Tag Archives: benzo.org.uk

03/20/18

Are Benzos Worth it?

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Holly Hardman is directing and producing a documentary film on benzodiazepines called “As Prescribed.” The film looks at the painful side effects and debilitating withdrawal symptoms individuals can experience when withdrawing from benzodiazepines like Xanax, Valium, Klonopin, Restoril and Ativan. Hardman is herself a survivor of benzodiazepine injury. It took her almost two years to taper off Klonopin. She experienced akathasia, the feeling that you are about to jump out of your skin, and aphasia, the inability to form words and sentences. Holly still has sporadic physical reactions from the withdrawal. “People are given these medications for normal life experiences and don’t realize what can happen.”

Hardman’s doctor assured her in the early 1990s that Klonopin was safe to take long-term for chronic fatigue syndrome. It wasn’t until 2012 that she discovered her persistent medical symptoms were the adverse side effects of Klonopin. “Hardman and other advocates against benzo overprescription want to get the message out benzos, like opioids, can be dangerous even when taken exactly as prescribed. . . . We shouldn’t assume these prescriptions are harmless.”

The Lown Institute noted in an article on benzodiazepines that there is a widespread but mistaken perception of benzodiazepines being “harmless quick fixes for insomnia and anxiety.”  Over prescribing benzodiazepines (BZDs) commonly happens with elderly patients, who are often taking multiple medications. “Almost a third of older adults using benzos in 2008 were taking them long-term.” Elderly adults are also more likely to suffer negative side effects from BZD use.

In addition to the anecdotal evidence of the personal stories in the film, adverse effects from long-term benzodiazepine use are well documented in the research literature. Hata et al. authored “What can predict and prevent the long-term use of benzodiazepines?” in the Journal of Psychiatric Research. They said adverse effects of BZDs include: daytime drowsiness, light-headedness, ataxia (loss of full control of bodily movement), psychomotor disturbance, and anterograde amnesia (loss of the ability to form new memories). “Various studies suggest that long-term use may be harmful. Long-term use carries the risk of dependence, withdrawal syndrome, cognitive impairment, diminishing effect, tolerance, and difficulty in discontinuing treatment.”

Hata et al. also found older age to be one of the predictive factors for long-term use of BZDs. Additional factors predictive of long-term BZD use were: high dosage (equivalent to greater than 5 mg of diazepam per day), psychiatric prescribers (versus a PCP), and concurrent use of more than one benzodiazepine. “Continuation of BZDs for more than 36 months was observed in 57.8% of 3470 new users.” The authors noted where this was a significantly higher percentage of long-term users than what was found in a previous study. They speculated it might be because of the higher proportion of patients over the age of 65 in their study. Among the elderly, they found there was a statistically significant risk of serious falls, fractures and cognitive decline with BZDs.

In response to these risks, although several international clinical guidelines and expert consensus statements have been published that recommend limiting the long-term use of BZDs, especially in older patients, the prevalence of long-term use remains widespread. Thus, reducing the long- term use of BZD is an important worldwide issue.

When reviewing the Hata et al. research for Mad in America in “Preventing Long-term Benzodiazepine Use,” Hannah Emerson pointed out how the study supports the global efforts to limit the use of benzodiazepines and provides research that illustrates how to predict and prevent such use. She lamented that despite the widely known harmful effects of long-term BZD use, their long-term use continues unabated. However, “by augmenting a list of predictors for long-term BZD use and highlighting nuances that lead to discontinuation, studies like this serve to influence prescription practices to be better informed, designed, and executed.”

Crowe and Stranks did a meta-analysis of the effects of benzodiazepines on cognitive functioning in long-term current users. They also commented that while BZDs are useful in the short-term, “the published evidence indicates that when they are used for longer periods, they often culminate in significant harm.” Despite this, BZDs continue to be widely prescribed across the globe. They described some of the previous meta-analyses of long-term BZD use, which found there was significant impairment across all the measured cognitive domains, “including sensory processing, psychomotor speed, non-verbal memory, visuospatial processing, speed of processing, problem-solving, attention/concentration, verbal memory, general intelligence, motor control/performance, working memory, and verbal reasoning.”

Some previous meta-analyses found evidence of improvement for individuals in cognitive functioning following the discontinuation of BZDs. However, others discovered significant impairment persisted long after discontinuation. Wanting to incorporate studies published since the previous meta-analyses, Crowe and Stranks decided to do their updated review of the residual cognitive effects of BZDs in current users and those who had recently withdrawn from them.

“Statistically significant negative side effects were found for the cognitive domains of working memory, processing speed, divided attention, visuoconstruction, recent memory, and expressive language.” Cognitive deficits associated with BZD use persisted following withdrawal; and statistically significant negative effects were found with all cognitive domains except for executive functioning. When BZD use was followed up after withdrawal, cognitive deficits persisted in all cognitive domains except for sustained attention. These deficits were statistically significant and evident in some individuals 42 months post-withdrawal.

Crow and Stranks found the greatest deficits for long-term BZD use in the areas of working memory, processing speed, divided attention, visuoconstruction, recent memory and expressive language. Their findings largely confirm those found be previous meta-analyses. However their analysis found a larger magnitude of negative effects with working memory for current long-term BZD users. Findings for users who had withdrawn from long-term BZD use were consistent with the results of previous studies. They continued to have significant impairment in all areas of cognitive function.

In conclusion, the results of this meta-analytic study are important in that they corroborate the mounting evidence that a range of neuropsychological functions are impaired as a result of long-term benzodiazepine use, and that these are likely to persist even following withdrawal. Furthermore, the findings highlight the problems associated with long-term benzodiazepine therapy as well as the important clinical implications of these results.

So where can you turn for help? There are a number of resources out there. For BZD support groups, try Benzo Brains on YouTube; W-BAD (World Benzodiazepine Awareness Day); BenzoBuddies; benzo.org.uk; and others. Try another article on this website, “It Takes Away Your Soul,” where the above organizations and others are linked. Holly Hardman’s documentary, “As Prescribed,” has a website with a short trailer on the documentary.

If you are seriously considering an attempt at tapering off of BZDs, do your research first. Listen to some of Jocelyn Pedersen’s videos on Benzo Brains. Start with “What is Benzodiazepine Withdrawal Syndrome?” Join BenzoBuddies. Try the information on w-bad.org. W-BAD also has a YouTube channel.

Regularly you will hear about the Ashton Protocol or Ashton Method for benzodiazepine withdrawal. There are YouTube videos about Heather Ashton’s method; and a digital copy of The Ashton Manual is available on benzo.org.uk for free. There are links for all of these in “It Takes Away Your Soul.” Mad in America has also compiled a helpful annotated bibliography on “Withdrawal from Benzodiazepines.” In closing, here is a quote from Jocelyn Pedersen’s video, “What is Benzodiazepine Withdrawal Syndrome?”

If forty to eighty percent of people are potentially at risk for being this severely disabled, we really need to start weighing the risk versus the benefits of these drugs. . . . Is it worth it to be prescribing benzodiazepines?

08/22/17

It Takes Away Your Soul

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In case you missed it in July, there was an annual day of awareness … for the problems that result from the prescription and use of benzodiazepines. World Benzodiazepine Awareness Day (W-BAD) is on July 11th. The first W-BAD was in 2016, so it’s just getting started. The need for greater awareness of the adverse effects from benzos can be seen in the 2016 W-BAD promotional video, here. It’s over 24 minutes long, so be prepared to spend some time. If that’s too much time for you to take at the moment, here’s one take away quote from Wendy in Melbourne Australia about her experiences while on and then getting off of benzos: “It takes away your soul.”

I was pleasantly surprised to see an extended quote on the dangers of benzodiazepines from Dr. Neil Capretto was used in the 2016 W-BAD video. Dr. Capretto is the Medical Director for Gateway Rehabilitation Center, a drug and alcohol treatment program I’m familiar with in Western Pennsylvania, Dr. Capretto said:

People were innocently put on this medication [benzodiazepines] and in some instances it works out well. [But] there is a significant risk and we see it all of the time. Many people who have lost many years of their lives, who have lost jobs, been on the verge of suicide. I’m aware of cases where people have committed suicide. The drug can be dangerous, it can be fatal. During withdrawal the heart rate can go up, they may have a seizure, sometimes the body temperature can go up and in some cases it’s fatal.

The W-BAD video has individuals from around the world, telling about their experiences while using benzos, when tapering off them, and the ongoing protracted withdrawal experiences they suffered through. For some individuals, those adverse effects lasted months and in some cases were permanent. There were three W-BAD objective listed towards the end if the video, which are listed below.

To encourage the establishment of a mandatory maximum prescribing period of no more than 4 week, including taper period (based on the Committee on Safety of Medicines’ 2-4 week prescribing guidelines).

To encourage the establishment of ‘specialized’ withdrawal facilities for those who so desperately need them.

To encourage the provision of proper training for doctors and medical staff and to help them learn more about proper tapering practices to discontinue the drugs as well as about the serious implications of benzodiazepines.

The Committee on Safety of Medicines is an independent advisory committee that advises the UK Licensing Authority on the quality and safety of medicines. In 2005 it was replaced by the Commission on Human Medicines, combining the functions of the Committee on Safety of Medicines and the Medicines Commission. The Committee issued guidelines for UK physicians and medical professionals on the use of benzodiazepines in January of 1988. Pause for a minute. These concerns were evident almost thirty years ago.

The original document said there had been concerns regarding benzodiazepine dependence for several years, and cited a British Medical Journal article from 1980 to support the claim. It noted that withdrawal symptoms could include anxiety, confusion, insomnia, depression, and perceptual disorders. These symptoms could occur even when following therapeutic doses over SHORT periods of time (emphasis in the original). “These may sometimes be difficult to distinguish from the symptoms of the original illness.”

They discouraged the use of benzodiazepines to treat insomnia, unless it was severe and subjecting the person to extreme distress. If used, they should be used intermittently. “The use of benzodiazepines to treat short-term ‘mild’ anxiety is inappropriate and unsuitable.” When the anxiety is severe, disabling or subjecting the person to unacceptable distress they can be used for short-term relief—“two to four weeks only.”  The Committee then gave the following quote from the above noted article in the March 29, 1980 issue of the British Medical Journal. The point of all this is these concerns and recommendations with benzodiazepines have been know since the 1980s, but have been largely ignored on a global scale, as illustrated in the 2016 W-BAD video linked above.

The committee further noted that there was little convincing evidence that benzodiazepines were efficacious in the treatment of anxiety after four 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.It further suggested that patients receiving benzodiazepine therapy be carefully selected and monitored and that prescriptions be limited to short-term use.

Finding a “specialized” withdrawal facility can be difficult. Be careful of what the centers promise and their cost. Do your homework when searching for a “specialized benzodiazepine withdrawal facility.” A mere “benzodiazepine withdrawal facility” search will net multiple residential drug and alcohol treatment centers. Not every person who has been using benzodiazepines long enough to need medical inpatient detoxification support has been abusing benzos, and treatment at a drug and alcohol treatment center is often inappropriate. Plus the withdrawal protocol is often too rapid.

The New Beginnings Recovery Center in North Palm Beach Florida is an example of a treatment program that uses a protracted withdrawal method. I have no experience with their treatment program and can’t endorse it. But what I’ve seen of their methods fits with a patient or client-centered method of withdrawal, which I do think is best with benzodiazepines. Here is a link to the New Beginnings page on their Benzodiazepine Withdrawal Treatment Program. Here is a short YouTube video clip discussing the Heather Ashton Method for benzodiazepine withdrawal used at the New Beginnings Recovery Center.

Going slowly, at a pace controlled by the individual withdrawing from benzos, is the method most likely to produce positive results. It will take several weeks, months, and even in some cases, years. I’ve run across two medical professionals who advocate for this protracted withdrawal method, Dr. Peter Breggin and Dr. Heather Ashton.

I am personally familiar with Dr. Breggin’s work and have read many of his resources, including two that would be helpful for benzodiazepine withdrawal: Your Drug May Be Your Problem and Psychiatric Drug Withdrawal. Start with Your Drug May Be Your Problem for personal information on the process and try Psychiatric Drug Withdrawal for more technical discussions, if that’s needed. Both books discuss withdrawal from multiple classes of psychiatric drugs. There is a YouTube channel for Peter Breggin. He also has his own website with more information at: breggin.com.

The Ashton Protocol, or Ashton Method, is new to me, but from what I’ve reviewed it fits with the protracted withdrawal process I’m familiar with in Dr. Breggin’s material. Here is a YouTube clip, “Dr. Heather Ashton- Benzodiazepine Withdrawal.” You can see several other YouTube videos about her method with a “Dr. Heather Ashton” search on YouTube. Dr. Ashton also wrote “Benzodiazepines: How They Work and How to Withdraw,” which has become known as “The Ashton Manual.”  A digital copy is available here on benzo.org.uk for free. A printed copy can be ordered.

From the brief review I’ve done so far, it seems likely to be a very helpful resource for individuals looking for assistance in getting off of benzodiazepines. Within a documentary by Shane Kenny, “The Benzodiazepine Medical Disaster,” which is linked below, Dr. Asthton said she wrote the manual for patients who weren’t getting help from the doctors. They seemed to know better what to do than the doctors. “It was for them. And the interesting thing is, although patients from all over the world have snapped it up, doctors still don’t read it.”

Protracted withdrawal will extend far beyond any acute medical withdrawal phase, and ongoing medical and therapeutic support on an outpatient basis is advisable. Getting medical support for protracted benzodiazepine withdrawal as an outpatient could be challenging. You may have to educate a willing physician on the necessity of an extended, rather than a shorter-term withdrawal. You can use the material recommended above from Peter Breggin and Heather Ashton to first educate yourself, and then any physician or psychiatrist willing to work with you on a protracted benzodiazepine withdrawal.

There are also many online information and support groups, such as: benzo.org.uk, which as been around since July of 2000. “Benzo.org.uk is dedicated to sufferers of iatrogenic benzodiazepine tranquilliser addiction.” In addition to the link to The Ashton Manual noted above, it has a wealth of information, including a FAQ document and links to online benzodiazepine withdrawal support groups on a support page. They also called out a specific support group called BenzoBuddies.

BenzoBookReview.com is a website with a list of books on benzodiazepine withdrawal. Information there includes memoirs and how-to guide books, with reviews and summaries of each book. The site is for anyone interested in information about benzodiazepine misuse and how to help benzodiazepine sufferers. That includes their families, doctors, psychologists, psychotherapists, drug counselors, and all professionals.

Other helpful resources include: Benzodiazepine Information Coalition, Beyond Meds, and Mad in America. Search the Mad in America site for “benzodiazepines.” Information on their “Withdrawal Resources” page will include a scientific literature review on withdrawal from benzodiazepines, as well as other classes of psychotropic drugs. Mad in America linked a short video by the group Benzodiazepine Recovery, “Benzodiazepine Withdrawal Symptoms” where individuals shared their top three most debilitating benzodiazepine withdrawal symptoms.

There are several helpful YouTube resources, such as Benzo Brains, by Jocelyn Pedersen. W-BAD also has a YouTube channel and a website: w-bad.org. Their YouTube channel has a short informational video (almost 3 minutes) on the risks of taking benzodiazepines. Start there to begin the education process with someone.

Look under Resources on w-bad.org for the Documentaries link. You will find information on “As Prescribed” by Holly Hardman, which is in production. Scrolling further down you will see a link to another documentary, “The Benzodiazepine Medical Disaster” by Shane Kenny. It features an in depth interview with Heather Ashton. Also remember what Melanie said about why this information on benzodiazepines is so important: “It takes away your soul.”