BENZODIAZEPINE GUIDELINES
ROUTINELY IGNORED
TRANSCRIPT
You and Yours
BBC Radio 4
July 16, 2002
Winifred Robinson: Doctors are told they must protect patents from addiction by limiting their use of tranquillisers. So why don't they? And would tough new legislation help? Lawyers and campaigners working for people addicted to powerful tranquillisers are calling for new laws to prevent doctors from overprescribing them. More than a million people in the UK are addicted to benzodiazepines - the group of drugs including Valium and temazepam. Government guidelines issued back in 1988 say that doctors should issue prescriptions for no longer than four weeks but these guidelines are routinely flouted and ignored. Part of the problem according to campaigners is that doctors have nothing to fear from the courts. A group action by tranquilliser addicts failed. Patients have to take individual GPs through the courts and few are successful. One recent landmark case was won by Ray Nimmo who lives in Scunthorpe. Now aged 50 he was prescribed Valium and a cocktail of other tranquillisers for 14 years. He was awarded £40,000 in an out-of-court settlement. He told Rani Kaur how it happened.
Ray Nimmo: I was 32-years-old in 1984 and was suffering from a dental infection. My doctor prescribed and antibiotic and I had an allergic reaction to it. I was left with this severe abdominal pain. My doctor said this was a muscle spasm and prescribed this, well, he said it was a muscle relaxant but it was a very short-acting and very powerful benzodiazepine tranquilliser called Xanax. I took this for about a month but it didn't work and he prescribed a succession of different tranquillisers until by January 1985 I was on a pretty high dose of diazepam - Valium.
Rani Kaur: How many years were you on these?
Ray Nimmo: Well, for 14 years from 1984 to 1998 I was just left on repeat prescriptions of these drugs. I was told that I was the problem, that I needed to stay on these drugs. I just became suicidally depressed, so anxious, agoraphobic, lethargic. I just didn't want to go out of the house. I didn't want to answer the door or the telephone. I was just like a zombie - living in this twilight world of paranoia and fear. It was dreadful.
Rani Kaur: Were you able to work?
Ray Nimmo: Well, no. By March 1986 I just had to give up work. I couldn't cope with life let alone a career or a job of any kind. My family were just completely at a loss. My wife managed one day at a time - trying to look after me, managing all the household, doing all the shopping, looking after our young son. My son's 20 next month. I really don't even remember him for all those years. It's as if my whole memory is blotted out. It's as if all those 14 years happened to someone else.
Rani Kaur: Ray did you ever go back to your GPs and did they ever offer any alternatives?
Ray Nimmo: Well, not really, no. They always insisted that I was the problem, that I was suffering from some mental illness. I know now that it was drug-induced mental illness. I just took them at their word and I had no reason to question their authority. They were doctors. I belong to that generation of people that trusted doctors.
Rani Kaur: At what point did you feel that something was wrong?
Ray Nimmo: Well, it wasn't until 1998 when I was suffering from a groin infection and I was referred to a surgeon at the local hospital and, after an ultrasound scan, he just looked at me and said: "There's nothing really physically wrong with you but I believe all your problems are down to being on diazepam." Well, I was so surprised. It was like a bolt from the blue. For the first time ever a doctor told me that the drugs were my problem. They were the cause of all my problems. I wanted to find out more so, very quickly, we found another GP and he diagnosed Valium-induced depression and Valium addiction. He said: "Let's get you off these drugs and see what we find."
Rani Kaur: How did you get off these drugs?
Ray Nimmo: Well, over a three month period he brought me gradually off these drugs. The depression resolved, the anxiety stopped, even the abdominal pain - the very thing I was prescribed these drugs for - just disappeared and I started to get better. I started to become the man I used to be. Gradually I started to think: "This is a terrible injustice" and I thought, well, I don't want revenge but I'd like some form of justice. These doctors had done some serious harm to me, and not just to me but also to my family and it was so unnecessary.
Winifred Robinson: Ray Nimmo talking to our reporter Rani Kaur. Pamela Armstrong-Sharples is the co-founder of the Council for Involuntary Tranquilliser Addiction and she's in our Liverpool studio. It was an extraordinary account that - given that I said that the guidelines, meant to limit prescriptions of these drugs to no longer than 4 weeks, came out in 1988 and Mr Nimmo was still taking them in 1998. Is he just a very unfortunate one off?
Pam Armstrong: I'm afraid it's a very common story and it's one that I deal with every day and it's very depressing considering we've been campaigning since the organisation was founded in January 1987 by myself and Peter Ritson. I mean, we just can't believe that it's still going on.
Winifred Robinson: These guidelines to doctors - what do they actually say?
Pam Armstrong: Well they say that benzodiazepines should only be prescribed for up to 28 days and then for only very disabling insomnia or anxiety, and not at all for bereavement because many people have been prescribed them for all those reasons for longer than 28 days.
Winifred Robinson: And how did the guidelines affect prescription rates?
Pam Armstrong: Well, I think the prescription rates have gone down but not significantly enough considering all that's gone on over those years. There is now considerable awareness that there's a problem. I think every doctor in Britain knows that benzodiazepines are addictive and knows that if they start someone on a benzodiazepine they are potentially starting an addiction.
Winifred Robinson: Why then are they not as cautious as they should be?
Pam Armstrong: I think they greatly underestimate the problem and I think that although the guidelines are there - I have to say I don't think many doctors actually know about the Current Problems No. 21 which was issued by the Committee on Safety of Medicines in January 1988 because it isn't policed, because there are no sanctions. If doctors do create new addicts I'd like to see sanctions for that quite firmly at this point in time because there is no excuse for it.
Winifred Robinson: You said you'd like to see sanctions.
Pam Armstrong: Some form of sanctions so that the policing of this directive from the Committee on Safety of Medicines. I see no point in us having this QUANGO organisation which licences drugs if it does nothing to actually police what it's licensing and nothing to actually sanction doctors who do the wrong thing - who just flout it.
Winifred Robinson: There are safeguards in place according to the Department of Health, for example there are pharmacy advisors who have to monitor prescription rates for these drugs and to have low rates of prescribing these drugs is actually one of a number of the performance targets the GPs are asking to meet. So why don't those sanctions work then?
Pam Armstrong: Again I think it's because doctors underestimate the problem. They don't realise the amount of misery that long-term benzodiazepine use causes and they also often have little alternatives to offer in spite of the fact that it's very fashionable to have counselling and to use alternative therapies they are actually not very readily available to GPs and very often there are very long waiting lists for them and I think that's one of the problems. The pen is in the GP's hand and he can offer the prescription very rapidly and patients themselves often put pressures on doctors. They want something quickly. They don't want to be put on a waiting list so the quickest thing to do is to offer a prescription and hang the consequences.
Winifred Robinson: Pamela Armstrong-Sharples from the Council for Involuntary Tranquilliser Addiction. Thank you.
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