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I don't think recommending long-term benzo / z-drug usage outright is a good idea. They should be the absolute last resort. I have never met anyone who hasn't u

by joesmo 10y ago

I don't think recommending long-term benzo / z-drug usage outright is a good idea. They should be the absolute last resort. I have never met anyone who hasn't used them long term who was aware of their risks. These are some of the most prescribed medicines on earth and even the doctors prescribing them have no idea of their effects, let alone how to get you off them. This is, most likely but not necessarily, a life-long addiction one enters into where the risk of going without can cost one's life. Also, some people have paradoxical effects: basically, the opposite of sedation / sleep. Getting off them takes at least a couple of months, if you're lucky, up to a year or more during which you can't really do anything like work, etc. They are especially nasty to people suffering from depression, something quite common (if not actually the same underlying condition) in the sleep-deprived. At the very least, one should exhaust all other possibilities, including much safer sleeping aids like melatonin and cannabis, before making a plunge into what is almost guaranteed to be a life-long dependency.

pizza 10y ago
Melatonin is about as dangerous as it is effective, imo - lightweight. Cannabis is not without risks either, but they're nearly negligible. Outright recommendation is not really what I was talking about, either - I was talking about situations where I would go multiple days without being able to sleep, and not for a lack of trying.. David Nutt et al. are better qualified to talk about it than I am I guess. Over the last decade there have been further developments in our knowledge of the risks and benefits of benzodiazepines, and of the risks and benefits of alternatives to benzodiazepines. Representatives drawn from the Psychopharmacology Special Interest Group of the Royal College of Psychiatrists and the British Association for Psychopharmacology together examined these developments, and have provided this joint statement with recommendations for clinical practice. The working group was mindful of widespread concerns about benzodiazepines and related anxiolytic and hypnotic drugs. The group believes that whenever benzodiazepines are prescribed, the potential for dependence or other harmful effects must be considered. However, the group also believes that the risks of dependence associated with long-term use should be balanced against the benefits that in many cases follow from the short or intermittent use of benzodiazepines and the risk of the underlying conditions for which treatment is being provided. https://www.bap.org.uk/pdfs/BAP_Guidelines-Benzodiazepines.pdf https://www.bap.org.uk/pdfs/BAP_Guidelines-Benzodiazepines.p...
- joesmo 10y ago
  There are definitely cases where long term use of benzos is the only viable solution and your sounds like one of them. But this paper just rehashes the same things about benzodiazepines. Are they saying that only some people become dependent on benzos? Do they have an example of anyone who's been on them for four weeks that isn't dependent? I doubt you could find someone who has been on them for two weeks who isn't dependent. They completely gloss over the fact that doctors have no idea how to get people off and rehabs are even more clueless (you can't do anything in 30 days other than damage for a long-term benzo user). Doctors often use a patient's dependance to squeeze money out of him and not provide any actual care outside the prescription, a prescription they know with certainty will bring the patient back regardless of how awful the rest of the services are. Often, they will stop seeing patients without warning, literally leaving them in life-or-death situations that they need to resolve themselves, situations they might not be able to resolve without going to a black market or emergency room. I'm not saying the guidelines are bad, just that they are extremely incomplete, they unacceptably play down the risks involved, and most doctors have never heard of them. The situation will hardly change given how much profit comes from benzos to all parties involved (except the patient)

by joesmo 10y ago

pizza 10y ago

Melatonin is about as dangerous as it is effective, imo - lightweight. Cannabis is not without risks either, but they're nearly negligible. Outright recommendation is not really what I was talking about, either - I was talking about situations where I would go multiple days without being able to sleep, and not for a lack of trying.. David Nutt et al. are better qualified to talk about it than I am I guess. Over the last decade there have been further developments in our knowledge of the risks and benefits of benzodiazepines, and of the risks and benefits of alternatives to benzodiazepines. Representatives drawn from the Psychopharmacology Special Interest Group of the Royal College of Psychiatrists and the British Association for Psychopharmacology together examined these developments, and have provided this joint statement with recommendations for clinical practice. The working group was mindful of widespread concerns about benzodiazepines and related anxiolytic and hypnotic drugs. The group believes that whenever benzodiazepines are prescribed, the potential for dependence or other harmful effects must be considered. However, the group also believes that the risks of dependence associated with long-term use should be balanced against the benefits that in many cases follow from the short or intermittent use of benzodiazepines and the risk of the underlying conditions for which treatment is being provided. https://www.bap.org.uk/pdfs/BAP_Guidelines-Benzodiazepines.pdf https://www.bap.org.uk/pdfs/BAP_Guidelines-Benzodiazepines.p...

joesmo 10y ago
There are definitely cases where long term use of benzos is the only viable solution and your sounds like one of them. But this paper just rehashes the same things about benzodiazepines. Are they saying that only some people become dependent on benzos? Do they have an example of anyone who's been on them for four weeks that isn't dependent? I doubt you could find someone who has been on them for two weeks who isn't dependent. They completely gloss over the fact that doctors have no idea how to get people off and rehabs are even more clueless (you can't do anything in 30 days other than damage for a long-term benzo user). Doctors often use a patient's dependance to squeeze money out of him and not provide any actual care outside the prescription, a prescription they know with certainty will bring the patient back regardless of how awful the rest of the services are. Often, they will stop seeing patients without warning, literally leaving them in life-or-death situations that they need to resolve themselves, situations they might not be able to resolve without going to a black market or emergency room. I'm not saying the guidelines are bad, just that they are extremely incomplete, they unacceptably play down the risks involved, and most doctors have never heard of them. The situation will hardly change given how much profit comes from benzos to all parties involved (except the patient)