Hellish Withdrawal 101

Melissa Bond described herself as never having any physiological or psychological dependencies on anything “… besides perhaps rock climbing, yoga and writing large volumes of poetry.”  She developed pregnancy-related insomnia and went to an MD who specialized in hormonal imbalances, where she confirmed her insomnia involved an endocrine problem. She didn’t know at the time that her doctor had a “strong proclivity for prescribing benzodiaepines.”  You can read about her experience in the article she did for Mad In America: Killer Brain Candy.

After 2 years of Ativan for pregnancy-related insomnia, and the knowledge that the drug was slowly disassembling her brain and body, Melissa Bond went through a hellish withdrawal. She writes about it on her website and in her forthcoming book “Dear Little Fish.”

Melissa followed medical advice; and was told by a doctor who she trusted and respected that he knew a man who had used benzos for nineteen years and didn’t have a problem. “This drug, he told me, is phenomenal. You’ll sleep. And when you don’t need them anymore it may or may not be slightly difficult to get off but you’ll be fine.” That wasn’t what happened.

The advice I give to the drug addicts and alcoholics applies here as well. Whenever a medical person recommends that you take a potentially addictive drug for any reason, ALWAYS ALWAYS get a second opinion from someone with knowledge about addiction. Do research on people who have used the medication being prescribed to you. Mad in America, RxISK and Psychiatric Drug Facts with Dr. Peter Breggin are good places to start. And as you will see on these sites, hellish withdrawal problems aren’t confined to just the drugs classified as “addictive.”

What follows is just some basic information on how drugs are classified as controlled substances by the U.S. government. Remember that Melissa’s experiences were with a benzodiazepine, which are considered a Schedule IV controlled substance—the next to the lowest of the schedules.

There was a time when there was no federal laws regulating the use or distribution of drugs. Cocaine was in wine, cola and toothache drops; opiates were in everything from cough suppressants to teething medication. As a direct result of the Hague Convention in 1912, which was an international attempt to regulate opium, the U.S. passed the Harrison Tax Act in 1914. But it only regulated and taxed the production, importation and distribution of opiates and coca (cocaine) products. Doctors could prescribe these “narcotics” in the course of medical treatment. However they could not be used as a way to treat addiction.

While the Controlled Substances Act (CSA) of 1970 essentially replaced the Harrison Tax Act, there have been several lasting effects from this 100 year-old legislation. It began using the term ‘narcotics’ to refer to any illegally used substance. It also initiated the social construct of the “criminal” drug addict and the black market for drugs. But there still wasn’t any federal oversight and regulation of drug development. It wasn’t until the 1962 Kefauver-Harris Amendments that the Food and Drug Administration (FDA) was created, which was to approve the safety and effectiveness of a drug being developed for human consumption.

The CSA is the federal drug policy regulating the manufacture, importation, possession, use and distribution of certain substances. It created five Schedules or classifications for drugs; with varied qualifications for a substance to be included in each of the schedules. Two federal agencies, the Drug Enforcement Administration (DEA) and the FDA typically determine which substances are added to or removed from the various schedules. There have been several amendments to the CSA since 1970, including the Psychotropic Substances Act of 1978 and The Electronic Prescriptions for Controlled Substances Act of 2010.

The placement of a drug into a specific Schedule or the reclassification of a drug from one Schedule to another is based upon a series of laws under Title 21, which governs food and drugs in the United States. Each Schedule requires that the “potential for abuse” for a substance has to be determined before in can be placed within its respective Schedule. According to the DEA,  “The abuse rate is a determinate factor in the scheduling of the drug.”

The hierarchy begins with Schedule V drugs at the lowest level and ends with Schedule I drugs at the highest level. The designated abuse potential of drugs increases as you move up the hierarchy from Schedule V to Schedule I. Schedule I drugs are defined as having no current accepted medical use and a high potential for abuse. They are the most dangerous drugs, “with potentially severe psychological or physical dependence.”  Schedule V drugs are defined as having the lowest potential for abuse and are generally antidiarrheal, antitussive [cough suppressant] and analgesic medications. See the DEA link for a description of each of the five drug Schedules.

Sometimes the Schedule within which a drug is placed is controversial, and doesn’t seem to follow what would to be a common knowledge of a drug’s abuse potential. One example of this is marijuana. While it has a significantly lower dependency liability and harm potential than heroin (See “The Most Addictive and Harmful Drugs”), it is placed within Schedule I with heroin. This means that research into its potential medicinal use is highly regulated and difficult to do. There are other times where drugs are rescheduled, as was the case with Vicodin, when it became a Schedule II controlled substance instead of a Schedule III controlled substance in October of 2014 because it had become the most widely abused prescription opioid.

The following chart places some of the more common drugs within their current Schedules. You can review a pdf of all Controlled Substances in alphabetical order if there is one you don’t see here and want to check.