (…) The withdrawal syndrome can actually kill you, it can cause your heart rate to go up, your blood pressure to go up to the point where you die.”
But how did the matter of overprescribing come to be in the case of yet another type of medicines? To answer the question, it is necessary to come back to the main focus of the current analysis, the report of Ashleigh Garrison.
The author begins her summary, What’s leading the charge in benzo Rx, with the previously discussed problem, overprescribing benzodiazepines. However, the question of “why” remains – what is the reason behind the spike in recommending the given medicines? What are the roots of the reason itself?
The findings reveal the problem to most likely be caused by primary doctors, with the crucial notice that they do not overprescribe benzodiazepines in order to gain personal or business benefits, but because of yet another instance of “drive-by appointments”. When discussing the increase in endorsing opioid-based treatment, the explanation for the phenomenon was the capabilities of the physicians being insufficient for the number of patients interested in therapy. Referring to the benzodiazepine crisis, Garrison provides a similar resolution – the primary doctors who are usually in charge of supplying prescriptions, do not possess the necessary knowledge, qualifications, and/or experience to recommend a correct way of treating the patient's problems with mental wellbeing.
Nevertheless, such justification raises a substantial objection – if a physician is not licensed to advocate for a certain type of therapy, why are they appointed to do so? Alex Stuckey (2017) of the Salt Lake Tribune seems to have delivered a satisfactory explanation, stating that the age of current doctors and, subsequently, the lack of interest in medical career, as well as inability to pursue it, mostly due to financial reasons, among younger generations of Utahns, is manly to blame:
“Physicians [qualified to prescribe antidepressants/benzodiazepines; psychiatrists] of the baby-boom generation are preparing for retirement more than ever. In 2015, 18 percent of Utah physicians reported plans of retiring within five years, compared to 9 percent in 2010. (...) as more physicians retire from the medical profession, the trend is worsening an ongoing doctor shortage in Utah, experts say. With 207.5 physicians per 100,000 population, the state ranks 43rd in the nation. (...) the shortage is being compounded by problems at the other end of the pipeline: too few residency slots for graduating Utah medical students, rising costs of higher education and lower physician pay compared to other states.”
Unfortunately, the issue does not simply end at the insufficient number of psychiatry graduates. In certain areas, the access to primary doctors, who could, eventually, provide them with a desired medicine, is also restricted. In her report published by Desert News, Wendy Leonard (2018) informs the reader of the alarming trend of a primary doctor being a fast diminishing occupation in the state.
“The number of physicians, clinicians and nurses the state is turning out has always been estimated based on current need, which might have fuelled the shortage of qualified providers Utah is up against. (...) Because the demographics within Utah vary greatly, so do the needs. The entire state could use more primary care physicians. (...) Primary care physicians have a unique opportunity to intervene with patients early on, reducing the incidence of disease and perhaps preventing long-term problems. Yet, the number of primary care providers is dwindling. Utah needs an average of 379 new physicians each year to keep up with population growth, aging, and physician retirement. (...) spread between rural and urban settings that have different health care needs. (...) Perhaps the greatest disadvantage of a scarce primary care presence is growing concern for the mental health of many Utahns, as suicide rates in Utah fall well above the national average.”
In the passage, Leonard touches on various concerns surrounding the matter of overprescribing benzodiazepines, compelling to the analysis presented in the thesis, allowing the reader to understand the phenomenon in greater detail.
First, the author takes into consideration the probable lack of forward-thinking among Utahns (however, the problem is not exclusive to the state). The numerous components, constituting the overall picture and state of a certain area, that are present and decisive at the time being, will presumably change in the years to come. The absence of a specific concern, namely the rise of the number of those suffering from anxiety disorder, in an environment that does not envision the feasible future variations in the composition of the population, creates a shortage of professionals that is going to undoubtedly generate the problem of “drive-by appointments” in the following years. Alas, the eventual acknowledgement of the concern, however vital, is not likely to bring immediate resolution – even if the concern of the lack of younger Utahns pursuing career in medicine became resolved, graduating and acquiring a licence is a time-consuming process that, in case of absence of desired physicians in a given time, leaves those in need of professional help without proper care.
The next point raised by Leonard concerns the noticeable split between the addicted living in rural and urban areas. The division was described in detail when analysing the issue of lack of proper health care and irresponsible medical practices in the places affected by opioid epidemic the most.
Both issues – the opioid and the benzodiazepine abuse – seems to share the core of the issue. Those in non-urban areas have no access to proper treatment due to insufficient number of physicians, and thus fall victim to “drive-by appointments”, being prescribed opioid-based medicines without appropriate evaluation due to a big number of patients awaiting medical care; the overprescribing then leads to substance dependence. On the other hand, those residing in cities, where the abundance and choice of physicians is usually present, are able to find the doctor willing to recommend opioids, and therefore, to develop (however, the patients looking for treatment in urban areas are usually already addicted, and trying to find a way to obtain the desired prescription – the concern discussed in the previous chapter as well) prescription addiction.
Besides the general division between the aforementioned populations, the author suggests yet another disparity – the differences between the needs of rural and urban communities.
Before the investigation can begin, one should be familiarised with the composition of the population of Utahns. The number of residents of Utah living in rural areas equals 262,825, with the overall number of Utahns slightly exceeding three million (about 1 out of 10 residents does not live in the city).
With the needed data in mind, one can start interpreting further information. The official website of Georgetown University details the reviewed discrepancy.
To portray the phenomenon in an easily comprehensible way, it is necessary to start with the study of the broader contrast.
As illustrated on the graph, the division between kinds of limitations favours the residents of cities in each category; the discrepancy is most visible when considering “major activities”. The findings also suggest the general consensus associated with the problem – the rural population experiences more health disadvantages, therefore finding themselves in more frequent need of medical care. The research published by the website supports the thesis:
"The rural population is consistently less well-off than the urban population with respect to health. The rural population is more likely to engage in risky health-related behaviors and to experience higher rates of chronic conditions and activity limitations. Rural residents are also more likely to be uninsured for longer periods of time, and are less likely than urban residents to receive some types of health care, including tests for various chronic conditions. Limited access to health care in rural areas is generally associated with the fact that there are fewer providers. (...) About one-fifth of the U.S. population resides in a rural area. (...) A larger proportion of the rural population than the urban population reports fair to poor physical and mental health. For example, the proportion of rural residents reporting fair to poor physical health is almost one and a half times the proportion of urban residents. (...) Less than 11 percent of physicians in the U.S. practice in rural areas, yet about 20 percent of the population resides in rural areas. Provider recruitment and retention problems in rural areas are related to several factors including lower salaries, geographic isolation from peers and educational opportunities, and fewer amenities such as schools and recreation."
The criteria for “drive-by appointments” and improper medical care seem to have been met in the quoted description. The fragment, however, established a much needed, yet not sufficient picture of the roots of prescription addiction (both benzodiazepine and opioid) in Utah.
As explained at the beginning of the chapter, benzodiazepines are used in treatment of psychological conditions, most of the time related to stress and anxiety. In the piece quoted earlier, Wendy Leonard mentions suicidal tendencies among the population of Utah, an issue connected strictly to disordered mental well-being, the rates of which, according to the author, “fall well above the national average”.
LiveStories proves Leonard's statement true (data per 100,000 population):
What can be noticed yet again, is the spike in the numbers at the beginning of the 21st century.
The deduction from the graph and the acknowledgement of high suicide rates in the state, further answers the question of why benzodiazepine abuse happens to be most prominent in Utah – lack of suitable medical care, combined with prevalent suicidal tendencies, creates an environment where the abuse of prescription medicines is expected to flourish.
The preceding accounts and information confirm the premise of the mutual core of benzodiazepine and opioid abuse, as well as the state of Utah being affected by the former the most. The data included in the chapter, presented in a clear and comprehensible form, is positive to inform one (even without them possessing any prior knowledge of the subject) of the issue of benzodiazepine abuse, the reasons behind it, and the consequences to which it inevitably leads. However, as mentioned previously several times, the direct, personal report on any given matter, is likely to paint the most genuine, authentic picture of the issue.
The approach to the to the personal account of those affected by the benzodiazepine epidemic, however, is going to differ partially from the one presented in the previous chapter. While the opioid crisis, as portrayed in Oxyana, was described by the interviewees involved in it who were themselves addicted to the medicine, or directly participated in the epidemic by various other means, the picture included in the present chapter displays the benzodiazepine epidemic as experienced by professionals engaged in investigating its causes, progress, and consequences.
The Benzodiazepine Medical Disaster, a documentary originally published by RTE1, comprises of a series of interviews, concluded by Shane Kenny, an Irish journalist and a former press secretary of Irish government, who struggled with benzodiazepine withdrawal himself, with Heather Ashton (now retired professor of psychopharmacology and psychiatry at Newcastle University) and Malcolm Lader (professor of psychopharmacology at King's University, also retired).
Before the analysis of the documentary begins, it should be recorded that despite the non-American origin of the interviewees, the information covered by the film does not focus solely on the situation in The United Kingdom, but rather presents universal data, centered around the precarious effects of benzodiazepines on human psyche and body that can be contributed to any group or society. Additionally, as during the study of Oxyana, the data provided by the film will be compared to and supported by knowledge attained from various external sources.
Kenny opens the film by mentioning the notorious question of overprescribing; however, the journalist raises a point that has not been acknowledged in the thesis yet. The list of illnesses that benzodiazepines are used to treat has expanded greatly – instead of limiting the use of the medicines to their original purpose, mental problems connected to anxiety, they are now recommended in cases of muscle spasms, sport injuries, ear diseases (Kenny's situation), mild forms of anxiety that could be cared for with other, less hazardous drugs, and are even used as painkillers. Such form of overprescribing does not only fuel the problem, as in case of “classic” overprescribing, but also considerably enlarges the group of individuals exposed to the threat of addiction.
At the beginning of her interview, Ashton and Lader share their opinion on the benzodiazepine epidemic:
“This was, and still is, a real tragedy. People lose their jobs, their income, their relationships, their marriages. What we need is a wake-up call, where we find people who show signs of brain damage, even if it's just functionally, to start. This would act as a catalyst.”
The first part of the stance draws clear comparisons between opioid and benzodiazepine abuse. The interviewees in Oxyana described their dire day-to-day life that resulted from addiction – the need for money being one of the most pronounced issues since the job opportunities had been greatly reduced.
The latter part, however, presents a new – and considerable – issue. They psychological effects of medicine abuse have been analysed in detail, but can the misuse be responsible for physical changes in the user's brain?
Lader himself conducted two studies with the aim to prove his suspicions. By using the imaging method of analysing the structure of the brain (Lader's team handled the research in the early 1980s; no other, credible technique was available at that time), the professor and his colleagues arrived at a concerning conclusion. The patients who used benzodiazepines for several years showed the signs of brain atrophy; interestingly, the subjects were reported to have been of “relatively young age”, meaning the phenomenon was not likely to be attributed to other causes.
However, Lader was not the only one concerned with physical consequences of long-term use of benzodiazepines. As early as 1976, a Tennessee physician, David Knott, spoke openly about his scepticism towards prolonged use of the drugs:
“I am very convinced that Valium, Librium and other drugs of that class cause damage to the brain. I have seen damage to the cerebral cortex that I believe is due to the use of these drugs, and I am beginning to wonder if the damage is permanent.”
Drug companies responsible for manufacturing benzodiazepines do recognise the alarming results of long-time use, and the list of side effects the user can be exposed to is easily accessible. Nevertheless, Kenny acknowledges a piece of information that would be crucial when considering benzodiazepine treatment, yet it is missing – the symptoms connected to misuse or prolonged use of the drugs are usually long-lasting, and unlikely to disappear without medical assistance.
Ashton and Kenny focus on a specific kind of side effects, the withdrawal syndrome, adding more detailed information to what the thesis has already established in connection to the phenomenon.
According to Ashton, approximately 15% of the affected patients report that the acute physical consequences of their benzodiazepine addiction seem to be permanent (“persistent withdrawal syndrome”), whereas the mental disorders, in most cases, cease to continue.
To support Ashton's findings, ABC News Lauren Cox (2008) discloses the account of an American patient, Alison Kellagher, who used Xanax for almost twenty years:
“I went to a psychiatrist and he just immediately prescribed a Xanax, and it was to take every day. (...) I was in a profoundly alerted consciousness, immediately after stopping. It was the feeling of being in terror, but it was just a physiological state of terror. The first three months was 24-7. Then, it started to let up a little bit by three to six months. By a year, I was pretty comfortable. I wasn't 100 percent, but I was functioning and feeling almost normal.”
Although Kellagher does not provide any additional detail in her statement, the first part of the quote, being prescribed the medicine “immediately”, undoubtedly brings to mind the notorious “drive-by appointments”. The second part illustrates Ashton's thesis of the suffering being mainly physiological.
In the subsequent interview, professor Lader introduces the viewer to a significant comparison between benzodiazepines and opioids. According to Lader's findings, benzodiazepine withdrawal is more pronounced and difficult to overcome that heroin withdrawal. He briefly describes his research: by examining a group of patients who struggled with both benzodiazepine and heroin addiction, he collected numerous accounts of the easiness of stopping abusing opioids in comparison to quitting the other drug (with proper medical help). He also mentions the public's reaction to his discovery; apparently, a significant number of people would not believe the research to be conducted properly due to the general belief that heroin is one of the most dangerous drugs present in modern western societies. As a response to the accusations, Lader brings up a regular occurrence – opioid addicts admitted to prison are forced to go cold turkey (to quit the use of the substance immediately, without any preparation, gradually lowering the dose, or medical assistance) on the drug/medicine are able to successfully halt the abuse (however, a professional aid might be present).
Mentioned earlier was the account of report of Tessa Torgeson, who shared her experience with benzodiazepine withdrawal. Torgeson, however, was also a heroin addict, and therefore is able to prove the results of Lader's research by personal experience:
“The benzo withdrawals were worse than cigarettes - and even heroin. (…) I was angry at the doctors that had originally prescribed me ample benzos for the first few years of my recovery. But I don’t blame them for my addictions. In order to truly heal, I needed to stop blaming and start taking responsibility.”
Lader lists yet another aspect of why he believes benzodiazepine withdrawal causes such severe problems – those addicted to opioids do not report their symptoms to be permanent, or even long-term.
But what exactly are those permanent results of benzodiazepine abuse? The list presented below was comprised of the accounts of the patients admitted to Professor Ashton's clinic, who were affected by the issue:
⦁ pain in limbs, back, neck, teeth, and jaw
⦁ the feeling of being stabbed with needles and pins (paresthesia) in the face and limbs
⦁ stiffness of back, limbs, and jaw
⦁ seizures, dizziness
⦁ hypersensitivity to light, touch, sound, and taste
In rare cases, psychological suffering was also noticed:
⦁ recurrence of the original problems, strengthened (anxiety disorder and depression)
⦁ disordered concentration, memory loss
⦁ insomnia, hallucinations, nightmares
⦁ phobias (most commonly agoraphobia)
⦁ panic attacks
Evidently, long-term or permanent withdrawal syndrome is not only longer in duration, but also produces more severe results.
To further detail the distressing aspects of benzodiazepine abuse recovery, Kenny reminds the viewer of an interesting fact – in the 1970s, in the USA a different family of medicines was commonly used to treat anxiety disorder and depressive episodes. Known as barbiturates, they were soon replaced with benzodiazepines due to the reports that the users of the former were exposed to a high risk of developing addiction. The mechanism of action present in barbiturates was also considerably different, although still acting on the same neurotransmitters. As stated by MedicineNet:
“Barbiturates are central nervous depressants. They reduce the activity of nerves causing muscle relaxation. They can reduce heart rate, breathing, and blood pressure. Barbiturates affect the neurotransmitter gamma-aminobutyric acid (GABA) that nerves use to communicate with one another.”
Nevertheless, Kenny and Lader agree that the enthusiasm among the general population created by the new, “safer” drug happened to be precipitate and caused mainly by the lack of deeper knowledge of benzodiazepines, and the desire for a medicine that would not cause respiratory problems even in those that were not misusing it. Moreover, NorthPoint Recovery (2017) raises yet another points as to why benzodiazepines quickly rose in popularity:
“Would it surprise you to learn that by 1977 reports indicate Valium was the most commonly prescribed drug? Why? Because Valium makes you feel super duper awesomely fantastic. (...) It may make you feel good for a while, but before long you’ll be hooked on the stuff and go through horrific withdrawal if you try to stop taking it.”
As can be deduced from the passage, recreational use and the euphoria-inducing side effects of benzodiazepines were the main culprits that helped replace one addictive substance with another.
The film concludes with Kenny expressing his dissatisfaction with the fact that, despite nearly half a century of benzodiazepine abuse, the problem still remains widely ignored by the authorities and bodies responsible for the treatment of those affected by it.
Lader responds that he, too, is baffled with the fact, yet cannot find a reasonable answer as to why no sufficient precautions are being taken and the awareness is not being raised appropriately to the scale of the issue. He stresses that he does not want to point fingers at anyone without a concrete proof (or, in his own words, he is “not going in terms of a conspiracy theory, but it's very difficult to avoid wondering what is actually going on here”), yet the lack of explicit action leaves him to try to find his own explanation.
Finally, he admits that, even if for only a minor scale, he feels that his own steps might have played a part in the problem discussed:
“Yes, I do [regret not pushing the issue more actively], I mean I felt that I might have done [it], but there are times that you'd rather like to stop banging your head against the wall.”
Such statement might leave one to speculate whether Lader means his own limitations concerning physical and psychological abilities, or whether there are other obstacles (although he advises the viewer not to make unsolicited assumptions) that prevented him from continuing his work.
As a finishing statement, Kenny emphasises yet another oddity surrounding the benzodiazpine epidemic: that those abusing illegal substances are (in most cases) able to receive appropriate and sufficient help, unlike the victims of drugs sold in pharmacies, who also are usually not informed of the dangers of the usage of the medicine they have been prescribed. He explains his point in a considerate way:
“The legal pharma industry can and has done much good making drugs that save lives and alleviate illness, but there's no excuse for the scandalous neglect of this pandemic, of life-destroying pain and suffering benzodiazepines have caused and continue today. There's no excuse now either for the ignorance or negligence of the medical professionals who often wrongly prescribe them. Governments and health authorities have shamefully failed their societies pandering to “big pharma” because of their economic needs. […] It's long past time that they face up the truth about these drugs and start doing something about it.”
The chapter helped draw attention to those who are supposedly not affected by the opioid epidemic, yet seem to be yet other victims of it. The previous issue, widely ignored itself, when (rightfully) eventually paid attention to and discussed, is likely to be the only one of its kind that is focused on, mostly to the outrageous data and consequences that suddenly enter the minds of those formerly oblivious to it. This leaves the fact of misuse and the severity of side effects of other prescription drugs – however prevalent and no less life-threatening that the abuse of OxyContin – put to the side or perpetually left in the shadows, all the while awareness of the problem appears to be the first and most important step in minimising its asperity, and, ultimately, putting a long-overdue and to the avoidable suffering and difficulties.
No comments:
Post a Comment