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COSTS OF TRANQUILLITY - THE 'HAPPY PILL'
IS A HORROR STORY
February 18, 1988
by Liz Hodgkinson
Few prescription drugs have ever been subject to such a complete reversal of fortune as tranquillisers. Initially hailed as the 20th century's wonder drugs, they are now believed to cause far more problems than they were ever prescribed to solve. And as Valium 'celebrated' its 25th anniversary last year, it is perhaps a significant time to ask whether these drugs still have a real future in medicine.
A group of 80 legal firms who represent tranquilliser addicts are now proposing to sue pharmaceutical companies for alleged negligence in supplying drugs increasingly regarded as 'addictive'. If it is accepted that tranquillisers such as Valium, Librium and Ativan can cause serious dependency and withdrawal problems, why did nobody stop it a very long time ago?
'The simple answer is that none of the researchers tested for dependence,' Heather Ashton says. She is a doctor and reader in clinical psychopharmacology at Newcastle University, who also treats difficult withdrawal cases. 'It never seems to have crossed their minds that such drugs could cause dependency.'
'Modern tranquillisers came in as a replacement for barbiturates, extremely dangerous drugs which could be fatal in overdose and were also known to be highly addictive. Tranquillisers were safe from that point of view, as overdoses don't kill. They were also not seen as addictive, as people tended never to come off them. They were initially considered to be a drug that one could take for ever, without suffering harm. By 1979 about 30 million prescriptions in the UK were being written out a year.'
'The realisation that all was not well came in 1980', Ashton says, 'when Professor Malcolm Lader, of the Institute of Psychiatry in London, published the first papers showing that people on normal doses became disturbed if they took the drugs for any length of time.'
'We did know at the time that they were similar to barbiturates, but they gave a wider choice of substance,' Lader says.
Benzodiazepine tranquillisers were invented in the 1950s by Dr Leo Sternbach, of Hoffman La Roche, the giant Swiss drug company which now market three of the best known brand names - Valium, Librium and Mogadon. Sternbach discovered that a new chemical he was working on could sedate and relax animals without any apparent adverse side-effects. The first human trials showed the same thing - the drugs sedated and reduced anxiety, yet allowed people to go about their daily lives.
Benzodiazepine tranquillisers are, crudely, general anaesthetics used in sub-anaesthetic doses. Although they have many names - diazepam, chlordiazepoxide, lorazepam, oxazepam, alprazolam - they all work in much the same way. They can be short, intermediate or long acting. The long-acting tend to be used as hypnotics, or sleeping pills, whereas the short-acting ones, of which Ativan (lorazepam) is the best known, are often prescribed for a specific crisis.
When the new drugs were first marketed in 1960 they became instantly popular. Many people felt perfectly well on the drugs, and they were soon prescribed to help with examination nerves, for flu, muscle spasms, grief at bereavement and general anxiety. 'In the era of the permissive society, people expected to be able to take a pill for everything,' Ashton says. 'It's easy to blame doctors for over-prescribing these pills, but there was tremendous pressure from patients. So many people wanted to go on taking the drugs.'
Support groups claim that about one million people are addicted to tranquillisers in this country.
Some doctors are now saying that all benzodiazepines could be withdrawn. Others, such as Lader, feel that they have a very limited use for cases of chronic anxiety, although Lader does not believe that they should be given for more than four weeks at a time, as dependency can set in. 'There is a definite case to be made out for tranquillisers as an acute form of treatment, to tide people over something specific,' Ashton says. 'They are still front line drugs for treating convulsions, and are very good for this problem. They don't cure the convulsions, of course, but they enable patients to calm down.'
Ron Lacey of MIND, the mental health charity, says that his organisation has been monitoring tranquillisers for many years and now feels that there is an extremely limited place for them. 'We are not saying they should all be withdrawn, as they are useful for acute insomnia and anxiety. But they should be a rarely, not a commonly, prescribed drug.'
Dr Peter Tyrer, a psychiatrist who runs a specialised tranquilliser withdrawal unit at Mapperley Hospital near Nottingham, feels that a great deal of nonsense is talked about tranquilliser withdrawal. 'It's been made out to be terrible and difficult,' he comments. 'But our research shows that 50 per cent of patients don't have any symptoms at all.' Tyrer works closely with local GPs to offer a mixture of self-help and medical help. 'We treat people entirely in outpatients, with our eight-week withdrawal programme. The aim is to get them permanently off their drugs in that time, with a 20 to 25 per cent reduction in their dosage per week.' Some people, Tyrer believes, are probably better off continuing with the drugs. These are elderly people who say that they sleep better and their arthritis is less trouble when they take the drugs.
On Monday the Princess of Wales officially opened the Slade Road Tranquilliser Unit in Birmingham, which helps addicts to come off their drugs by using psychological methods. Moira Hamlin, the psychologist who runs the unit, says: 'It's nonsense to be taken off the drugs without being offered strategies for coping with the stress. Patients learn assertiveness skills, how to increase their self-esteem, how to change their attitudes and, most of all, how to think positively.'
Earlier this week it was announced that the Council for Involuntary Tranquilliser Addiction, a volunteer group set up about a year ago in Nottingham, was joining forces with solicitors to fight 'the largest legal battle of its kind' against the drug companies. The council wants to find out whether there are cases to answer, and will then establish a precedent for suing the companies. The outcome will probably be that individuals have to fight their own cases. MIND is putting its weight behind the first test case to secure damages for addicts.
Meanwhile, a new tranquilliser marketed as non-addictive, will be available on prescription from April. Called buspirone, it works in a completely different way to the benzodiazepines and in a 10-year trial in the United States, where it has been available for a year, it has shown little, if any, addiction potential.
But is the drug really a breakthrough - or just history repeating itself? 'We shall just have to wait and see', Ashton says. 'The search for the truly safe drug is always going on, but we have to ask whether drugs of any kind are the best way of dealing with everyday troubles.'
The Ashton Manual · Professor Ashton's Main Page
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