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BATTLE AGAINST DRUG ADDICTION
BITTER PILLS - LEGALLY PRESCRIBED
BUT POTENTIALLY HARMFUL
Andrea, Val and Helen have all experienced the agonies
of dependence on prescribed drugs
Each of these women has fought a long battle against drug addiction. But there was nothing illegal about their habit - the pills they were taking had been prescribed by doctors.
The drugs were tranquillisers and sleeping pills commonly used to treat stress and anxiety. The dangers of addiction were first recognised 15 years ago and safeguards were put in place recommending they shouldn't be prescribed for longer than four weeks. But still more women are becoming addicted, so why haven't the lessons been learned?
Perhaps you think all this sounds strangely familiar? Then, tragically, you're right. Back in the 1980s there was a huge media furore about the problems of dependence caused by benzodiazepine tranquillisers and sleeping pills. In January 1988 the UK's Committee on the Safety of Medicines (CSM) issued strong warnings about taking them for longer than four weeks. Yet a recent survey estimated that around 1.5 million people in the UK have been taking benzodiazepines for longer than four months.
Patients are still being given drugs with apparent disregard for the guidelines
Some of these people began taking the drugs before the 1988 guidelines and have never stopped. Others have been prescribed them by psychiatrists, and then family doctors continue prescribing them once the patient is discharged. But, shockingly, new patients are still being given benzodiazepines with apparent disregard for the guidelines. Some GPs are still prescribing the drugs long term to new patients because they don't really believe the problems associated with them.' says Heather Ashton, Emeritus Professor of Clinical Psychopharmacology at the University of Newcastle upon Tyne and an expert on benzodiazepine dependence. 'I get calls every day from people having problems with these drugs who say that their GPs won't help.'
Why it's frighteningly easy to become addicted
Benzos are a family of drugs that include Valium (diazepam), nitrazepam, temazepam and lorazepam. 'Initially they're effective for helping those who have sleep problems or anxiety, but people can become tolerant after just a few weeks,' explains Professor Ashton. The drugs operate on receptors in the brain, blocking stress-causing messages and making you feel calmer. But the brain's natural balancing mechanism means that the effect is only short term, so you rapidly become tolerant to the drugs. If people take them for longer than the recommended time, what can happen is that they start feeling anxious or depressed - a sign that their body has become tolerant to the drug and needs a larger dose in order to feel an effect. If the dosage is increased it can carry on, with patients taking ever-larger doses to achieve the same effect.
Typical symptoms of long-term benzo use include muscle weakness, poor memory and concentration, mental confusion, lack of co-ordination and balance, apathy, insomnia, and stomach and menstrual problems. 'You've got to remember that most of these people had no mental illness and saw their doctor because they had problems sleeping or felt stressed,' says Ian Singleton, Director of the Bristol Tranquilliser Project. 'People complain of "losing" whole years, while others have lost their jobs, their homes, and their relationships.'
So why are these drugs still being prescribed? There are some safeguards. Apart from the CSM and drug company guidelines, the Department of Health has pharmacy advisers who monitor prescription rates for these drugs, and low prescribing rates are included among GPs' performance targets. Some experts believe part of the problem lies in the pressures on overstretched family doctors who only have time to deal with the symptoms rather than the underlying causes. 'You can't cure anxiety with drugs but it only takes a minute to write out a prescription, as opposed to 20 minutes talking to a patient and finding out what's making them feel like this,' says Professor Ashton.
Dr Jim Kennedy, spokesperson on prescribing issues for the Royal College of General Practitioners, believes that doctors are well aware of the dangers and do take them seriously 'Why GPs still prescribe long term is a good question and one we'd like answered,' he says. 'There are a number of factors which don't excuse it but could be contributing. Certainly there's an element of patient demand - some GPs have problems saying no to patients or not giving them something when they're in difficulties.'
The problems of withdrawal
Often it's when people try to stop that the problems really start. 'Coming off the drugs too quickly without the right support can be dangerous, causing convulsions, psychosis, hallucinations and severe panic attacks,' explains Professor Ashton. 'Withdrawal symptoms can last months or years in 15% of long-term users. In some people, chronic use has resulted in long-term, possibly permanent disability.'
There isn't even any Government funding to help with withdrawal. The handful of medically based clinics, like the one run by Professor Ashton, have lost their funding. The Bristol Tranquilliser Project is the only one funded by the local primary care trust, and the Council for Involuntary Tranquilliser Addiction (CITA) survives on the revenue it earns from running withdrawal clinics for GP practices in the North West. CITA's Pam Armstrong-Sharples says that providing a similar service nationwide would be cheap and effective. 'There's no mystery about how to deal with withdrawal - we plan it carefully, liase with GPs and provide counselling,' she says. 'There are many more GPs who want this service but have no money to pay for it.'
Dr Jim Kennedy agrees that more resources are needed. 'To help someone withdraw successfully GPs need knowledge, skills and resources,' he explains. 'It requires significant investment from the practice and is a big psychological strain on the practitioner. For example, you have to see the patient weekly for maybe 20 minutes instead of the usual seven to 10 minutes. We need more resources, more time and more help from specialised teams to manage the withdrawal.'
In the meantime, many who've taken these drugs are disillusioned that the system which created their problems has abandoned them. Barry Haslam, who's now registered disabled because of the lasting memory damage he suffered, has jointly launched Beat the Benzos, to campaign for funding for withdrawal centres and for benzodiazepines to be reclassified as class A drugs. The group has sponsored an early day motion, already signed by 180 MPs. 'We'd like to see a mandatory four-week prescribing rule to stop these drugs wrecking more lives,' he says.
What's now worrying experts is that some GPs are switching from prescribing benzos for sleep problems to zopiclone, zolpidem and zaleplon - newer, non-benzodiazepine drugs that work on the same brain receptors and, like benzodiazepines, should be restricted to four weeks' use because of the risk of dependence. Although the prescribing instructions to stop the same appalling addiction problems happening again are clearly set out, will they also be ignored? If the lessons aren't learned, there may be yet another epidemic in the making.
New drugs new problems
When SSRIs (selective serotonin re-uptake inhibitors) first came on the market, this new generation of antidepressants (such as Prozac and Seroxat) was hailed as revolutionary - safe, non-addictive and effective. Does that sound familiar? It wasn't long before problems appeared. Although millions of people were helped by the drugs, there were reports that a minority became suicidal or violent while taking them and that others suffered severe withdrawal symptoms. An expert working group is now reviewing all the evidence relating to these drugs.
What if you need medication?
If your doctor suggests you take benzodiazepines or SSRIs - or any new form of medication - ask what type of drug it is (there are more than 20 benzodiazepines and you may not recognise the name), the reason it's being suggested and for how long, and about any possible side-effects and dependency problems.
Read the Patient Information Leaflet (PIL) which comes with every new medication Follow its instructions carefully and keep it for as long continue taking the medication.
Never stop taking a medicine without first consulting your doctor. If you experience side-effects. see your doctor immediately.
Talk to your GP if you're worried about your current medication and the effect it's having on you. If you want advice about benzodiazepines or SSRIs, these organisations offer help and support: call the CITA Helpline (0151 932 0102; Monday-Friday, 10am 4pm; Saturday-Sunday 10am-1pm) or visit www.benzo.org.uk, which has links to support groups plus information about safe withdrawal.
If either you or a relative have been affected by these drugs and want to do something about it, write to your MP about the benzodiazepine situation. Ask what's being done to help those who become dependent on the drugs and what measures are being taken to prevent further addictions.
COMING OFF THE MEDICATION CAN BE WHEN
THE REAL PROBLEMS KICK IN
Valium is traumatic
In 34 years only one GP has suggested I stop taking Valium'
Andrea Mackenzie was 20 when she was first prescribed Valium. Thirty four years later she's struggling to stop taking it. 'In all that time only one GP - and I've had lots - has suggested I think about coming off,' says Andrea. 'In a way I was lucky - I reached my 40s without too many problems.' She took Valium through her first two pregnancies - at the time nobody knew of the dangers - but when warnings about the drugs started to appear and she was pregnant again she managed to cut right down. But Andrea suffered postnatal depression, then her mother died suddenly. 'The doctor I saw dramatically increased my dose. Looking back, all I can remember is feeling numb.' Over the next 10 years Andrea tried, unsuccessfully, to stop taking Valium, then three years ago, after losing her home and her marriage, her dose was doubled. 'I felt so desperate that I agreed,' she says. Now 54, she's spent the past year gradually reducing her dose. 'It's traumatic. It feels as if the floor moves, I get electrical charges through my body, dreadful stomach cramps, urinary problems, all sorts of things, but most of all the world feels like a frightening place. I want to think I can stop completely but I don't know if I can.'
alongside heroin addicts
'I feel angry people are still being given these drugs'
Val Eley was 42 and working long hours running a pub when, in 1985, she went to her doctor complaining of stress. He prescribed Valium but after three months Val developed a burning sensation in her body. The doctor increased the dose, then, as her symptoms worsened, added two other benzodiazepines and an antidepressant. 'I was taking so many tablets but felt terrible,' recalls Val.
As the adverse publicity about benzos grew, Val tried to come off them. 'I felt I was going mad - several times I lost consciousness. I ended up in a psychiatric hospital where they gave me electric shock therapy and topped me up with benzos. The doctor said it couldn't be withdrawal - I'd had a nervous breakdown.' The only available help was a detox clinic and Val went through the agonising process of withdrawal alongside heroin addicts. She hasn't taken benzodiazepines for 13 years but still has severe problems. I just feel angry that people are still being given these drugs,' she says.
long way to go
'I've lost four years of my life
Helen Kay was prescribed Valium after suffering severe side-effects from another drug she'd been given to relieve stress and help her sleep. 'My youngest daughter was waking up six or seven times in the night. I was getting hardly any sleep and was stressed and totally worn out,' says Helen, 39. 'The drug they gave me made me terribly depressed and caused spasms, so they took me off it and gave me an SSRI antidepressant. But that made me very anxious and I couldn't sleep, so my GP prescribed Valium.' That was four years ago, 11 years after the CSM guidelines. 'I don't recall the doctor ever mentioning the four-week limit or that Valium could cause dependence,' says Helen.
Over the next few years Helen was switched from one antidepressant to another, but the prescriptions for Valium continued. Realising she was addicted, Helen tried to reduce her dose but did it too quickly and the withdrawal symptoms were so severe that she ended up in hospital. 'When I came out I started looking at the internet. I knew that I was addicted and had to come off,' she says.
Last April, with the help of CITA, Helen started to reduce her dose and she's now down from 15mg to 5mg daily. 'It's been horrific. The fear as you withdraw is horrendous. I was incapable of being on my own so we lived with my mother, and I'm starting to feel better at last. I laugh - which I haven't done for four years. I have a busy life with the girls and I work.'
'I'm so angry about what's happened to me. Although GPs acknowledge that Valium is addictive, at no stage has any GP suggested I stop it or offered help. Sometimes I've felt like a freak - the doctors won't accept that it's the drugs doing it, they always say it's you. I've lost four years of my life and I've still got a long way to go, but I'm determined to get off these drugs.'