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TWO DOCTORS SPEAK OUT AGAINST BENZOS
The Oldham Chronicle
Monday, September 4, 2000
The Irresponsible Prescription
Dr Ian Telfer
For short-term use only...
BENZODIAZEPINE drugs have a part to play in medicine, but a limited one only – helping people suffering from short-term emotional problems triggered by a definite reason.
That is the opinion of Dr Ian Telfer, consultant psychiatrist in substance misuse for West Pennine Health Authority, who is using his expert knowledge to help Oldham's GPs tackle the problem.
He blamed irresponsible prescribing for leaving today's doctors dealing with the problems caused by long-term use of benzodiazepine drugs.
But, he said, it was only in 1996 that drugs companies which produce benzodiazepines included references in their product data sheets – an owners' manual for doctors – that they were highly addictive.
The move formed the basis for a huge legal case in the 1990s against the drugs companies involved, brought by benzodiazepine users who claimed the drugs' addictive nature had been known about since 1979.
The case was unsuccessful for a number of legal reasons, but it did highlight the extent of the problem in Britain.
People who stopped taking the drugs were reporting withdrawal symptoms of anxiety, depression, sleeping problems and obsessive compulsive disorder – the very things for which they had benzodiazepines prescribed them in the first place – but now of a greater degree.
Dr Telfer believes benzodiazepines should not be prescribed for such symptoms. "They will not deal with the root cause of the symptoms," he explained. "They should only be used for a short duration for specific problems of a severity requiring medication. They have no role at all for the chronically anxious, for they only suppress what is taking place, and that will come back if the drugs are stopped. What they are useful for are such things as fear of flying, when to take Ativan before getting on the plane to allow you to do that is fine."
Dr Telfer believes they are useful to help people cope with a very definite short-term problem in life that hinders sleep – such as a traumatic house move, an exam or an interview.
What they should not be used for, he said, were events such as bereavements, where they interfere with the grieving and healing process and can cause longer-term problems. "When they first came out they were seen as some sort of panacea – or universal remedy," he explained. "But with constant use it was found they turned people into zombies in the end."
Dr Telfer has been involved in organising training sessions for Oldham GPs, where issues surrounding the use of benzodiazepines are discussed. "They effectively led to a number of GPs changing their prescribing patterns," he said.
Dr Telfer also highlighted the problem of benzodiazepines being sold illegally on the black market. He has made a study of people who have died from overdose of substances such as heroin and methadone, and said almost all also had large amounts of benzodiazepines in their system but few had ever been legitimately prescribed them.
The two main ways they could have got them are from Amsterdam, where drugs laws are more lax, or from people who have been prescribed benzodiazepines by their GP and sold them on.
"What we are trying to do in Oldham, and with some success, is to effectively turn off the tap by deterring initial use of benzodiazepines to avert long-term prescriptions," said Dr Telfer.
Doctor's Mission Offers Lifeline
to Oldham Addicts
Dr Rakesh Kohli
A ROYTON GP is leading a campaign to slash the number of people helplessly addicted to controversial tranquillisers or anti-anxiety pills. Dr Rakesh Kohli is the driving force behind a new scheme to offer all long-term benzodiazepine users in Oldham West an escape from their dependence on the drugs.
As a member of Oldham West Primary Care Group – covering Failsworth, Glodwick, Werneth, Crompton, Moorside and parts of Chadderton and Royton – Dr Kohli has helped to set up a training course for GPs practising in those areas, in a bid to help them wean their patients off their tablets.
Patients are being invited into their GP's surgery and offered assistance in stopping the drugs – once and for all. It is known that thousands of people living in Oldham regularly take benzodiazepine drugs. It is impossible to say how many addicts there are as no tally is kept on the number of individual users.
However, in February this year GPs in Oldham West issued 3,900 benzodiazepine prescriptions, while the figure for Oldham East was 3,200. Dr Kohli says the success of the scheme to fight addiction, relies heavily on patients actually wanting to stop taking them.
Urging regular users to go to their GP and ask for help to stop, he said: "These drugs are highly addictive and people just can't stop taking them overnight. It will be a slow process to reduce them because of the effects, and if people aren't motivated to come forward and help themselves, we can't solve the problem. There are a lot of elderly people taking benzodiazepines which were originally prescribed for sleeping problems and anxiety. When taken long-term they can cause confusion and loss of balance, and a lot of doctors now will not prescribe them at all. There are alternative drugs we can use, and if benzodiazepines are prescribed it should be only for a very short term – for two to four weeks."
West Pennine Health Authority, which covers Oldham, Tameside and Glossop, currently has the fifth highest number of prescriptions for benzodiazepines in the country. And it was those figures that prompted Dr Kohli into action. "I looked at them and realised something had to be done," he said.
"On further scrutiny, checking the number of prescriptions issued was perhaps not the best way of measuring the problem as comparisons were difficult to make. Most such prescriptions are for a month's supply but in areas like Oldham, where doctors treat a high number of drug addicts, we issue prescriptions weekly and sometimes even daily to make sure patients are taking them correctly," he explained.
Doctors are being urged to take extra care when prescribing the drugs – and to offer help to those who want to kick the habit. Few, if any, GPs now prescribe them long-term for new patients.
Dr Jane Rossini, Consultant in Public Health Medicine for West Pennine Health Authority, said the high number of prescriptions for the drugs in West Pennine came as no surprise. She said: "The level of benzodiazepine prescriptions is high in Oldham, but I suspect many patients started taking them at a time when perhaps we didn't know as much about benzodiazepines as we do now. A lot would have been stress-related – and you would expect stress to be a problem in a town like Oldham where there are high levels of deprivation and unemployment."
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