America is on track for an epidemic of addiction and overdoses from anti-anxiety medication, a top clinician warns.
With the nation’s attention on prescription painkillers, there has been scant conversation about the climbing rate of people being prescribed benzodiazepines, potent drugs like Xanax and Valium designed to alleviate anxiety and panic attacks on a short term basis.
Dr Anna Lembke, a psychiatry professor at the Stanford University School of Medicine and author of Drug Dealer MD, warns ‘benzos’ are being consumed and distributed in a way that eerily echoes the lead-up to the opioid epidemic.
Crucially, she warns, more and more patients are finding it impossible to reduce their dose or quit the drugs even after one prescription, paving the way to either an excruciating battle with withdrawal symptoms or a lifetime of addiction.
Opioid prescriptions peaked in 2012. But the rate of benzodiazepine prescriptions climbed 67 percent between 1996 and 2013, and more patients are struggling to quit, Dr Anna Lembke of Stanford warns
Dr Lembke – like many others – has long been concerned about the potent effects of benzodiazepines. Even in the 1960s there were research papers warning ‘mother’s little helper’ (as Valium was sweetly dubbed) could sew the seeds for severe cognitive damage or even Alzheimer’s.
But it wasn’t until 2015 that she began to feel we could be reached a critical point with fatal implications.
‘I started to see that, two or three years ago, more and more patients were coming in to my office seeking help specifically to get off benzodiazepines – all prescribed to them by a well-intended doctor,’ Dr Lembke told DailyMail.com.
‘In many cases they had no history of addiction, but found themselves utterly incapable of even decreasing their doses a bit. Even reducing it a little bit they had these incredible withdrawal symptoms that were just unbearable.’
She was also seeing patients who had managed to reduce their doses of get off but were left with tremors and full-body twitching, which they directly attributed to going on the benzodiazepines (‘these are the so-called “benzo survivors” who feel they have been harmed by going on them and struggling to get off’).
The other worrisome group is a completely new thing for Dr Lembke: ‘I only really began to see this in the last two years: young people experimenting with novel highs, getting benzodiazepines online using bitcoin.’ One of her patients got clonazolam online. Clonazolam is an incredibly potent mix of Klonopin and Xanax. Anything more than a millionth of a gram could be lethal.
Crunching the data in a recent paper, Dr Lembke saw a clear trend.
The rate of benzodiazepine prescriptions climbed 67 percent between 1996 and 2013 – up from 8.1 million to 13.5 million. In 2016, Xanax, Desyrel and Ativan were all in the top 10 of the most-prescribed psychiatric medications (second, sixth and ninth, respectively).
This uptick has proved particularly dangerous in tandem with the opioid epidemic. Millions of people have been mixing the two – whether on purpose or unwittingly – with devastating consequences. When taking benzodiazepines and opioids together, a person’s overdose risk quadruples. Since 1999, the rate of people dying of such a combination has increased seven-fold.
But the problem is, anxiety is on the rise, and benzos work – really well.
They were created somewhat accidentally in 1955, when Polish chemist Leo Sternbach, then working in New Jersey, was trying to create a less addictive form of the sedative barbiturate.
One of his failed attempts was proved to target a type of neurotransmitter called GABA (gamma-aminobutyric acid) which dampens nerve activity.
Since studies had shown anxiety and depression to be the result of hyperactive nerve function, he and his colleagues saw potential for a new class of drugs.
And it took off with resounding success.
While the best long-term control of anxiety comes in the form of behavioral therapy or a low dose of antidepressants, benzos offer almost instant relief.
Within as little as 30 minutes, the drug awakens the GABA neurotransmitters, and users feel a calming effect. Interestingly, we still do not fully understand how the drug interacts with the brain, but we do know that it produces short-term effects that millions of people are looking for.
‘They really do work very well short-term – like nothing else,’ Dr Lembke explains. ‘It’s the bad news that nobody want to face.
‘These were never meant to be given long term. There’s consensus that they should be used for the shortest duration for the lowest dose.’
But, she adds: ‘It’s really tough on prescribers because you run out of things to give people. And people want instant results.’
Getting people hooked was easy, if not inevitable. The rate of anxiety diagnoses have climbed dramatically in recent years, particularly among higher-income communities that can afford expensive drugs.
Many of the usual suspects are blamed – social media being the classic scapegoat. In a recent paper that showed affluent kids are more likely to be anxious than lower-income children, Dr Suniya S Luthar, a professor of psychology at Arizona State University, added that there seems to be a culture of success at all costs, especially in the upper rungs of society.
Whatever the reason, quick fix drugs have come to be accepted as a handy pick-me-up – regardless of the long-term dependence and cognitive damage that may be in store down the line.
Getting others to care about Dr Lembke’s concerns, however, is something else entirely.
‘People didn’t care about [the opioid epidemic] until people started dying,’ Dr Lembke explains.
‘Nobody really paid attention to the fact that the two to four million people were addicted to it. Obviously addiction was a big factor in the deaths, but it wasn’t until there were deaths that we started looking at addiction.’
This year, three states (Michigan, Florida and Tennessee) have brought in restrictions on opioid prescriptions, limiting a patient’s maximum supply to a week’s worth. Stores like CVS and Walmart have done the same.
The benzodiazepine ‘story’, as Dr Lembke puts it, has taken a different trajectory.
‘It’s been kind of weaving in and out of public consciousness since the 1960s,’ she says. ‘At first Valium was called “mother’s little helper”, but then the earliest alarm bells came out of Great Britain, with research showing dangers of short term cognitive deficits or causing Alzheimer’s. So, there’s been an awareness since then, but people didn’t want to hear the message.’
Fast-forward to the 2000s, and it’s the same thing: studies here and there citing concerns, but an overwhelming public demand for them.
‘With benzodiazepines, it wasn’t until they started looking at coroners reports of overdoses and realized that many people dying had also been on benzos,’ Dr Lembke says. ‘That’s when, on a national level, people have begun to say “oh wow, benzos are an issue”.’
When it comes to turning the tide, the best thing we can push for, Dr Lembke says, is more widespread awareness among prescribers and consumers that these are medications that should be used very sparingly.
‘They should not be dispensed or consumed in a cavalier manner.’
There are some ominous signs that the issue is expanding. Dr Lembke is seeing more patients hooked on Ambien and Belsomra, insomnia drugs largely viewed as safe but which work on the same GABA receptors as benzos. Gabapentin, used to treat seizures and pain from shingles, is also emerging as a cause of ‘full-blown addiction’.
For now, Dr Lembke is trying to promote her concerns and urge people to realize the critical implications of quick fixes.
‘Unfortunately, when it comes to the brain, there’s no such thing as a free snack.’
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Author: The Daily Sheeple