More than 150,000 Finns take
tranquillisers regularly
Elderly main consumers of benzodiazepines
Helsingin Sanomat
Monday, 11 December, 2000
by Päivi Repo, staff writer
Tens of thousands of Finns are dependent on depressant drugs. Medication originally taken for the treatment of anxiety or a sudden crisis can turn into a habit that is difficult to break, and can last for years.
Benzodiazepines have proven to be the most difficult problem in the field of prescription drug dependency.
Doctors no longer prescribe benzodiazepines as freely as they did in the 1970s, because of greater awareness of their addictive potential. However, 300,000 people take them each year, and more than 150,000 are long term users, taking the pills year after year.
In Sweden, in a long term study conducted in a single municipality, one quarter of the users monitored took the medicines during the whole 13-year duration of the study.
The most frequent users are women over the age of 75.
"The problem with benzodiazepines is that they are so good. It is hard not to use them, because they take away bad feelings", says Professor Jouko Lönnqvist of Finland’s National Public Health Institute.
"Their effectiveness is based on the fact that they are close to natural mechanisms. The brain produces similar substances. They are also safe, and people do not commit suicide with them."
Large amounts of benzodiazepines are used at institutions for the care of the elderly to relieve the residents’ anxiety and help them get to sleep. They are also sold illegally for recreational purposes, and are sometimes used in combination with alcohol.
About half of those who take benzodiazepines grow dependent on them during years of uninterrupted use, says specialist doctor Helena Vorma. She says that when use is suspended, a third of users suffer strong withdrawal symptoms, another third have mild symptoms, and the rest are able to stop without experiencing withdrawal.
"In short-term use benzodiazepines are safe, but in long term use, some become addicted. The addiction can be harmless or harmful, psychological, or physical", Vorma says.
According to Riitta Pekonen of a substance abuse clinic in Helsinki, people tend to hide their addiction to prescription drugs, as they feel that the condition is more shameful than alcoholism. Meanwhile, Riitta Pakaslahti of the Finnish Association for Healthy Lifestyles says that in Finland there is much less awareness of the harmful effects of the drugs than in many other countries.
"People think that we're druggies, even though most of us got the medication for a disease, and have maintained the original dosage", says one man who has taken the same medicine for 22 years.
He got the medication for anxiety, and now he feels that he is suffering from disease caused by the medicine. "In long-term use, benzodiazepines cause all kinds of different symptoms. The users try to get help from doctors, and end up with a new prescription and more benzodiazepines", he says.
In Britain, a campaign began in early November aimed at increasing awareness of the dangers of benzodiazepines, to teach doctors and nurses about the consequences of long term use, and to give support to those who get hooked. Britain has an estimated 1.2 million people who are dependent on benzodiazepines.
Helena Vorma says that a typical case involves medication originally prescribed in the 1970s for anxiety felt in social situations. The importance of the medication grew and grew until it became increasingly difficult to get by without medicine. Eventually life starts completely revolving around the medicine, at the expense of work and the family.
According to an international study, up to 80% of those addicted to benzodiazepines are able to return to work after withdrawal and rehabilitation. Helena Vorma is currently conducting a study on the effectiveness of the Finnish model. It has been used in almost all parts of the country, but there are no precise details on the number of people who have beat their addiction.
"The withdrawal symptoms are terrible, at worst they are intolerable: lots of pain, a feeling of unreality, fear of going insane. Many fear that the old disease might be coming back", says Pekonen, who has trained dozens of health care professionals in work with addicts in withdrawal.
According to Pirkko Valtola, chairwoman of Finland’s association of municipal doctors, new prescriptions are given mainly for people undergoing a crisis in their personal lives, or for people who are ill themselves, or who are coping with the illness of a close relative. According to present instructions, there should be a plan for stopping the medication already when the first prescription is given.
Benzodiazepines are no longer prescribed to any patient who happens to walk into a clinic. Valtola feels that the rules should be tightened further. She feels that patients should not be given 100 pills with instructions to take when needed.
Riitta Pekonen says that she has noticed that patients with vague complaints might often be given a prescription of benzodiazepines. "Should I prescribe benzodiazepines or should we talk?" is how Pirkko Valtola describes the choice that many doctors face.
Päivi Repo, staff writer
email: paivi.repo@sanoma.fi
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