Letter from Joan Gadsby to Chris Rose,
Editor, Vancouver Sun
February 12, 2001
Market-Media International Corp.
4507 Cedarcrest Ave., North Vancouver, BC, V7R 3R2, Canada
Phone: (604) 987-6064 Fax: (604) 987-6063
February 12, 2001
Mr. Chris Rose
Commentary Page Editor,
The Vancouver Sun
Email crose@pacpress.southam.ca
Re: A CALL FOR ACTION AND ACCOUNTABILITY! PRESCRIPTION DRUGS – A SERIOUS HEALTH EPIDEMIC (tranquillizers, sleeping pills, anti depressants)
I have watched with considerable interest the Vancouver Sun's commitment and support for much needed action on illicit drugs and the 4 pillar approach to drug problems in Vancouver – prevention, treatment, enforcement and harm reduction.
I have also read the many tragic stories your paper has devoted space to of people and their families affected by illegal drugs.
However, I am dismayed and concerned at the lack of attention given to an even greater and a more serious and insidious problem affecting more people – the continued indiscriminate prescribing and use of legal drugs – tranquillizers, sleeping pills and anti depressants.
Benzodiazepines (tranquillizers and sleeping pills such as Valium, Librium, Dalmane, Restoril, Serax, Ativan, Rivotril) have been called the most widely prescribed group of drugs in the world and the biggest selling drugs in the history of medicine ($21 billion estimated in 1999 worldwide). Just as tragically these drugs have created hundreds of thousands of "accidental" or "involuntary addicts" here in British Columbia, across Canada and worldwide.
Many people of all ages, income levels and occupations have suffered immensely and needlessly and some have even lost their lives as a result of trusting their doctors to "do no harm" in prescribing these drugs – in many cases for years contrary to established guidelines (for short term, intermittent use only i.e. 7 – 10 days) and without being properly informed of the significant adverse effects which have been known for over 2 decades to doctors, to pharmaceutical companies, to Health Canada but not to patient/consumers.
This long standing major health issue of epidemic proportions has considerable socio economic and political implications costing millions of dollars and affecting the quality of life of countless vulnerable men and women and their families – just as do illicit drugs. The high cost includes not only health and safety in the work place, but career devastation, family dysfunction, productivity losses, insurance claims, car accidents, falls, lost years of people's lives, lost lives, (overdoses) costs to the legal and justice system, workers' compensation board claims, insurance claims, social welfare costs, emergency admissions, physicians' fees, pharmacists' fees, drug costs, detox facilities and increased overall costs for healthcare and other public/private sector services.
In British Columbia as in the rest of Canada we have an ongoing significant problem with not only seniors (23% of whom receive repeat prescriptions for years – 27% on the North Shore) but an estimated 10 – 15% of the population from young teens to all ages are misprescribed these drugs with two thirds being prescribed to women. All of this has been identified and documented in extensive research including concerns expressed by the Chief Medical Health Officer for British Columbia who strongly recommended an awareness campaign to address the issue, the British Columbia Auditor General in his report on appropriate drug utilization, the Women's Health Bureau and the Attorney General's Ministry, etc. over the past 6 years.
Alarmingly, a British Columbia report released in May 1999 revealed that in 1997 benzo prescriptions continued to surpass all other prescriptions for women exceeding cardiac drugs, anti depressants and estrogen. The question this all raises is WHY is this continuing?
How has this been allowed? Pharmaceutical companies have spent millions of dollars over the years marketing and promoting these drugs, and physicians regrettably have bought into this by being slow in upgrading their knowledge or have been resistant to change.
The Pharmaceutical Manufacturers' Association of Canada in an extensive public relations article in the Globe and Mail in April 1997 entitled "Your Money or Your Life" acknowledged this and that there is "an urgent need to educate the medical profession" with "some of the worst problems of inappropriate prescribing occurring with well established medications such as benzodiazepines – tranquillizers".
And yet as reported also in a recent excellent series of articles in the Globe and Mail entitled "Under the Influence" member companies of the Research Based Pharmaceutical Companies continue to deleteriously "buy" and effect doctors' prescribing habits with an assortment of gifts and incentives in addition to influencing research and development projects and clinical trials at Universities, Hospitals and other institutions. Their motive is to create markets, expand sales and bottom line profits for themselves and not necessarily with a patient/client centered focus. To say this is an ethical problem is a gross under statement.
What are the adverse side effects of tranquillizers and sleeping pills – taken short and long terms? The list is endless and follows:
Cognitive Impairment
• Decreased mental alertness • Confusion • Impaired Judgment • Disorientation • Slurred speech • Impaired learning (new verbal and visual information) • Decreased short and long term memory • Lack of concentration • Impairment of decision making • disorganization of thought • induced amnesia • impaired recall • Fogged state of mind • Dementia • Delirium • Drowsiness • Lethargy • Sedation
Note: Cognitive impairment can occur when (1) taking the drugs (2) during withdrawal and (3) for many years after withdrawal and may not be reversible. This can occur taking therapeutic doses long term – i.e. over many years
Behavioural Problems
• Paradoxical reactions and agitation • Increased behavioral disinhibition • induced rage • aggression • hyper excited states • release of hostility • anti social behaviour (affecting family and others)
Psychomotor Effects
• Sedation • Ataxia (total or partial inability to coordinate voluntary bodily movements especially muscular movements) • Impaired visual – spatial ability • blurred vision • staggering (i.e. "dry gin" effect) • dizziness, leading to falls • Impaired operation of a motor vehicle associated with increased accidents i.e. visual and motor coordination
Psychiatric Symptoms
• Creation of depression • worsening of depressive symptoms • altered moods • creation or appearance of psychiatric symptoms such as psychotic reactions, manic depression, hypomania • Ego-alien suicidal ideation (i.e. patients felt "driven" as if by some outside force to commit suicide without the concomitant wish to die)
Note: Psychiatric disorders can't be diagnosed when there is usage of these drugs – source: DSM IV Psychiatric Manual. These are substance (i.e. legal drugs) induced anxiety and mood disorders which disappear when a person is off the drugs.
Addiction
• Dependency on drugs • cross addiction to alcohol and other drugs (to withstand anxiety caused by mini withdrawals between pills • Build up of tolerance to drugs so that more are needed in higher doses over time.
Other
• Emotional anesthesia • gastro intestinal disturbances • sleep disturbances • risk of congenital malformations in pregnancy • floppy baby syndrome • potentiation of the effects when taken with other central nervous system depressant drugs such as sleeping pills and anti depressants • overdoses • toxicity
Withdrawal
• Mini withdrawals between pills • Discontinuance of all drugs creates withdrawal symptoms. Acute, (weeks to months) and protracted, (up to several years.)
Rule of thumb is 1 month of withdrawal for every year of usage.
Withdrawal symptoms can include insomnia, panic attacks, agitation, hallucinations, paranoia, depersonalization, derealization, depression, pressure in head, rebound anxiety, loss of appetite, weight loss, visual distortions, flashbacks, lack of concentration, agoraphobia, dizziness, sweating, nausea, nightmares, palpitations, creeping sensation in the skin, increased sensitivity to light, touch and smell, pins and needles, numbness and seizures and sometimes death.
Sources: International research compiled over 11 years from various sources and documented in my book "Addiction By Prescription".
Some additional alarming facts on legal drugs including benzodiazepines, anti depressants and Ritalin follow:
Canadians swallow more than $6 billion in prescription drugs each year
Estimated health care costs of inappropriate prescriptions exceed $2.56 billion a year in Canada
Prescription Drugs are the fastest growing sector of health care costs and health care costs are the largest component of federal and provincial budgets
Prescription Drugs now exceed the cost of physician services in Canada
The World Health Organization (WHO) estimates that 33% of diseases today are caused by medical treatment i.e. iatrogenic or doctor induced illness
An estimated 60% of users of tranquillizers and sleeping pills become addicted and suffer adverse reactions to the drugs
Pharmaceutical companies spend more on marketing and promoting of drugs than on research and development – an estimated $15,000-$20,000 on every doctor
40% of tested impaired or dead drivers of motor vehicles show prescription drugs in their systems – predominantly tranquillizers and sleeping pills
Guidelines for acceptable duration of benzo use in Canada date back over 2 decades. In 1982, with 1 – 2 weeks use recommended. Other sources stated a maximum of 2 – 4 weeks or for intermittent use only. Most recently, Health Canada states 7 – 10 days
The infrastructure available i.e. detox facilities and doctors knowledgeable to help people withdraw from these drugs is minimal
The elderly receive more than twice the number of prescriptions for psychotropic drugs as do younger people and many live with dementia, and delirium and impaired cognitive functioning in extended care homes
Non "psychiatric" conditions account for 70% of benzo users
Cross addictions to other drugs and alcohol occur in 73% of benzo users – many of whom never used alcohol or other drugs previously
43% of emergency room suicide attempts or unintentional overdoses involve tranquillizers and sleeping pills
Prescription drug addiction to benzodiazepines is far more gripping and debilitating than addiction to heroin or cocaine and withdrawal is well documented to be much worse
A booming market also exists for anti depressants such as Prozac, Paxil, Zoloft and Luvox with worldwide sales in the billions of dollars and Prozac sales of more that $2 billion with more than 24 million users worldwide in 1997. Many benzo users are also prescribed antidepressants with 70% being prescribed for women. Concurrent prescribing of benzos and anti depressants is estimated to be for 60% of patients
The drugging of children with Ritalin, a highly addictive central nervous system stimulant, continues with increasing regularity and controversy with Ritalin use in Canada nearing a world record having increased 50% last year alone. In the United States usage of Ritalin is up an estimated 70% between 1990 and 1998. Is it a question of hook them young and they are customers for life?
Statistics from 39 studies done in US hospitals spanning 4 decades found that 2.2 million serious injuries and more than 100,000 deaths were attributed to prescription drugs taken as instructed. Further, the ingestion of prescription drugs was found to be one of the leading causes of death, along with heart disease, cancer and stroke
68% of people prescribed benzos receive their prescriptions from only one doctor
New "diseases" are being created by drug manufacturers including the latest – "social anxiety disorder" for which the anti depressant, Paxil is being promoted heavily on television currently. Paxil prescriptions in Canada increased 23.9% in the past year reaching just under 3 million prescriptions. A key target market for anti depressants fast emerging today is to prescribe them to teenagers
I know only too well the serious effects of benzodiazepines and anti depressants. I am a survivor of an indifferent healthcare system that does not work.
In my case, I was wrongly prescribed these drugs (Valium, Librium, Dalmane, Restoril, Serax and Ativan) after my son died of a brain tumor Christmas of 1966 for over 2 decades by my former trusted family physician and it was not until I survived an intentional overdose in February 1990 when I almost lost my life and subsequently went through the horrors of protracted withdrawal that I found out the serious consequences of taking these drugs (which I took on the advice of my doctor and in the same way I took birth control pills). At no time did I give informed consent – like many others who did not and do not, and suffer the consequences.
Furthermore, when I finally found out the effects of the prescribed drugs and went back to my former trusted family physician to ask him to help me get off them, he refused to help. Sadly this denial, ignorance and apathy continues today amongst unfortunately too many of the medical profession in BC, Canada and worldwide.
This horrendous experience which has cost me more than $2 million to date began my 11 years of rebuilding my health, my life and my family and my 11 years of research into these drugs worldwide.
My career has included being a successful marketing executive with 4 of Canada's largest companies and as a former poll topping Councillor in North Vancouver District for 13 years, I was selected in 1994 as one of Canada's most notable women by the Canadian University Women's Club and am for the past 8 years President and owner of my own company, Market Media International Corporation which provides with senior contract executive associates consulting services in strategic marketing and planning, business development, government relations and issues management to a wide variety of private and public sector clients. I currently sit on the National and BC Board of Women Entrepreneurs of Canada.
I never touched illegal drugs nor would I ever though my former doctor suggested I should try marijuana at one time.
I firmly believe that God kept me alive to carry this message and to affect much overdue systemic change. My initiatives over the past 11 years to combat this serious and often buried health epidemic include:
Author of book "Addiction By Prescription" – one woman's triumph and fight for change published by Key Porter Books, Toronto, Canada April 2000. Internationally endorsed by experts chosen as non fiction for a Canadian writer and available internationally online at www.chapters.ca. The book was one of the biggest hits at the Frankfurt Germany Book Fair in October 2000 and will be available in other languages in the future. Available also in paperback in March this year. (Copy was sent last year to Patricia Graham, Managing Editor of the Vancouver Sun when it was first released for a book review by Vancouver Sun)
Co Executive Producer and Research Consultant of television documentary "Our Pill Epidemic" – the shocking story of a society hooked on drugs which has been broadcast nationally on CTV and is available in video (1-800-471-5628)
Project Leader/Consultant for development and implementation of national multi stakeholder strategic action plan and awareness campaign for benzodiazepines (currently in proposal stage seeking private/public sector funding in this province and nationally
Becoming a recognized international authority and public speaker on the responsible and informed use of benzodiazepines (tranquillizers and sleeping pills) and anti depressants. Numerous guest appearances on television, radio, other media and lecturer/presenter at Universities, conferences, health and wellness shows
In April 1997 I presented to the Standing Committee on Heath in Ottawa but no report was ever written and an Election called. I hope to present again this Spring.
Senator Lucie Pépin raised this "tragic" issue of overmedication in the Senate in Ottawa last year and I hope to present to Senate Hearings on the subject also this Spring.
Last November I presented to an international conference on Benzodiazepines in London, England where I met many people from throughout the world whose lives and families have been devastated by these drugs and who are committed to doing something about the problem. (Reference my home page on the web site www.benzo.org.uk). I have also become Vice President of the International Benzodiazepine Awareness Network affiliated with over 12 groups worldwide.
In the UK there were 17,000 lawsuits filed against doctors, pharmaceutical companies and health authorities on behalf of claimants with over $200 million spent on legal aid. The matter was further referred to the European Court of Human Rights. In Canada, I am aware of 12 lawsuits pending.
There is in my view a direct parallel with the misprescribing of these drugs and their long term consequences with the highly publicized Red Cross Blood scandal which has devastated so many peoples lives. It was all known over 2 decades ago to pharmaceutical companies, to government and to doctors. But little has been done to address this issue. Is a Class Action Suit required to get Action? The Regional Head of Health Canada in Vancouver seems to think so further to my meeting with her July 6, 2000.
In my October 1, 2000 letter to Prime Minister Jean Chrétien which I gave him personally with a copy of my book, I raised this question having received only rhetoric from Health Minister Allan Rock and his predecessor Dave Dingwall. I also implored him "not to allow this serious issue of legal drugs to continue to fall into the deep black hole of inaction, delay, stonewalling, bureaucracy and politics as it has over the past decade".
My efforts to obtain partnership funding from public/private sector sources to develop and implement a multi stakeholder focused strategic action plan to address this issue is starting to receive some much needed support and endorsements from all stakeholders. My framework of obstacles with solutions is extensively documented in my "Call to Action" chapter of my book which I recommend and authorize the Vancouver Sun to publish as part of this article. (It also follows for your reference).
I am also encouraged by my work with a nucleus of "tuned in" doctors in British Columbia and across Canada to create awareness and affect systemic change in doctors' prescribing habits. My strategic action plan proposal has received endorsement from the National Coordinator of a $618,000 project aimed at measuring and modifying doctors inappropriate prescribing of benzodiazepines involving all 16 medical schools in Canada.
Today, 10½ years off these prescribed drugs, the quality of my life has increased tenfold and I run 2½ miles every day along the West Vancouver seawall – a key factor in my recovery.
Sadly and tragically while I have been rebuilding my health my life and my family, my oldest daughter, Deb, died of breast cancer May 1, 1999. But there were no pills required to cope with her serious illness or the tremendous grief and pain I feel from losing another of my beloved children to cancer. Nor were they ever required before or after my son's death.
My book "Addiction By Prescription" has been targeted at the hundreds of thousands of people who suffer with their families from benzo misprescribing and who go through their own personal "hell" while they are on the drugs and in withdrawal – and to other stakeholders who are committed to positive change. I can supply the Vancouver Sun with names of other individuals who have become "Accidental Addicts" from these prescription drugs – many of whom are reclaiming their lives, many going through withdrawal without help from the medical profession and names of families who have lost family members to these legal drugs through overdoses. (I am aware of 11 deaths in the past 7 months).
The facts and research on the misprescribing, misdiagnosis and mistreatment surrounding tranquillizers and sleeping pills and their serious adverse side effects are all well documented.
It is only logical that there should be a combined effort in addressing the "softcare prescription drug variety of drug use and addiction" as part of the Framework for Action for Illicit Drug Problems in Vancouver. While the drug pushers are different, the need for funding for a comprehensive and strategic action plan on Addiction to Drugs is shared and critical to positive change. Note: Many illegal drug users also use benzodiazepines which some buy on the street while others are prescribed them in withdrawal – regrettably substituting one addiction for another.
Governments at all 3 levels can no longer ignore the dire consequences of their Inaction on Addiction to legal and illegal drugs. In his January 16, 2000 response letter to mine of July 17, 2000, Health Minister Allan Rock states "I wish you well in your efforts to address this important issue" – a clear abdication of his responsibility to protect the health and safety of Canadians.
In British Columbia, the government, (including Premier Ujjal Dosanjh and various Ministries – notably Health and Children and Families) – although it acknowledges the problem of tranquillizers and sleeping pills, sends reply letters applauding my efforts and encouraging me to keep up the fight, it provides no money for the strategic action plan. As you said in your recent editorial "There is no excuse for government to delay funding". I couldn't agree more.
The time for action and accountability is now before other lives are lost or destroyed – whether from legal or illegal drugs. One dollar spent on prevention can save $12 on future costs. There can be and should be an integrated approach to positive partnership solutions to the long standing serious health epidemic of misprescribed drugs. And I will continue to do my part to make this happen. Together, we can make a difference!
Joan E. Gadsby
President
Author of "Addiction By Prescription" and Co Executive Producer Television documentary "Our Pill Epidemic" – The Shocking Story of a Society Hooked on Drugs"
Home page on website www.benzo.org.uk.
4507 Cedarcrest Avenue, North Vancouver, B.C. Canada V7R 3R2
Tel: (604) 987-6064 Fax: (604) 987-6063
Benzodiazepines – Time For Action And Accountability
"Addiction by Prescription" (soft cover) Press Release
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