David Freud Tuesday, 19 February 2008
DWP Ref ITA 2/08
Dear Mr Freud
I am Chair of the All Party Parliamentary Group on Involuntary Tranquiliser Addiction, a group formed to draw attention to the continuing serious problem of ITA. In particular we are campaigning on the lack of withdrawal services for an estimated 1.5 million people with ITA who have become addicted to tranquilisers whilst in the care of their doctors. This is a different and separate group from drug misusers.
We believe there is a high co-relation between tranquiliser addiction and disability benefit that has not been recognised by government. Tranquilisers are extremely addictive and toxic. Addicts normally have to stop work because of numerous side effects including depression which progressively disable them as the drug builds up in their bodies. An unknown number of ex-addicts also remain damaged by these drugs after they have ceased ingestion.
Tranquilisers consist of Benzodiazepines such as Valium, Mogadon and Ativan and the newer but similar zed drugs. They are more addictive than heroin and addiction can occur within two weeks. Safe, tapered withdrawal can often take six months and in some cases two years. The intense suffering and pain of tranquiliser withdrawal means that addicts often find they are unable to withdraw without specialist help and support and therefore many remain addicted and on benefits for decades.
No withdrawal services are provided by the NHS for Involuntary Tranquiliser Addiction apart from one clinic in Oldham and a specialist nurse in Belfast. Many people suffer chronic ill healthand are unable to work because of the addiction to legally prescribed, powerful drugs which include tranquilisers but also anti-depressants and painkillers overprescribed by the medical profession.
The social cost of this ill-health is enormous and I agree that it is in the order of the magnitude of £62,000 as you are reported to have calculated. Anecdotally, many involuntary tranquiliser addicts have been in professional jobs and their skills are therefore lost to society.
A clear strategy for achieving your objective of returning people to work and removing them from benefits would include:
1 Provision by the NHS of withdrawal services to detox addicts from tranquilisers, followed by appropriate rehabilitation designed to return them to the workforce.
2 Enforcement of the MRHA and manufacturers’ guidelines for tranquilisers that restrict use to two weeks, as these guidelines are being ignored by doctors.
I would welcome a meeting to discuss these urgent issues and I look forward to hearing from you.
Yours sincerely
Jim Dobbin MP
Annette Dale-Perera
NTA
London
SE1 7DU Tuesday, 19 February 2008
Ref ITA 1/08
Dear Annette Dale-Perera
I am Chair of the All Party Parliamentary Group on Involuntary Tranquiliser Addiction. This group was formed to draw attention to the continuing serious problem of ITA. In particular we are campaigning on the lack of withdrawal services for people with ITA. This group, estimated at 1.5 million, has become addicted to tranquilisers whilst in the care of their doctors and is a different and separate group from drug misusers.
In correspondence with the DoH we feel we have been unable to establish this point. In the responses we have received regarding provision of services, we feel there is an implication that the NTA is responsible for providing services for this group. We shall be grateful if you will assist us by clarifying your agency’s position in practice, regarding the provision of withdrawal and rehabilitation services to involuntary tranquiliser addicts. We enclose copies of correspondence between various members and supporters of our group and the DoH.
I should like to meet with you to discuss these issues. I am available most Mondays until 3.00pm and most Thursdays.
I look forward to hearing from you.
Kind regards
Jim Dobbin MP
H O U S E OF C O M M O N S
Proposals for Manifesto from APPG on
Involuntary Tranquilliser Addiction
February 12, 2008
INTRODUCTION
By several criteria involuntary addiction to prescribed tranquillisers is the most serious drug problem in the UK today.The number of Benzodiazepine related deaths each year exceeds that of all illegal drugs except heroin. The number of addicts (1.5 million) exceeds by far the number addicted to all illegal drugs. The magnitude of addiction - tranquillisers are more addictive than heroin. The duration of addiction: Addicts often remain addicted for 10, 20, 30 years. The social cost of addiction is enormous, but as yet unquantified by official statistics. The suffering of tranquilliser addicts is extreme and is immoral. They have been introduced to an addictive drug by their trusted medical advisor. They are then abandoned with no treatment for their iatrogenic illness.
SUGGESTED POLICIES FOR MANIFESTO
1. Education of doctors and the general public on the dangers of involuntary tranquilliser addiction, with the objectives of reducing the 1.5 million addicts and in order to prevent the creation of new addicts by the implementation of the treatment guidelines which restrict prescribing to 2 weeks.
2. To provide specialised withdrawal services to involuntary tranquilliser addicts including; local self-referral clinics, self-help groups, a 24 hour national helpline and regional residential withdrawal clinics. To set up a working party to identify good practice for tranquilliser withdrawal.
3. Rehabilitation for prescribed addicts designed to enable them to return to work - most addicts are unable to work. These policies to be set targets which are regularly monitored and the results to be published.
4. Medical research into the mechanism of tranquilliser damage to the body to enable treatment to be provided to ex-addicts who have suffered damage from addiction.
5. To quantify the tranquilliser problem by collecting official data on the subject. For example:
a) The number of long-term addicts.
b) The number of babies born addicted from addicted mothers.
c) The number of ex-addicts who are permanently damaged.
d) The number of new addicts created each year.
e) The number of addicts who successfully withdraw each year.
f) Figures on the duration of addiction.
g) A costing of specialised tranquilliser withdrawal services, which have a high success rate when done properly and in comparison with withdrawal from illegal drugs.
h) Attempt to quantify the social cost of tranquilliser addiction including:
1. Calculate the correlation between tranquilliser addiction and incapacity benefit.
2. The amount of time and money wasted by referral of tranquilliser addicts to hospitals for investigation of wrongly diagnosed illnesses e.g. ME/MS/depression which are really unrecognised tranquilliser side-effects.
3. Accidents, including road traffic accidents due to "tranquilliser driving" and accidents in Old People's Homes, including broken hips, due to "drugging up" of patients.
6. Benzodiazepine tranquillisers pre-date the Medicines Act (1968) and the current licensing system (1972). They were awarded "licences of right" as a registration project with little or no scrutiny. To conduct an independent review of the tranquilliser licences for safety efficacy and number of licences issued.
7. To consider if the internet trade in addictive drugs, based within the UK, is by-passing the prescription system. How tranquillisers are increasingly becoming a drug of abuse used by illegal addicts to "boost" illegal drugs or to "come down".
8. To review the practice of treating addicts to one drug by transference to a second more addictive drug, eg. heroin to methadone or alcohol to tranquillisers.
9. To identify and allocate responsibility for the tranquillisers problem between the various ministries and agencies; The Home Office, Department of Health, Department of Work & Pensions, Primary Care Trusts, the National Treatment Agency, local health authorities, GP practices, local authorities and pharmacists.
10. To introduce a levy on the pharmaceutical industry to deal with the legacy of problem drugs - gambling and alcohol industries pay a levy to provide services for victims of their products. A "pharmaceutical levy" similarly to be used to provide services for prescribed drug casualties.
11. A public enquiry into the tranquilliser scandal.
Jim Dobbin MP, Chair
John Grogan MP, Vice Chair
Nigel Evans MP and Paul Rowen MP, Joint Secretaries
Email Pat Dobbin
Email Mick Behan
LETTER FROM CHRIS DAVIES MEP TO RT HON ALAN
JOHNSON MP, SECRETARY OF STATE FOR HEALTH
8 November 2007
The Rt Hon Alan Johnson MP
Secretary of State
Department of Health
Richmond House
79 Whitehall
London
SW1A 2NS
Dear Alan
Addiction to Tranquillisers (Benzodiazepine Drugs)
My constituent Barry Haslam has asked me to write to you regarding the issue of over-prescription of tranquilliser drugs.
Mr Haslam has been campaigning regarding the issue of benzodiazepine drugs for some twenty-one years. As a former addict Mr Haslam was addicted to Ativan for some 10 years and as a result suffered hearing and thyroid problems, poor circulation and permanent brain damage.
It has been estimated that some 1.5 million people in the UK are affected by addiction to benzodiazepines drugs such as Valium, Ativan or Mogadon on a long term basis.
I am told that Home Office statistics show that some 17,000 people have died because of benzodiazepines in the past 40 years. Withdrawal symptoms range from the debilitating to the horrific: panic attacks, agoraphobia, depression, psychosis or severe cognitive impairment. All of which have all been recorded as experienced by victims as well as evidence of permanent brain damage.
Beat the Benzos was set up to work throughout the European Union with the intention to provide help to those affected and to campaign in their behalf. Specific intentions include the establishment of specialised withdrawal clinics, the publication of information packs and websites and a 24-hour helpline for sufferers.
This campaign activity is currently lobbying for the provision of withdrawal support through the NHS and to raise awareness of the risks associated with benzodiazepines. It is also pushing to enforce official guidelines regarding the prescription and usage of such drugs by GPs and psychiatrists and to update warnings accompanying such drugs so that they are similar to those in the United States, Australia and Canada.
Further to raising this in the European parliament and more recently with Commission officials, Mr Haslam has asked that I convey to you the details regarding the work done by Beat the Benzos.
It is Mr Haslam's view that successive governments have avoided responsibility for tackling the awesome problems involved and that as a result, he believes massive social exclusion and economic consequences for the UK have ensued.
In 1994 he received a letter from David Blunkett MP who told him that the current situation was a 'national scandal', and that he would seek to make it a priority once in Government.
I write to ask about current government policy in relation to the above. As you will know, campaigners are calling for the implementation of prescription guidelines by general practitioners and the provision of greater support services for involuntary and voluntary addicts of these drugs.
I would also be grateful for the Department's response to calls to conduct a review of disability guidelines to ensure recognition of tranquilliser addiction.
More details can be found at www.benzo.org.uk.
With best regards,
Yours sincerely
Chris Davies MEP
Liberal Democrat MEP for the North West of England
87a Castle Street, Stockport SK3 9AR
Tel 0161 477 7070 · Fax 0161 477 7007
Email chrisdaviesmep@cix.co.uk
Letter from Barry Haslam of Beat the Benzos to Phil Woolas MP, Local Government Minister
10 October 2007
Phil,
Ten years ago, you visited Oldham Tranx in order to see first hand the horrors of legal benzodiazepine drug addiction - the misery and devastation which these drugs cause; both to the individual and families. I was then impressed by your concern and as a trustee of ‘Beat the Benzos’, by your continued involvement.
Ten years on, the further up the government greasy pole you’ve climbed, the more that you have backed off from confronting government and holding them accountable for this ‘National Scandal’ (David Blunkett 1994). I feel strongly that you have let me down and the 5,000 legal benzodiazepine Oldham drug addicts – never mind the 1.2 million addicts in this country.
This labour government has been guilty of abject surrender to the vested interests of the drug companies and the Association of the British Pharmaceutical Industry. We the victims of these neuro-poisoning drugs have paid for government negligence, apathy and greed in suffering and disablement and deaths.
I hereby enclose my labour party membership card No. A972903 and resign from the labour party.
I have campaigned on these drug issues for the past 21 years. I have stood up to be counted, for my fellow victims and my fellow human beings. I will continue to stand up for them.
Barry
Professor Heather Ashton
You Tube
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Bristol and District Tranquilliser Project AGM
LECTURE
Professor C Heather Ashton, DM, FRCP
October 2005
School of Neurosciences
Division of Psychiatry
The Royal Victoria Infirmary
Queen Victoria Road
Newcastle upon Tyne NE1 4LP
Thank you for that kind introduction and for asking me to speak today. First of all I would like to offer my congratulations to all involved with the Bristol and District Tranquilliser Project on this special 10th Anniversary AGM. I am proud to be the patron of this project which has clearly worked wonders since its modest inception in 1985 and has helped so many people.
But actually it is a tragedy that there ever was, and even more that there still is, a need for projects such as this. Why, in this age of so-called scientific medicine, should we require charitable organisations with non-medical staff to help people having problems with drugs prescribed by their doctors? It is surely crazy.
It happens that I am old enough to have witnessed the start of the Era of Psychopharmacology - of drugs that affect the mind. Around the 1950s a whole host of such psychotropic drugs - all discovered by chance - entered the medical scene. These included the major tranquillisers such as chlorpromazine (Largactil), since developed into a range of antipsychotic drugs; it included the first antidepressants, the tricyclics and monoamine oxidase inhibitors, now joined by the SSRIs such as Prozac; and it included the so-called minor tranquillisers, the benzodiazepines Valium and Librium, now including a number of Z-drug hypnotics such as zopiclone and others.
These early discoveries were very exciting at the time, as they seemed to promise a cure for all psychiatric diseases. Schizophrenics taking antipsychotics could be, and were, let out of hospital to live in the community. Patients with depression could, allegedly, be freed from suicidal thoughts and from the perceived threat of electroconvulsive therapy (ECT). And the minor or major anxieties of life could be universally replaced with tranquillity and peaceful sleep induced by benzodiazepines. One eminent neurologist, Sir Henry Miller, even wrote that from now on all mental illness could be cured by a handful of pills and there would be no need for psychiatrists. He also memorably said that medical practice would now be so easy that it could safely be left entirely to women doctors!
At the same time it was believed, by a sort of backwards logic, that the cause of mental illness would be revealed by these drugs. Antipsychotics were found to block brain receptors for the neurotransmitter dopamine; therefore schizophrenia must be due to an excess of dopamine. Antidepressants were shown to increase the activity of the neurotransmitter serotonin; therefore depression must be due to a lack of serotonin. Benzodiazepines increased the activity of the neurotransmitter GABA, so anxiety must be due to lack of GABA.
Of course these naïve and simple hopes turned out to be in vain. 50 years later we still do not know the cause of schizophrenia or depression or even how the drugs work. The prognosis of these illnesses has changed little. And anxiety and insomnia are as common as ever. It has become clear that the drugs do not cure anything; they do, often usefully it must be said, control some symptoms but have little effect on the underlying processes. And, as everyone here knows, the drugs carry their own disadvantages. But these same drugs have made millions for drug companies.
One activity that the new discoveries engendered was a neurotransmitter hunt. There was a search, mainly in the pharmaceutical industry, for new drugs acting on dopamine, serotonin or GABA. Once the basic work had been done, drug companies did not have to foot the cost of developing new drugs. It was much cheaper to manufacture "me too" drugs with similar actions but perhaps fewer side-effects. As a result, the world ended up with over 20 different but similar compounds in each class of antipsychotics, antidepressants and sedative/hypnotics. "You have to go where the market is", remarked one scientist working for a drug company.
And there was a change in the way drug companies were run. This is a quote from Pierre Simon, a pharmacologist working for Sanofi Pharmaceuticals, taken from David 's book The Pharmacologists: "In the beginning, the pharmaceutical industry was run by chemists... This was not so bad. [But] now most of them are run by people with MBAs, or things like that, people who could be the chief executive of Renault, Volvo or anything. They don't know anything about drugs." But, clearly, they do know where the market is.
Another quote from the same pharmacologist: "When you find a drug that is really active on one receptor... The problem comes when you present it to the financial analyst. You say 'I have a new drug, a very interesting antagonist of [receptor X]." 'Good', says the financial analyst, 'what is the market?' So you have to decide for what indication the drug should be developed at what dosage, what will be the price of the drug, and so on. This is totally stupid, but it's what you have to do." So the chemist or pharmacologist has to decide for what indication the drug will be developed. If the indication is not there, it must be created - in other words a disease suitable for the drug must be invented.
One of the many examples of this process was the development in the 1970s of Xanax (alprazolam), a very potent benzodiazepine, for panic disorder. According to Dr. David Sheehan at the Institute of Research and Psychiatry in Tampa, Florida, the marketing of this drug involved "a clear strategy" to take advantage of the medical profession's current confusion about the classification of anxiety disorders and (I quote:) "to create a perception that the drug had special and unique properties that would help it capture a market share of benzodiazepines and would displace diazepam from the top position... There was in fact nothing unique in this regard about Xanax... All the benzodiazepines were good for panic disorder." Nevertheless, Xanax was marketed by Upjohn with approval of the FDA (US Food & Drug Administration) in doses of up to 6mg (equivalent to 120mg of Valium).
Some vignettes provided by Dr. Sheehan give an insight into the rather cavalier way in which trials with alprazolam were conducted. There was no suitable animal model of panic disorder so it was decided to try it out on a small group of patients who had panic attacks. "It was dark; it was fall in Boston" said Dr. Sheehan. "I particularly remember two sisters who were so phobic of medication, especially that they might die of the medication at home, they they asked if they might take the medication in the unit so that I could rescue them if anything bad happened... So they took two alprazolam tablets in the waiting room, waited for 30 minutes and then felt ok and decided to take the subway home. I was still in my office when I got a phone call. It was the two sisters; one of them had got a phenomenal effect, was sedated and ataxic and had to be helped off the train and got home by her sister. They called me up and one sister said 'This is incredible, she's cured'. The sister who telephoned had experienced no effect at all."
"Another patient in this group, a dynamic executive type, phoned the next day and said 'Doc, I am lying here on the couch in my office'. "Oh my god, that's terrible", I replied. 'No Doc this is not terrible at all', he said, 'I haven't felt this good in 10 years, you have no idea what a relief this is. I feel so calm, I just don't feel any anxiety, it's really wonderful'.
"Then a further group of these patients in the study said 'Doc, this is amazing - there are so many panic patients out there in the world... the company that makes this is going to make a fortune... You should buy stock in this company - you won't have another opportunity like this."
History does not relate what happened to these patients if they continued to take Xanax long-term. But there is no doubt that Upjohn had a field day. Xanax duly overtook Valium as the most widely prescribed benzodiazepine. Xanax was dropped from the NHS limited list in 1985, but it is still widely prescribed in 4-6mg doses in the US and I get calls every week from people having long-term problems with this potent drug.
Alongside the development of Xanax, the confused psychiatrists were working on a new classification of anxiety disorders. Panic disorder became a new separate anxiety state in the new Diagnostic and Statistical Manual (DSM III) published by the American Psychiatric Association and at present anxiety, under a later DSM IV, is still split into separate categories which include panic disorder, agoraphobia, social phobia, other specific phobias and generalised anxiety disorder or GAD. But of course people with generalised anxiety get panics and develop agoraphobia and people with panics have generalised anxiety and other phobias. The inference of the new classification was that these separate disorders respond to different drugs, but in fact they merge together and they all respond to the same drugs include all the benzodiazepines and also to all the antidepressants including the old ones and the SSRIs like Prozac. If they all respond to the same drugs and the symptoms are common to all types, they clearly cannot be separate entities.
But of course you don't have to have anxiety to be prescribed a benzodiazepine. They have been prescribed for sports injuries, muscle spasms, premenstrual tension, exam nerves, depression, general malaise and much else. Because they make some people feel good at first, like the ladies on Xanax, these prescriptions tend to be continued long-term. I am sure everyone here knows how the long-term patients themselves - not the doctors - discovered that if you take benzodiazepines long-term you become dependent on them or, in common parlance, addicted.
How the dependence potential of the benzodiazepines was overlooked by doctors when it was clear that they could replace their predecessors such as the barbiturates is a matter for amazement and casts shame on the medical profession which claims to be scientifically based. Cross tolerance between different drugs, for instance between barbiturates and alcohol, was well understood at the time and clearly implied that if one drug could replace another it must have common characteristics and usually a common mode of action. In fact barbiturates and alcohol, like benzodiazepines, act on GABA receptors. The similarity between benzodiazepines and barbiturates was ignored (despite a few warning voices, including my own, which went unheard) and doctors were urged to prescribe benzodiazepines instead of barbiturates. They complied with such zeal that benzodiazepines became for a time the most commonly prescribed drugs in the world. Incidentally, they were helped by Roche who attacked barbiturates in order to sell their first benzodiazepines Librium and Valium.
The backlash came, as I have mentioned, when the patients themselves complained that the drugs were addictive, mainly because they got withdrawal symptoms if they tried to stop. Eventually, in the early 1980s controlled trials of such patients by Malcolm Lader, Peter Tyrer and others demonstrated beyond doubt that withdrawal symptoms from regular therapeutic doses of benzodiazepines were real and that they indicated physical dependence on the drugs. Eventually the medical profession accepted officially, on the grounds that they produced a withdrawal syndrome, that benzodiazepines were dependence-producing, i.e. addictive.
Not to be outdone, the drug companies rapidly produced a series of drugs that were not chemically benzodiazepines but produced the same effects. These were the Z-drugs zopiclone, zolpidem, zaleplon and now eszopiclone (Lunesta). They were marketed as sleeping pills but in fact have similar properties to benzodiazepines. They act on GABA receptors, cause dependence and, like benzodiazepines, cause a withdrawal syndrome.
With declining popularity of the benzodiazepines came a renewed interest in antidepressant drugs which led eventually to the SSRIs (selective serotonin reuptake inhibitors) - that we have today. It started as a deliberate tactic to displace benzodiazepines. Drug companies sponsored large international symposia attended by 100s, sometimes 1000s, of physicians where speakers warned of the harm benzodiazepines were doing because of dependence and suggested that serotonergic drugs would work not only for depression but were also good anti-panic drugs and good in generalised anxiety, social phobia and even in post-traumatic stress disorder (PTSD) and obsessive compulsive disorder (OCD).
The first serotonergic drug was a flop, but then Prozac came on the scene and was an immense success. So successful was Prozac that five different drug companies vied to corner some of the market with me-too SSRIs that are cheaper to make. Dr. Sulser of Vanderbilt University noted that if a drug company could get just 20% of the Prozac market it could make 400-500 million dollars a year with very little investment in research and development. He added sadly: "I don't know how to solve this dilemma in an industrial society that is so heavily driven by profits". The outcome of this is that we now have 5 other SSRIs in addition to Prozac: fluvoxamine, paroxetine, sertraline, citalopram and the newest escitalopram. According to David Healy, the effective incidence of depression, OCD, social phobia, and PTSD has increased a thousand-fold worldwide since 1980.
But there is a sting in the tail of this story too. After a while it became apparent from patients' experiences that SSRIs, like benzodiazepines, produced a withdrawal syndrome when they were stopped - in fact the withdrawal reaction is quite similar to benzodiazepine withdrawal. This is another example of surprising ignorance and lack of thought on the part of physicians. It was known that the older antidepressants, tricyclics and MAOIs (which were also beneficial for both depression and anxiety disorders) produced a withdrawal reaction - this had been well described by Peter Tyrer as long ago as 1984. Yet the doctors appeared to be taken by surprise by SSRI withdrawal reactions. Furthermore, doctors were not good at managing either benzodiazepine or SSRI withdrawal. It is no wonder that the Bristol project became involved with antidepressants. Here at last patients could find someone who listened to them.
As I mentioned before, the benzodiazepines had been accepted as being dependence-producing, or addictive, on the basis of their withdrawal effects. Now there were clear withdrawal effects from SSRIs. In a scramble to prove that SSRIs were not addictive, psychiatrists changed the definition of drug dependence. Criteria for substance dependence were altered in the 1994 DSM IV by the American Psychiatric Association. In this edition, withdrawal effects alone were not enough. A patient now also had to have evidence of tolerance, dosage escalation, continued use despite efforts to stop and other characteristics to qualify for dependence. And the withdrawal syndrome was replaced by the patronising euphemism "discontinuation reaction". As if a patient would think there was some subtle difference between "discontinuation" and "withdrawal".
I can't help feeling there is something Orwellian in these manipulations like the slogan in Animal Farm which started as "4 legs good; 2 legs bad" but when pigs started walking on their hind legs the slogan was changed to "2 legs good; 4 legs bad". Or the addition to another slogan "All animals (or withdrawal effects) are equal - but some (e.g. discontinuation effects) are more equal than others".
So where are we now, 50 years into the Era of Psychopharmacology? We still don't know the causes of mental diseases and we still don't know how or if the drugs work. The antidepressants appear to have relatively little effect on depression and are only marginally better than a placebo. The SSRIs, though they are safer, are no more efficacious than the older antidepressants, or than drugs which act on noradrenaline with little effect on serotonin. Bipolar depression (manic depression) used to be treated just with lithium; now bipolar patients usually take at least 5 drugs - lithium, an antidepressant, an antipsychotic, an anticonvulsant and usually a benzodiazepine. This is supposed to keep their mood stable, but the course and prognosis of bipolar depression has actually not changed since the patients only took lithium. The new antipsychotics such as clozapine are not much more effective than the older drugs. The over-prescription of benzodiazepines has led to them entering the drug scene. There is now a growing problem of benzodiazepine abuse which carries all the risks of drug abuse in general, including, for injectors, hepatitis C, HIV infection and AIDS. Antidepressants are also abused by people taking illicit drugs including young people taking ecstasy or amphetamines.
It is clear that money, not science, is driving pharmacology. Yet the drug companies are the only ones with the funds to conduct drug trials and doctors persist in the belief that a drug will be found that is the answer to each mental illness. Meanwhile, the few projects like this are left to pick up the pieces left by drug companies and doctors.
Well - this is not meant to be a diatribe against drug companies, drugs or doctors. It is simply a statement of some published facts which attempts to highlight some failures in the whole system under which we have insidiously come to operate.
So in conclusion, what can we do? I have only a few suggestions.
One measure we could take is to separate the pharmaceutical industry from health care policies. This year the House of Commons Health Committee issued a report entitled "The Influence of the Pharmaceutical Industry". The conclusions were damning. The report states: "The Department of Health has for too long assumed that the interests of health and the [pharmaceutical] industry are one". In practice the industry affects every level of health care provision from the licensing of new drugs, to the promotion of drugs to prescriber and patient groups, to the prescription of new medicines and the compilation of clinical guidelines. The Committee cited evidence that industry-sponsored clinical trials are specifically designed to show new drugs in the best light, that negative trial results and adverse drug reactions are suppressed (as with heart complications from Vioxx and suicides with SSRIs), and that selective publication strategies and ghost writing of articles are common. The crux of the problem is that the Department of Health sponsors both the drug industry and public health matters. The Committee recommended that the sponsorship of the industry should pass to the Department of Trade and Industry while the Department of Health Committee should concentrate solely on public health.
This seemed to be a hopeful development but the government's response was to ignore this recommendation the medical profession should take much responsibility for allowing the present situation to arise. They have been guilty of decades of thoughtless prescribing which persists for benzodiazepines despite national and international guidelines recommending that benzodiazepines are indicated for short-term use (2-4 weeks) only. Therefore we need to increase our efforts to train medical personnel better in more careful prescribing and also in the management of withdrawal in patients who have already become dependent on benzodiazepines. Arguably we should perhaps train more clinical psychologists to improve non-drug or psychological therapies, particularly for anxiety disorders and depression.
Secondly, we also need to train doctors and nurses and drug company personnel to listen to patients more. Listening to patients seems to be a lost art. In the present system, doctors do not have enough time with 10-20 minute appointments and are more influenced by results from high-powered investigations than by what patients say. Many are overworked by the need to keep up with government targets. Nurses are too few and have too many rules to abide by. In a recent case, nurses in a busy orthopaedic ward failed to notice that an old lady was blind; and an old man with asthma in a resuscitation ward couldn't talk intelligibly and the nurses failed to notice that it was because he hadn't got his false teeth with him. Yet it was nurses who first noticed the psychological effects of the first major tranquilliser chlorpromazine (Largactil) and one of the first antidepressants, imipramine. And it was patients who first drew attention to withdrawal effects of benzodiazepines and SSRIs.
Under the present NHS system there are more hospital administrators than there are nurses and more managers than there are physicians or surgeons. There is little communication between all these different supposed health care workers. Where are the "joined up" policies the government is always recommending? It seems that it is only in projects like this that people actually listen to individuals.
In addition, perhaps we should turn our attention beyond the idea of drugs as cures for mental disease and look more in our research towards causes and prevention. These days it is very hard to get a grant in universities, either from independent bodies like the MRC or from drug companies, for research which explores new and original ideas and does not have an immediate application or clearly lead to a defined or possibly lucrative outcome. Yet it is basic research that leads to scientific breakthroughs.
Finally, the public, that is all of us, should keep up the pressure on the authorities and should publicise what we see and hear every day. I don't think that the powers that be who set government targets about hospital turnover, waiting lists, NHS spending and who have appointed so many administrators, have any idea what goes on in the lives of individuals who, through failures of the whole present system, are driven outside the system to seek advice from poorly funded support groups and organisations like this one.
In the words of the anthropologist Margaret Mead: "Never doubt that a small group of thoughtful citizens can change the world. Indeed, it is the only thing that ever has." Well, at least we can keep on trying.
A CALL FOR EUROPEAN UNION GUIDELINES ON THE PRESCRIBING
OF BENZODIAZEPINES, EUROPE'S MOST HARMFUL DRUGS
Barry Haslam
Beat the Benzos Campaign
February 2004
1 Introduction
The misuse of benzodiazepines (benzos) presents a major public health problem across Europe. Commonly known by brand names including Valium, temazepam, Librium and Ativan, they are widely prescribed by doctors as sedatives to treat conditions such as anxiety and to relieve muscle spasms. In the United Kingdom alone over 1.2 million people are long-term addicts, dependent upon prescription drugs that are more dangerous and addictive than heroin.
Benzo campaigner Barry Haslam believes he "lost 10 years of his life" through becoming addicted to the drugs after being prescribed them by his doctor. He founded the charity ‘Beat the Benzos' to highlight the plight of addicts like himself, and has compiled a report on the personal experiences of addicts in the UK and across Europe. Together with his Euro-MP Chris Davies (Liberal Democrat, North West of England) he will be presenting it to Commissioner David Byrne on February 4, 2004. Reflecting Barry's experience, it concentrates on the situation in the United Kingdom, while highlighting the fact that other European nations have problems of a similar scale or worse.
Each year in Britain 17 million prescriptions are issued for benzos. The Committee on the Safety of Medicines recommends that a course of treatment should last no longer than four weeks. Consumption lasting for longer than this period can cause physical dependence. Side effects include insomnia, anxiety, drowsiness and increased aggression. but despite warnings the drugs are still sometimes issued through repeat prescriptions for years on end.
Last year Chris Davies secured the backing of the European Parliament for a call to act. MEPs requested the preparation of a Council recommendation on the risks associated with addictive prescription drugs such as benzos, and best practice support for patients suffering long term withdrawal symptoms or permanent impairment.
The Commission has agreed to this proposal, and has said that preparatory work involving an inventory of existing studies in this field will be undertaken. Commission officials have also made clear that they would welcome suggestions from those with first hand experience.
2 The Problem
In the period 1990-1996 (excluding 1994), benzos were responsible for 1,810 deaths in the UK. They are comparable with the most dangerous of illegal drugs.
Benzos also induce suicidal tendencies and may have accounted for many more deaths by other methods. Some 761 regular users of benzos are known to have committed suicide during this period.
Source: Home Office Statistics
2.1 CRM Report
The Committee on the Review of Medicines (1980) states that sleep laboratory studies show most hypnotics tend to lose their sleep promoting properties within 3 to 14 days of continuous use. The committee further noted there was little convincing evidence that benzos were efficacious in the treatment of anxiety after 4 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.
2.2 CSM Report
Despite advice from the Committee on Safety of Medicines (1988) that benzos should not be prescribed for more than 2 to 4 weeks there are still many long-term users in the UK.
2.3 Drug misuse and risks
Benzos are often used in combination with opiates. Up to 90% of attendees at drug misuse treatment centres report use of benzos. Some 49% had injected them.
Source: Drug misuse and dependence; Guidelines on clinical management, Dept of Health, 1999
2.4 Associated health risks
· Risk taking sexual behaviour
· Foetal and neonatal risks in pregnancy
· Increased violence and criminal behaviour
2.5 Illegal Sources
Interpol have estimated that 8 million temazepam capsules a year are being smuggled into the UK.
2.6 Abuse of the elderly
It is claimed that benzos are routinely overused in care homes and homes for the elderly for the convenience of staff and management.
2.7 Cause of accidents
Benzos impair co-ordination and judgement. It is claimed that there are more benzo drivers than drunk drivers and there are no mechanisms in place for controlling this.
Source: Benzodiazepines: How they work and how to withdraw, C H Ashton, 2002
2.8 Cognitive impairment/Long term damage
Long term prescribing of benzos can cause permanent and irreversible brain damage, brain atrophy, cognitive impairment and thyroid damage. More research is needed on the long term effects of benzos many years after withdrawal.
Sources: Manchester Disability Appeal Tribunal 14/11/1996 - Appellant Barry Haslam and Benzos: Cognitive Impairment/Long Term Damage, 1968-1996
2.9 Dangers to the unborn child
Benzos were detected in 18% of new-born babies at the Princess Royal Hospital, Glasgow between October and November 2000.
Prenatal benzo exposure can cause toxicity and/or withdrawal effects in the new-born baby.
Source: Request to review the current status of benzos - Submission to the Home Office, Benzact, July 2003
3. Sample of Responses Detailing Personal Experiences
Mr D, Wigan, UK - Prescription addict to Ativan. "Can't get downstairs. Can't have a shower. Started avoiding people. Have panic attacks and feel anxious. Left the house for the last time in 1986. Lost 20yrs of his life due to this drug."
Mr H, Ormskirk, UK - "Having been prescribed them for 21 years, I insisted that enough was enough in 1989. The hell of withdrawal was worthwhile, because I became my true self again - a true rebirth."
Mrs B, St Helens, UK - "I was first prescribed nitrazepam and Valium in 1970. My son was forced to witness my appalling descent into increasingly irrational behaviour, verbal aggression and suicidal ideation when I frequently overdosed on the psychoactive drugs which were supposed to be helping me."
Mrs M, Salford, UK - "I first came across temazepam and diazepam when I was about 12 or 13 years old after pinching a few from her (mother) I took a liking to the buzz I got off them. This went on for many years and when I was 18 I started using crack cocaine and became mentally addicted. I used benzos, beer and cannabis to bring me down.
"When I was 26 I started to inject heroin. A doctor and psychiatrist prescribed me chlorpromazine but I thought they were trying to make me mad and refused to take them. I just kept telling them if they gave me ‘mazzies' I'd be OK.
"I've started having fits which I've never had before. After a week my jaw goes funny. I start hallucinating and hearing things again. I've nearly burnt down the house twice this year because I left the oven on. I don't see any future without them (mazzies) as I am heavily addicted and dependent on these tablets."
Mrs R, Grange Over Sands, UK - "I have been off these drugs for 10 years but have had two spells of addiction. The first occurred when I was 19 and a psychiatrist put me on Valium and despite several attempts to come off them I didn't succeed until after 13 years when I was 33.
"The symptoms were very much worse the second time around. I feel very strongly that doctors simply do not understand how serious and dangerous these drugs are. It's very worrying that doctors don't seem to understand the drugs they prescribe."
Mrs W, Darwen, UK - "I started with anxiety and depression in my early teens and by the time I was 17 I was on medication. Most of us have been used as guinea pigs and most still are."
4 Wider European Experiences
a) Ireland
Whilst the major medical bodies, including the Royal College of Psychiatrists and the Irish College of General Practitioners, have advised that benzos should not be prescribed for more than 2 to 4 weeks, there is evidence that there are still many long term prescribed users of these drugs in Ireland.
The General Medical Services scheme covers approximately 31% of the population. Benzo usage in GMS adult population suggests that, in 2000, 11.6% of the adult GMS population were using benzos. It also suggests that the usage of benzos is increasing gradually from 87 DDDS (Daily Defined Doses) in 1995 to 116 DDDS in 2000.
A 1999 study of drug users admitted to a detoxification unit for benzo withdrawal identified equal abuses of diazepam, flunitrazepam and flurazepam.
The report on inquests held by the Dublin City Coroner in relation to Opiate related deaths in 1998 and 1999 provides further evidence of the problem of benzo misuse in this population. From 1998-99, 1308 inquests were held and 163 were Opiate related. When the drugs implicated in these deaths are examined it can be seen that in both years the most common drug group involved was benzos, outstripping heroin and cocaine.
Information from the Department of Psychiatry of the Elderly at St James' Hospital, Dublin states that many elderly patients have been taking benzos on a long-term basis and are physiologically and psychologically dependent.
Ireland is a party to the UN Convention on Psychotropic Substances 1971. In view of the requirement to include zolpidem in the controls under the Misuse of Drugs Act, consideration is being given to extension of controls to the other hypnotic drugs of this nature, namely zaleplon and zopiclone. The drug zopiclone was introduced as a safer alternative to benzo drugs but it is also addictive and harmful.
b) Portugal
Portugal is the second biggest European consumer of benzos.
Studies performed in Portugal point to 23% of adults (patients from a health centre in Lisbon) consuming benzos on a regular basis.
In the late 1980s, Portuguese users were consuming around 35 DDD (Daily Defined Doses) of benzos per day. At this time Portugal was the country with the lowest benzo consumption rate. In the late 1990's Portugal had become the second biggest consumer of this type of medicine, use having increased from 35 to 85 DDD per inhabitants per day.
c) Netherlands
Over the last 15 years the prescription of benzos has been under continuous discussion in the Netherlands. Following publication of scientific studies a temporary decrease in use was noticed, but this appears to have been shortlived.
Source: Benzo use in the Netherlands: Changes and hope for the future, F W Van der Waals (1998)
The latest data on benzo use in the Netherlands was published by the Drug Information Project of the Supervisory Board for Healthcare Insurance. Data is collected from an insured population of 5 million people. The database accounts for 50% of sick fund members.
Prescriptions 1993 (millions) 1998 (millions)
Anxiolytics 5.9 6.4
Hypnotics 4.8 5.2
Total 10.7 11.6
DDDs 1993 1998
Anxiolytics 114.1 113.5
Hypnotics 129.4 134.2
Total 243.5 247.7
Costs (Euros) 1993 1998
Anxiolytics 46.2 49.8
Hypnotics 39.9 45.7
Total 86.1 95.5
More than 60% of Anxiolytics and 70% of Hypnotics are repeat prescriptions and the number of chronic users has increased from 500,000 in 1992 to 700,000 in 1998.
d) France
As far back as the 1980s the attention of the Poisoning Prevention and Drug-Monitoring Centre in Marseille has been drawn to clinical observations and medical appraisals which point to the possible existence of behavioural disorders in healthy subjects when taking benzos.
Source: Adverse effects of benzos with potential social consequences, J Jouglard (2000)
5 Conclusion on the European benzo situation
The Pompidou group of the Council of Europe issued a questionnaire to members in 2000. The aim of this questionnaire was to identify sources of information on benzo consumption, the prevalence of abuse, the harmful effects caused and the strategies implemented to reduce demand. There were very few replies to this questionnaire and no country was able to provide figures on the prevalence of abuse or on illegal consumption. The shortage of information on the legal and illegal use of benzos was primarily accounted for by the fact that the information was not available. There were no systematic data collection procedures or the existing information sources were incomplete or difficult to exploit.
Member states have failed to adequately address benzo drug issues and public health protection.
Evidence that does exist from some member states suggests that the scale of the problem is huge. The European Commission needs to take a lead in encouraging European leaders to take action.
6 Recommendations for European Union Best Practice Guidelines
· The problem of addiction to prescription drugs needs to be given a much higher profile. The consequences for individuals and society are at least akin to those created by heroin and alcohol addiction.
· Medical authorities need to stress to doctors the dangers of addiction to benzos and ensure that prescribing guidelines are being followed.
· The European Commission should consider legislation to establish a compensation scheme for benzo injuries, funded by drugs' manufacturers. Such a scheme exists in New Zealand for all drug injuries.
· A 24 hour helpline should be established in all Member States for benzo drug addicts and their families.
· Member states should consider the provision of benzo detoxification centres and respite clinics.
· Financial aid should be given to appropriate self help/support groups.
· Medical authorities should publish advice to doctors on how to assist benzo users escape from addiction. Written withdrawal contracts for benzo addicts, agreed with their doctor and witnessed by a third party, may have a role to play.
· Long-term addicts who do not wish to withdraw should have their wishes honoured.
· EU-wide research into the long term effects of benzos should be commissioned.
· The European Commission should consider requiring all benzo packaging to state clearly: "Caution!! This product contains ingredients which if misused, or taken over a prolonged period, will cause a physical and/or psychological dependency. Consult your doctor and/or pharmacist for further information."
· An independent drug scrutiny board should be set up in each Member State. This would monitor all new drugs from the date of approval.
· Pharmaceutical companies should be required to update their provision of advice and information to patients in the form of leaflets on an annual basis.
For more information contact:
Barry Haslam
Telephone: 01457 876355, Facsimile: 01457 876361
Email: barry@beatthebenzos.freeserve.co.uk
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