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Former user of Klonopin sues doctors

by Michele Kurtz, Boston Globe Correspondent
November 4, 2001

Allison Aron needed some help sleeping. She was in college and had just lost her best friend to cancer. She paid a visit to her psychiatrist, who prescribed Klonopin, and every night Aron popped a little blue pill.

It didn't dawn on her to ask whether the antianxiety drug - the same type as such better-known medications as Valium and Xanax - could cause her harm, or what might happen if she stopped taking it. And she says that the doctor and a subsequent psychiatrist - who for years prescribed her the drug strictly over the telephone - didn't warn her either.

When she tried six years later to gradually kick what had become a six-pill-a-day routine, she found herself in the throes of terrifying withdrawals. Numbness crept into her hands and feet, sleep eluded her for weeks at a time, and she suffered panic attacks.

Aron hasn't had a Klonopin since 1999, and still the 29-year-old Framingham resident says she's in therapy for some ongoing withdrawal symptoms. Bolstered by family members, Aron recently filed a medical malpractice lawsuit against her two former doctors, contending they got her hooked on Klonopin without telling her she could grow dependent on it.

The suit comes at a time when Klonopin has become increasingly popular among American physicians. Between 1994 and 1999, prescriptions for Klonopin by emergency room doctors and primary care physicians doubled to more than 3 million, a jump considerably higher than for other popular antianxiety drugs.

But with that increased popularity has come growing concerns. Some critics argue that Klonopin and similar drugs are being prescribed too liberally, and worry that more and more anxiety-ridden Americans will seek the prescriptions to help calm fears ignited by Sept. 11. They argue the drugs are dangerously addictive.

''Let's say a woman's son is going off to war, and she's prescribed one of these drugs [for anxiety],'' said David Angueira, Aron's attorney. ''Let's say the war lasts for four years. At the end of four years, what do you have? Another hooked patient.''

But many psychiatrists contend that the drugs, among the most popular psychiatric medications on the market, work wonders when used properly and are overwhelmingly safe. They warn that unreasonable concern about medications like Klonopin will scare physicians away from prescribing it for people who need it most.

''The idea that these drugs turn citizens into addicts is fiction,'' said Dr. Carl Salzman, a professor of psychiatry at Harvard University Medical School and chairman of a national task force that examined the safety of benzodiazepines - the family of drugs to which Klonopin, Valium and Xanax belong - a decade ago. ''And in fact, these medications are the safest psychiatric drugs we have.''

The emerging debate in the United States about the safety of Klonopin and other benzodiazepines follows a similar one that has raged in Europe for years.

Doctors prescribe benzodiazepines differently: some believe in doing it for no more than a couple of weeks; others see its use in longterm care.

According to materials of the American Psychiatric Association, benzodiazepines are widely misunderstood, and an ''inappropriate fear of addiction'' has caused some doctors to underprescribe the drugs. Many psychiatrists in this country say few people are at risk of real addiction to benzodiazepines besides those who are already prone to addiction.

Klonopin, the brand name for clonazepam, was introduced in the United States in 1975 by Roche Pharmaceuticals as a drug for seizures. It was part of the benzodiazepine family that gradually replaced barbiturates as the safer choice for tranquilizers or antianxiety drugs.

Historically, women have been the primary users of tranquilizers, once popularly known as ''nerve medicine'' and later as ''Mothers' Little Helper,'' after the 1966 Rolling Stones' song. More recently, celebrities such as pop singer Stevie Nicks have gone public with their dependency on benzodiazepines, saying their long-term use sapped their creativity and ambition.

Doctors frequently prescribe the pills for people with short-term anxiety problems or to help with sleep during travel, said Dr. Gerald Rosenbaum, interim chief of psychiatry at Massachusetts General Hospital who has written about Klonopin. The drug slows down the central nervous system and decreases nervous excitation.

''They're the standard of care for acute, emergency, antianxiety, antitrauma,'' Rosenbaum said. After the attacks on the World Trade Center, teams of caregivers prescribed quantities of benzodiazepines to people whose family members worked for Cantor Fitzgerald, which lost about 700 employees, Rosenbaum said.

Officials with Roche Pharmaceuticals say that's just the kind of short-term anxiety problem Klonopin is designed to treat. Prescriptions written for any longer can be tricky. In fact, company materials alert doctors that sufficient studies have not been done on patients who take Klonopin for more than nine weeks, said Shelley Rosenstock, Roche's director of public affairs. The materials also warn that patients should not stop using the drug abruptly.

Yet some psychiatrists and general physicians prescribe Klonopin and similar drugs for longer periods. In some cases, it's appropriate as a maintenance drug for people who have long-term anxiety disorders and for whom antidepressants are problematic, Rosenbaum said.

For Aron, the prescription started as a temporary sleep aid, but she continued refilling it. When she had other problems - such as severe premenstrual syndrome - she says her doctor told her to take more of the drug and called in higher-dose prescriptions. ''Bottom line, I don't know why I was taking it,'' said Aron, a makeup counter manager at a large retailer. When she finally came off of the drug after checking herself into a hospital, she said, she emerged from a fog to find her life had essentially been on hold for years.

''I should not have to be slowed down like this,'' she said, explaining why she chose to file a lawsuit two weeks ago against Dr. Arnold Kerzner and Dr. Thomas Laage, both psychiatrists in Belmont. According to Aron's lawsuit, each of them prescribed her Klonopin for years but never told her she could become dependent on it and suffer serious withdrawals.

Laage's attorney, William J. Dailey Jr., would not comment on the case but said his client ''enjoys a wonderful reputation.'' Kerzner could not be reached for comment.

Two months ago, Aron started ''Benzos Anonymous,'' a support group at McLean Hospital for people who have struggled with dependency on benzodiazepines. Roger Weiss, a psychiatrist who runs the alcohol and drug abuse treatment program at the hospital, said the group is a comfort to people who suffer from the odd withdrawal symptoms associated with benzodiazepine users such as ''itching in their teeth.''

Several psychiatrists interviewed last week said they know of no proof that withdrawal symptoms can last for years. But Aron and others said they speak from experience.

Geraldine Burns, 46, of West Roxbury, is also suing her former psychiatrist in Middlesex Superior Court, saying that she experienced horrible problems during the 10 years she took Ativan, another benzodiazepine, and when she tried to discontinue it.

Dr. Alan Wartenberg, the medical director of the addiction recovery program at Faulkner Hospital, said all benzodiazepines cause physical dependency and doctors who prescribe them should warn their patients that some people experience painful withdrawals. When discontinuing the drug, doctors should carefully taper their use, he said. ''Unfortunately most doctors are much better at putting patients on drugs than taking them off,'' Wartenberg said.

This story ran on page B1 of the Boston Globe on 11/4/2001.

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