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theage.com.au (Australia)
June 16, 2003
by Julie-Anne Davies

"I'd have a quarter here and a quarter there, all my friends did, and we felt marvellous and just floated through our lives..." Bev Mason.

When Valium was unleashed on the world 40 years ago it was hailed as the wonder drug. But with so many people becoming dependent on it, it has proved to be not so wondrous, after all.

Bev Mason will celebrate her 80th birthday next February, a remarkable achievement in itself but even more impressive for a woman who spent 30 years hooked on drugs. She's clean now and spends her time counselling others to kick their habit. Many are Bev's age, addicted to the same tranquillisers and sleeping pills that nearly killed her.

Her drug problem began innocently enough back in the 1960s when popping a Valium to take away pre-dinner-party nerves was almost as common as a seafood cocktail.

"My husband was a business executive and we entertained a lot and I complained once to my doctor about feeling anxious before social occasions," Bev recalls.

"So he gave me the pills and I'd have a quarter here and a quarter there, all my friends did, and we felt marvellous and just floated through our lives."

When Bev's husband died, she was prescribed more Valium to help her deal with her grief as well as the sleeping tablet Mogadon. The drugs worked for a time, making her almost light-hearted in her despair. But then she had her first panic attack. From there she became agoraphobic, suffered terrible headaches and mysterious cramps, and ended up in hospital sedated on another tranquilliser.

"I realise now of course that I was causing withdrawal because I was increasing and decreasing my dose but at the time I thought I was mad."

Finally, Bev decided to get off the drugs altogether, although she describes coming off that last tab of Valium as a nightmare.

"It took months and months and my doctor actually said to me 'You'll never come off those pills, you've been on them too long', but I did."

Ask anyone to describe a typical Australian drug addict and almost without exception they will get it wrong. Forget the sad, emaciated, usually young heroin addicts or stumbling, brain-damaged alcoholics.

Instead, picture your neighbour, your child's school teacher, your mother, or more likely, your grandmother. These addicts score regularly, but legally, across their local pharmacy counter and most have no idea they have a drug problem.

They are hooked on benzodiazepines - more commonly known as tranquillisers and sleeping pills - which are prescribed in their millions every year by doctors at an annual cost to the community of nearly $55 million. They tantalise users with promises of dulling emotional pain, chasing away anxiety and crooning them to sleep.

But what most benzodiazepine users often don't get told or simply don't get, is that these drugs are highly addictive and withdrawal can be hell.

Further, benzodiazepines are only a temporary fix - it is often only a few weeks before the positive effects wear off and dependency begins. Doctors admit they have been unsuccessful in weaning Australians off their benzos despite a decade-long effort.

"Yes, we've been nagging the community for years on this one and you'd have to say, without a great deal of success," says Dr Lynn Weekes, head of the National Prescribing Service.

The most famous tranquilliser of them all is Valium - 40 years old this year and still going strong. Invented in 1963 by a Polish scientist working for the US pharmaceutical giant Hoffman-La Roche, its name comes from the Latin word for "strong and well".

Synthesised from a simplified version of the tranquilliser Librium, Valium was said to be stronger than Librium, non-addictive and unlike other tranquillisers, almost impossible to overdose on. It was instantly hailed as the "wonder drug" the world's middle class had unknowingly craved for.

In the 1960s and '70s, Valium sold in the billions, making a fortune for its makers and becoming a cultural icon for the baby-boomer generation.

The New York Times reported recently that "Roche executives did not expect much of it," at the time. "But a couple of them tried it on postmenopausal mothers-in-law whom they found insufferable, and were delighted by its calming effects."

Valium also became synonymous with the harried housewife and the stressed-out business executive, a panacea for the swerve balls life delivered. Grief, relationship breakdown, job worries, jet lag, exams, depression and anxiety were just some of the conditions for which it was prescribed.

Valium has also become ingrained in our popular culture. The Rolling Stones immortalised Valium in their 1967 song Mother's Little Helper:

She goes running for the shelter/Of a mother's little helper/And it helps her on her way/Gets her through her busy day.

In Jacqueline Susann's 1966 cult novel Valley of the Dolls - a novel about three ambitious women who popped pills to cope with life in New York's fast lane - Valium was nicknamed "dolls".

Then came the fall. In the 1970s and '80s, celebrities lined up to tell all about their struggle with the drug. Elizabeth Taylor confessed to a steady diet of Valium and booze, Elvis Presley had it in his body when he died. At the same time, the new line of anti-depressants known as "SSRI's" hit the pharmacy shelves, the first and most famous being Prozac.

But here's the thing. The Age of Anxiety is still with us and an analysis of Australians benzodiazepine use from figures supplied by Commonwealth Department of Health, indicate it never went away. That anti-depressants are also being prescribed in record numbers only amplifies the fact.

More tablets stamped with the trademark "V" were ingested last year than a decade ago: 1.5 million in 2002 compared with 1.1 million in 1992.

And, while we know that nearly six million prescriptions for benzodiazepines were written by Australian doctors in the past year, the Commonwealth Department of Health has no idea how many people are currently receiving repeat prescriptions, or for how long.

While doctors are prohibited from issuing repeat scripts for benzodiazepines, they can get authorisation from the Health Insurance Commission to prescribe the drugs in larger quantities. But the HIC does not know how often this request is made, a spokeswoman told The Age because the data has never been analysed.

Further, some of the benzos, notably Valium and Xanax (one of the new and fast growing line of tranquillisers) come in packages of 50 or 100, quantities many doctors believe simply encourages longer-term use.

The "best guess" on just how prevalent benzodiazepine use is in the community is based on data which is eight years old. "It is fair to say we don't have a good picture of what is happening out there," Weekes says.

What is clear though is that doctors are still prescribing benzodiazepines in large numbers.

There is a worrying assumption among doctors that the problem has disappeared, according to Gwenda Cannard, founder of TRANX, a Victorian organisation set up in 1986 to help the so-called "accidental addicts" of benzodiazepines. Cannard says that TRANX is busier than ever.

"Although doctors know benzos are addictive and toxic if used long term, there still seems to be a gap between that universally accepted knowledge and practice on the ground," she says.

"Some GPs obviously are not convinced that these drugs are dangerous."

Disturbingly, she says the profile of those seeking help through TRANX has changed dramatically in the past three years. Once the typical client was over 40, but now that person is most likely to be aged between 20-29.

"What we need to do is make people understand these drugs can make you sick. They can have a chronic toxicity - and not just in high doses either, low doses do it as well."

Drug and alcohol experts say benzo withdrawal is tougher in every way than getting off alcohol or heroin. It can take months, sometimes years, and there is no drug that can alleviate the pain except other benzos.

"Addiction and dependence are words that imply people are seeking these drugs for pleasure but in most cases people have taken them in good faith but have become hooked," says Will Day, a counsellor at TRANX and a researcher on the book The Accidental Addict.

The insidious nature of benzo withdrawal is that the symptoms mimic the original complaint for which the drugs were first supplied. The list is long but includes anxiety, insomnia and agoraphobia as well as a litany of muscle aches and pains that have no apparent cause.

"People often continue to take the drugs in the mistaken belief they are treating these symptoms, when in fact they are relieving their physical withdrawal symptoms," Day says.

Jackie, a 32-year-old mother of three, was branded a hypochondriac when she began to complain about her withdrawal symptoms.

At 25, she was prescribed one of the new breed of benzos, the anti-anxiety drug alprazolam, better known by its brand names Xanax and Karma, for post-natal depression. She unwittingly became addicted and on a dose so low - 0.25 milligrams a day - that her doctor refused to believe her when she complained about the side effects of trying to kick the drug.

"Trying to withdraw made me profoundly sick," Jackie recalls. "My dose was increased and I ended up on a higher dose for the withdrawal symptoms than for the original problem."

More than two years after she first started to ease herself off the benzos, she still suffers some withdrawal symptoms but most are gone. Her story neatly catches the surreptitious nature of benzodiazepine addiction. It isn't how much of the drug you take, but how long you are on it that usually determines dependence.

The highest users of benzos continues to be women over the age of 60, and the most common reason for prescribing is insomnia, especially in the elderly. The sleeping pill temazepam is the most prescribed benzodiazepine in Australia with 2.5 million authorised in 2002.

It is this area of prescribing that has attracted the most concern in recent years. The National Prescribing Service and the Royal Australian College of General Practitioners both issued specific prescribing guidelines to doctors on benzodiazepine treatment in elderly patients.

"With older people in particular, I think doctors just put them in the 'too-hard' basket and keep on handing them scripts," says author and journalist Beatrice Faust, who detailed her own benzo addiction and subsequent withdrawal in her 1993 book Benzo Junkie.

She argues one of the reasons for the silence is the medical profession's reluctance to admit it has a benzo over-prescribing problem. And Faust says users are ashamed to own up to their own addiction. She says she knows many older women who still battle benzo addiction 30 or 40 years after first being prescribed tranquillisers for what can loosely be described as life.

"I could weep for these women, they are ashamed and can't imagine trying to detox themselves after so long."

She says the affects of long-term use has left this group of women with myriad health problems. "Their muscles are sloppy, they are getting arthritis and there's little that can be done for them. They are anxious, depressed and suffer insomnia - all the symptoms they were promised would disappear simply by popping a pill."

In 1991, Australia's top medical authority, the National Health and Medical Research Council, issued a warning that benzodiazepines should only be used for short periods as there was a high risk of addiction, and a serious withdrawal syndrome after long-term use.

Dr Benny Manheit, who chairs the Royal Australian College of General Practitioners' drug and alcohol specialist committee, admits doctors are still grappling with benzodiazepine prescribing problems, not least he says because patients pressure their GPs to keep on writing the scripts.

"Yes, there are people being prescribed long term but part of this is patient-driven and part of it is doctor-driven," Manheit says.

He says dealing with the problem should be a shared responsibility and that patients and doctors alike need to stop automatically turning to pills to help solve complex life problems.

"It is very like the battle we've had as a community with antibiotics and the common cold - everyone wants the pills because they think it will be a quick fix but that's not how it works."

Peter Cashman is one of Australia's most well-known product liability lawyers, litigating successfully in a number of David and Goliath struggles against multi-national organisations, including class actions against the makers of the Dalkon Shield IUD. But there was one battle he had to forego and Cashman says it still hurts.

In the early 1990s, he tried to mount a class action on behalf of a group of benzodiazepine addicts, alleging that drug manufacturers had been aware of the dangers of addiction and other side effects from long-term use but had failed to make the information available to prescribers and patients.

Cashman was working in tandem with a firm of British lawyers that was mounting similar action on behalf of 17,000 people in Britain. After legal aid funding was withdrawn, the British case folded and, as Cashman, says: "We were only a four- partner firm then, trying to prosecute the Dalcron Shield case and we just couldn't afford another big action on our own.

"It is the only case I've thrown the towel in on in my whole career, and to this day it still rankles."

Cashman admits that some of his residual bitterness is personal - his mother was addicted to benzos.

"After my father died, she was given sleeping pills and ended up hooked. She was typical of thousands of Australians who were victims of the drug companies' gross over-marketing."

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