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BEAT THE BENZOS
A CALL FOR EUROPEAN UNION GUIDELINES ON THE PRESCRIBING
OF BENZODIAZEPINES, EUROPE'S MOST HARMFUL DRUGS
Beat the Benzos Campaign
The misuse of benzodiazepines (benzos) presents a major public health problem across Europe. Commonly known by brand names including Valium, temazepam, Librium and Ativan, they are widely prescribed by doctors as sedatives to treat conditions such as anxiety and to relieve muscle spasms. In the United Kingdom alone over 1.2 million people are long-term addicts, dependent upon prescription drugs that are more dangerous and addictive than heroin.
Benzo campaigner Barry Haslam believes he "lost 10 years of his life" through becoming addicted to the drugs after being prescribed them by his doctor. He founded the charity ‘Beat the Benzos' to highlight the plight of addicts like himself, and has compiled a report on the personal experiences of addicts in the UK and across Europe. Together with his Euro-MP Chris Davies (Liberal Democrat, North West of England) he will be presenting it to Commissioner David Byrne on February 4, 2004. Reflecting Barry's experience, it concentrates on the situation in the United Kingdom, while highlighting the fact that other European nations have problems of a similar scale or worse.
Each year in Britain 17 million prescriptions are issued for benzos. The Committee on the Safety of Medicines recommends that a course of treatment should last no longer than four weeks. Consumption lasting for longer than this period can cause physical dependence. Side effects include insomnia, anxiety, drowsiness and increased aggression. but despite warnings the drugs are still sometimes issued through repeat prescriptions for years on end.
Last year Chris Davies secured the backing of the European Parliament for a call to act. MEPs requested the preparation of a Council recommendation on the risks associated with addictive prescription drugs such as benzos, and best practice support for patients suffering long term withdrawal symptoms or permanent impairment.
The Commission has agreed to this proposal, and has said that preparatory work involving an inventory of existing studies in this field will be undertaken. Commission officials have also made clear that they would welcome suggestions from those with first hand experience.
2 The Problem
In the period 1990-1996 (excluding 1994), benzos were responsible for 1,810 deaths in the UK. They are comparable with the most dangerous of illegal drugs.
Benzos also induce suicidal tendencies and may have accounted for many more deaths by other methods. Some 761 regular users of benzos are known to have committed suicide during this period.
Source: Home Office Statistics
2.1 CRM Report
The Committee on the Review of Medicines (1980) states that sleep laboratory studies show most hypnotics tend to lose their sleep promoting properties within 3 to 14 days of continuous use. The committee further noted there was little convincing evidence that benzos were efficacious in the treatment of anxiety after 4 months' continuous treatment. It considered that an appropriate warning regarding long term efficacy be included in the recommendations, particularly in view of the high proportion of patients receiving repeated prescriptions for extended periods of time.
2.2 CSM Report
Despite advice from the Committee on Safety of Medicines (1988) that benzos should not be prescribed for more than 2 to 4 weeks there are still many long-term users in the UK.
2.3 Drug misuse and risks
Benzos are often used in combination with opiates. Up to 90% of attendees at drug misuse treatment centres report use of benzos. Some 49% had injected them.
Source: Drug misuse and dependence; Guidelines on clinical management, Dept of Health, 1999
2.4 Associated health risks
Risk taking sexual behaviour Foetal and neonatal risks in pregnancy Increased violence and criminal behaviour
2.5 Illegal Sources
Interpol have estimated that 8 million temazepam capsules a year are being smuggled into the UK.
2.6 Abuse of the elderly
It is claimed that benzos are routinely overused in care homes and homes for the elderly for the convenience of staff and management.
2.7 Cause of accidents
Benzos impair co-ordination and judgement. It is claimed that there are more benzo drivers than drunk drivers and there are no mechanisms in place for controlling this.
Source: Benzodiazepines: How they work and how to withdraw, C H Ashton, 2002
2.8 Cognitive impairment/Long term damage
Long term prescribing of benzos can cause permanent and irreversible brain damage, brain atrophy, cognitive impairment and thyroid damage. More research is needed on the long term effects of benzos many years after withdrawal.
Sources: Manchester Disability Appeal Tribunal 14/11/1996 - Appellant Barry Haslam and Benzos: Cognitive Impairment/Long Term Damage, 1968-1996
2.9 Dangers to the unborn child
Benzos were detected in 18% of new-born babies at the Princess Royal Hospital, Glasgow between October and November 2000.
Prenatal benzo exposure can cause toxicity and/or withdrawal effects in the new-born baby.
Source: Request to review the current status of benzos - Submission to the Home Office, Benzact, July 2003
3. Sample of Responses Detailing Personal Experiences
Mr D, Wigan, UK - Prescription addict to Ativan. "Can't get downstairs. Can't have a shower. Started avoiding people. Have panic attacks and feel anxious. Left the house for the last time in 1986. Lost 20yrs of his life due to this drug."
Mr H, Ormskirk, UK - "Having been prescribed them for 21 years, I insisted that enough was enough in 1989. The hell of withdrawal was worthwhile, because I became my true self again - a true rebirth."
Mrs B, St Helens, UK - "I was first prescribed nitrazepam and Valium in 1970. My son was forced to witness my appalling descent into increasingly irrational behaviour, verbal aggression and suicidal ideation when I frequently overdosed on the psychoactive drugs which were supposed to be helping me."
Mrs M, Salford, UK - "I first came across temazepam and diazepam when I was about 12 or 13 years old after pinching a few from her (mother) I took a liking to the buzz I got off them. This went on for many years and when I was 18 I started using crack cocaine and became mentally addicted. I used benzos, beer and cannabis to bring me down.
"When I was 26 I started to inject heroin. A doctor and psychiatrist prescribed me chlorpromazine but I thought they were trying to make me mad and refused to take them. I just kept telling them if they gave me ‘mazzies' I'd be OK.
"I've started having fits which I've never had before. After a week my jaw goes funny. I start hallucinating and hearing things again. I've nearly burnt down the house twice this year because I left the oven on. I don't see any future without them (mazzies) as I am heavily addicted and dependent on these tablets."
Mrs R, Grange Over Sands, UK - "I have been off these drugs for 10 years but have had two spells of addiction. The first occurred when I was 19 and a psychiatrist put me on Valium and despite several attempts to come off them I didn't succeed until after 13 years when I was 33.
"The symptoms were very much worse the second time around. I feel very strongly that doctors simply do not understand how serious and dangerous these drugs are. It's very worrying that doctors don't seem to understand the drugs they prescribe."
Mrs W, Darwen, UK - "I started with anxiety and depression in my early teens and by the time I was 17 I was on medication. Most of us have been used as guinea pigs and most still are."
4 Wider European Experiences
Whilst the major medical bodies, including the Royal College of Psychiatrists and the Irish College of General Practitioners, have advised that benzos should not be prescribed for more than 2 to 4 weeks, there is evidence that there are still many long term prescribed users of these drugs in Ireland.
The General Medical Services scheme covers approximately 31% of the population. Benzo usage in GMS adult population suggests that, in 2000, 11.6% of the adult GMS population were using benzos. It also suggests that the usage of benzos is increasing gradually from 87 DDDS (Daily Defined Doses) in 1995 to 116 DDDS in 2000.
A 1999 study of drug users admitted to a detoxification unit for benzo withdrawal identified equal abuses of diazepam, flunitrazepam and flurazepam.
The report on inquests held by the Dublin City Coroner in relation to Opiate related deaths in 1998 and 1999 provides further evidence of the problem of benzo misuse in this population. From 1998-99, 1308 inquests were held and 163 were Opiate related. When the drugs implicated in these deaths are examined it can be seen that in both years the most common drug group involved was benzos, outstripping heroin and cocaine.
Information from the Department of Psychiatry of the Elderly at St James' Hospital, Dublin states that many elderly patients have been taking benzos on a long-term basis and are physiologically and psychologically dependent.
Ireland is a party to the UN Convention on Psychotropic Substances 1971. In view of the requirement to include zolpidem in the controls under the Misuse of Drugs Act, consideration is being given to extension of controls to the other hypnotic drugs of this nature, namely zaleplon and zopiclone. The drug zopiclone was introduced as a safer alternative to benzo drugs but it is also addictive and harmful.
Portugal is the second biggest European consumer of benzos.
Studies performed in Portugal point to 23% of adults (patients from a health centre in Lisbon) consuming benzos on a regular basis.
In the late 1980s, Portuguese users were consuming around 35 DDD (Daily Defined Doses) of benzos per day. At this time Portugal was the country with the lowest benzo consumption rate. In the late 1990's Portugal had become the second biggest consumer of this type of medicine, use having increased from 35 to 85 DDD per inhabitants per day.
Over the last 15 years the prescription of benzos has been under continuous discussion in the Netherlands. Following publication of scientific studies a temporary decrease in use was noticed, but this appears to have been shortlived.
Source: Benzo use in the Netherlands: Changes and hope for the future, F W Van der Waals (1998)
The latest data on benzo use in the Netherlands was published by the Drug Information Project of the Supervisory Board for Healthcare Insurance. Data is collected from an insured population of 5 million people. The database accounts for 50% of sick fund members.
Prescriptions 1993 (millions) 1998 (millions) Anxiolytics 5.9 6.4 Hypnotics 4.8 5.2 Total 10.7 11.6 DDDs 1993 1998 Anxiolytics 114.1 113.5 Hypnotics 129.4 134.2 Total 243.5 247.7 Costs (Euros) 1993 1998 Anxiolytics 46.2 49.8 Hypnotics 39.9 45.7 Total 86.1 95.5
More than 60% of Anxiolytics and 70% of Hypnotics are repeat prescriptions and the number of chronic users has increased from 500,000 in 1992 to 700,000 in 1998.
As far back as the 1980s the attention of the Poisoning Prevention and Drug-Monitoring Centre in Marseille has been drawn to clinical observations and medical appraisals which point to the possible existence of behavioural disorders in healthy subjects when taking benzos.
Source: Adverse effects of benzos with potential social consequences, J Jouglard (2000)
5 Conclusion on the European benzo situation
The Pompidou group of the Council of Europe issued a questionnaire to members in 2000. The aim of this questionnaire was to identify sources of information on benzo consumption, the prevalence of abuse, the harmful effects caused and the strategies implemented to reduce demand. There were very few replies to this questionnaire and no country was able to provide figures on the prevalence of abuse or on illegal consumption. The shortage of information on the legal and illegal use of benzos was primarily accounted for by the fact that the information was not available. There were no systematic data collection procedures or the existing information sources were incomplete or difficult to exploit.
Member states have failed to adequately address benzo drug issues and public health protection.
Evidence that does exist from some member states suggests that the scale of the problem is huge. The European Commission needs to take a lead in encouraging European leaders to take action.
6 Recommendations for European Union Best Practice Guidelines
The problem of addiction to prescription drugs needs to be given a much higher profile. The consequences for individuals and society are at least akin to those created by heroin and alcohol addiction.
Medical authorities need to stress to doctors the dangers of addiction to benzos and ensure that prescribing guidelines are being followed.
The European Commission should consider legislation to establish a compensation scheme for benzo injuries, funded by drugs' manufacturers. Such a scheme exists in New Zealand for all drug injuries.
A 24 hour helpline should be established in all Member States for benzo drug addicts and their families.
Member states should consider the provision of benzo detoxification centres and respite clinics.
Financial aid should be given to appropriate self help/support groups.
Medical authorities should publish advice to doctors on how to assist benzo users escape from addiction. Written withdrawal contracts for benzo addicts, agreed with their doctor and witnessed by a third party, may have a role to play.
Long-term addicts who do not wish to withdraw should have their wishes honoured.
EU-wide research into the long term effects of benzos should be commissioned.
The European Commission should consider requiring all benzo packaging to state clearly: "Caution!! This product contains ingredients which if misused, or taken over a prolonged period, will cause a physical and/or psychological dependency. Consult your doctor and/or pharmacist for further information."
An independent drug scrutiny board should be set up in each Member State. This would monitor all new drugs from the date of approval.
Pharmaceutical companies should be required to update their provision of advice and information to patients in the form of leaflets on an annual basis.
Beat The Benzos Campaign
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