8 ms·

Benzodiazepines: Our Other Prescription Drug Problem

lmpostor 8y ago
Dirt cheap, "synergizes" with alcohol, street presses being incredibly overdosed, it is weird seeing the writing on the wall then watch it be inked into existence.
maxander 8y ago
What is the thesis here? Benzodiazepines are commonly prescribed and have the potential for abuse; these things are both true; I hadn't heard the rate of prescription was rising, but I'd believe it. There doesn't seem to be any evidence presented for a trend or rise in benzodiazepine abuse, or evidence of general harm from the use of the drugs. It highlights parallels between the existence of this prescription drug class and another class that is associated with significant issues, and makes it sound as if there were an issue here... and then leaves it at that, the literary equivalent of a wink and a nudge. Are they arguing that prescription of drugs with abuse potential is inherently a problem? Because that would be a very extreme position, one which would challenge a sizable fraction of the medications available to modern psychiatry. And this is a "journalist's resource," one associated with the Harvard Kennedy School? No wonder journalism is garbage these days.
- lmpostor 8y ago
  >A study published in 2016 in the American Journal of Public Health finds that from 1996 to 2013, the number of adults in the United States filling a prescription for benzodiazepines increased 67 percent, from 8.1 million to 13.5 million. The death rate for overdoses involving benzodiazepines also increased in this time period, from 0.58 per 100,000 adults to 3.07. In the first link in the article >the quantity of benzodiazepines they obtained more than tripled during that period, from 1.1-kg to 3.6-kg lorazepam-equivalents per 100,000 adults.
  - maxander 8y ago
    That's all prescribed doses, though. So, yes, the use of benzodiazepines is going up, which obviously carries with it the associated rise in side effects and drug-related deaths. It's not reasonably comparable to the narcotics epidemic, where illegal use is driving mortality rates.
    - benbreen 8y ago
      I see how that's true on a legal level, but if we're just talking about social and public health impacts, I don't see why the distinction between prescription and illegal use matters here. A three-fold increase in a category of drugs with major health impacts seems newsworthy to me. After all, the boundaries between legal and illegal use are far from fixed. Methamphetamine was once widely prescribed by physicians for weight loss, for instance (and is indeed still legally available as a prescription medicine) [1]. Presumably we can agree that a world in which prescriptions for methamphetamine have tripled might be a cause for concern, right? It's debatable whether this class of drugs has the same abuse and health risks, but based on my own reading and anecdotal experiences, I think they're pretty comparable. [1] https://resobscura.blogspot.com/2012/06/from-quacks-to-quaaludes-three.html https://resobscura.blogspot.com/2012/06/from-quacks-to-quaal...
- snowwrestler 8y ago
  When I was prescribed a benzo a decade ago, my doctor told me it was safe, non-habit-forming, and I could take it whenever I wanted to feel less nervous. There was no warning whatsoever about addiction, tolerance, or the serious side effects that were possible. Luckily I am generally skeptical of pharmaceuticals, at least to the extent that I try to educate myself about them. So I did my own reading up about it. But even then, while online sources did indicate that benzos could be habit-forming, I did not see the strong language and terrible stories that are coming out now about benzo addiction. So hopefully that illustrates the newsworthy issue: a lot of doctors, and even online medical info sites, did not adequately appreciate the risks of benzos, or warn people about those risks.
UpshotKnothole 8y ago
A friend of mine got hooked on heroin and ended up on methadone maintence. He’s since managed to get off that and is clean, but he had horror stories of people on methadone abusing benzodiazepines like crazy. Apparently mixing methadone and high doses of drugs like Xanax produce effects similar to heroin, but benzos are really hard to get off. He talked about a woman who couldn’t get her Xanax fix, and she started having seizures. Benzodiazepines take months to titrate off safely, and higher doses associated with abuse do unpleasant things to your seizure threshold and memory. Bad stuff unless you must have it.
- ghostbrainalpha 8y ago
  There is a pretty large community on Reddit just dedicated to recovery just from Benzo's. https://www.reddit.com/r/benzorecovery/ https://www.reddit.com/r/benzorecovery/
- deleted 8y ago
  [deleted]
- stryk 8y ago
  It is incredibly, incredibly dangerous to mix benzodiazepines (Xanax, Ativan, etc.) with Methadone. This is common knowledge amongst opiate addicts, at least everywhere I ever went in the US back in my wilder days. I have 3 close friends whom I grew up with that all died before age 30 from abusing that exact combination of narcotics, and know of countless more just in my home state alone. Benzos are a respiratory depressant, and when combined with Methadone it amplifies it to the point where you stop breathing in your sleep and never wake up from respiratory failure, lack of oxygen to the brain, or your body freaks out and has a coronary episode, etc. it's really really risky -- no joke & no exaggeration. If alcohol is in the mix too then it's even worse. And I'm not going to pretend like it's not enjoyable -- because it is. It's a great fuckin' buzz if downers are your thing. IMO it's better than heroin (no 'rush' to it, but the effects hit you like a ton of bricks and it lasts all night long. And it's a cheap buzz too), but it's also asking for your life to end. methadone clinics know this and every one that I've ever seen, heard of, or been to personally Benzos are their one big 'no-no' [as in: if we find it in your Whiz Quiz we kick you out, some won't even give you a second chance and most clinics have mandatory urine screening twice a month, some every week]. You can test positive for damn near anything else -- and they expect you to test positive for opiates -- but if you have benzos in there then you kick rocks.
piazz 8y ago
I was taking 3mg Lorazepam nightly for almost three years. Weening off of it safely took almost an entire year of miserable work, and the final stages I had to do while I had no other significant life responsibilities because of the incredible rebound insomnia and background anxiety you experience withdrawing off benzodiazepines. The only upshot is that when you finally do manage to get yourself off of a drug like this, you sort of feel like you can tackle most other challenges life throws your way. So yeah, this stuff is serious. And of course, my Lorazepam was prescribed legally, by a responsible, well regarded psychiatrist, with very little warning regarding how quickly one builds both tolerance and physiological dependence on this chemical.
- tnecniv 8y ago
  > And of course, my Lorazepam was prescribed legally, by a responsible, well regarded psychiatrist, with very little warning regarding how quickly one builds both tolerance and physiological dependence on this chemical. Sorry to hear that. Mine told me to take at most 1mg no more than once a week for that reason. Seeing what that quantity does to me, I can't imagine dosing at that quantity or frequency (obviously you acquire a tolerance, but still).
- icantdrive55 8y ago
  I really think most Psychiatrists know how addictive Benzodiazepines are, but Americans are very stressed out. In my case, I busted a gasket in my twenties. I went from the most capable person in the room, to the trembling guy who could barely leave his room. I can honestly say it ruined my life. I was given a benzo with a long half life. It worked a bit, but I never fully recovered. I think we all know the drug. 40 hour half life. I tried all kinds of medications over the years, and nothing worked except benzodiazepines , and alcohol. Yes--alcohol hits so many different parts of the brain, but is horrid on the body. I really tried to avoid alcohol, but some days the anxiety susptoms we just unbearable. I've been on the long half life benzodiazepine for decades. I take the same dose low dose, and try not to drink. I've never even asked my doctor, but he knows my low dose isn't going to cause physical problems. They are better than alcohol, if you're self-medicating. I belive his thinking is I need the drug. I've been on it forever. Why put him through a misserable detox, at this stage of the game? There are a few big studies done on patients whom were on opiates, and benzodiazepines for long periods of time. They didn't necessarily need to increase their dosages. I believe the studies were done on rest home geriatric patients. I feel at my age, what's the point of a long withdrawal. It's easy to say for myself because my doctor has reasonable rates. He is getting close to retirement, and that has me very worried. The last thing I want is a long misserable detox. I don't like the way this drug problem is playing out. I don't like blaming doctors. All their patients are very different. My wish is we let, especially Psychiatrists, make these hard calls concerning what's best for their patients. That's what they went to school for. I don't know why we are even discussing it here. I don't want to live in a world where doctors send their patients home a mess because they are afaird of being accused of some sinister reason for keeping a patient on a addictive drug. In all reality, so many doctors just don't prescribe certain drugs. Probally, one of the main reasons why former patients go to the streets, or liquor stores. (I would further like to see a governmental bill that would allow patients, whom have been on addictive drugs for years, the ability to authorize their own scripts. The Same dose, and any increase would require a doctor's visit. At this point my office visits are pointless. There is a bill that is in congress now I believe, but it's for drugs that aren't addictive. I doubt the AMA will ever let it pass though.)
jnovek 8y ago
Serious question: as we make opiods and now bezos increasingly difficult to prescribe, what are the alternatives for people with chronic pain or chronic anxiety? I have friends and family members with chronic pain and, through them and their communities, have become aware of many people who use opiods on a long-term, occasional basis to manage their pain. A family member of mine who suffers from chronic migraine lives in fear that she won't be able to get an opiod which she uses as a last-ditch rescue treatment before she ends up at the ER (not to mention that she gets treated like a drug seeker when she does end up there). I don't really see an alternative for acute intense pain; likewise an alternative for acute, intense anxiety. Meanwhile the crackdowns on these drugs also create a chilling effect for physicians. What do we do for people who fall in those categories? (Edit: not to claim that abuse of these drugs is not a problem... It just seems like the people these drugs are inteded to help are being sidelined in the dialog on the topic.)
- OldSchoolJohnny 8y ago
  Cannabis in both cases works well for a great many people.
  - jnovek 8y ago
    Cannabis derived treatments do seem promising... someday. Imagine that marijuana is (at a minimum) federally rescheduled to schedule 2 in the US. How long will it take to research canniboid-based painkillers once drug companies can legally do so? How pong for FDA approval? It will be a long time until there is an alternative that is taken seriously by anyone other than the most progressive physicians in the realm of cannabis, unfortunately.
    - penagwin 8y ago
      I agree with this. I'm personally rather upset that it's schedule 1, meaning it has no medical benefit whatsoever, which is clearly BS and it makes it hard to research.
  - Karrot_Kream 8y ago
qubex 8y ago
According to my psychiatrist (whom I turned to when I realised that I had an addiction problem I had to deal with) were it not for some highly unusual metabolic pathways my sixteen-year benzodiazepine habit would have had a chance to end my life multiple times (as it is I just ended up in ER once after inadvertently combining a hefty dose of Valium in the morning with a few celebratory margaritas at midday). Said pathways have also given me the privilege of being able to quit cold turkey (in the se se that I suffered no crippling withdrawal symptoms or rebound effects, but man is it difficult to break the habit). I count myself amongst the very lucky.
cc-d 8y ago
GABAergenics (the class of drug which benzodiazepines fall under) in general are pretty much the sole class of popular recreational drug which have a very real possibility of lethal withdrawals. In the case of alcohol, it often takes years for addicts to reach a point where withdrawal becomes lethal. In the case of short acting benzodiazepines/barbiturates, this point can be reached in less than a month. Of course, benzodiazepines are in schedule IV, which means they are viewed as being rather benign with no/low potential for abuse. In the eyes of the federal government, alprazolam (xanax) is far less dangerous than marijuana/the traditional psychedelics. Just another data point demonstrating the utter absurdity of US drug legislation and regulation.
- endianswap 8y ago
  You mean GABAergenic, right?
  - cc-d 8y ago
    I had copy-pasted a typo from a section of my other comment, good catch.
- subleq 8y ago
  You have your schedules mixed up. All controlled substances have a potential for abuse. Schedule IV drugs only have a 'low' potential for abuse 'relative to the drugs or other substances in schedule III', not low overall. You could argue that it should be schedule III, but all controlled substances, regardless of their schedule, are more tightly controlled than any other unscheduled prescription-only drug. Omeprazole is not a controlled substance and is OTC in the United States.
  - cc-d 8y ago
    https://www.health24.com/Medical/Meds-and-you/Medication/Omeprazole-Client-20120721 https://www.health24.com/Medical/Meds-and-you/Medication/Ome... You're right, the website that had showed up in google that I had used for my prilosec example is either incorrect or using some non-DEA scheduling sytem. I'll use another comparatively ridiculous example and re-edit my comments with the correction.
maddyboo 8y ago
I have battled with severe anxiety and panic disorders for years. At my worst, I was often unable to get out of bed for days at a time due to fear of having a panic attack outside the safety of my home. Taking an SSRI has helped a lot, but there are times where I can feel a panic attack coming and know the only way to stop it is with a Xanax. I regard benzodiazepines with a lot of respect. Their power is a blessing and a curse. Used responsibly, I believe they can be a very effective and safe tool to live a normal life free of panic attacks. At this point, I rarely take them - one dose every month or two at most. But the knowledge that I have a tool to quell a panic attack, should I need it, has actually done more for me than the pills themselves. Knowing I’m not powerless gives me the strength to overcome the panic attacks on my own. Recently, I’ve noticed doctors becoming more and more apprehensive about prescribing benzodiazepines. This is definitely a good thing - I think they should be reserved for severe cases as a last resort. But I also worry about a future where people who could have benefited greatly from them without abuse are denied a prescription.
- psergeant 8y ago
  Beta blockers have been a great SSRI top-up for me after I lost a year to a benzo problem
- jnovek 8y ago
  I'm similar -- thankfully, when I panic I can frequently get through it without taking a benzo, but I do have clonazepam on hand for the situations where it might be very useful. There are times where I would've likely made poor decisions during an acute panic attack that was aborted quickly by benzos. The ability to say "stop now" -- hell, even the security of know there's a way to say "stop now" -- is important to coping with anxiety.
  - antvei 8y ago
    I was like you and started keeping a clonazepam with me for situations where I might need it. Turned out to be the worst decision of my life. Pretty soon I was always carrying the pill with me. I felt safe having the pill with me even though I never used it. Pretty soon I couldn't go anywhere without the pill. In fact, my anxiety increased even more because I now had to make sure the pill was always with me. Activities such as white water rafting become impossible because the pill might get wet and dissolve. My advice, be careful. For ten years I kept a pill with me and was limited on what I thought I could do. I finally got help and have been pill free for around 6 months now. Everyday is a exposure but man it feels great not having to worry about that dang pill. And once you learn to deal with anxiety, you will never feel better. ps. You are not coping with anxiety.
honksillet 8y ago
Fun facts, in county jails (and I'm sure in hospitals) there are 3 classes of drugs that you will get detox medication for: opiods, benzos and alcohol. The detox meds for alcohol is benzos. The detox med for bezos is more benzos (although is a controlled, tapered manner). Both these two are much more dangerous to detox off of than opiods, with alcohol being the most dangerous. Everything else, cocaine, meth, etc is not particularly dangerous to withdraw from and usually these patients will not get specific detox medications.
toonervoustosay 8y ago
I've found Hemp-based CBD flower a viable alternative to benzos. There are a few farm-to-customer websites where you can order it for a much more reasonable price than full-spectrum cannabis. If anyone out there wants to rid a benzo dependency, try CBD flower. The effects are rather immediate (due to inhalation).
Karrot_Kream 8y ago
I feel for the patients that actually need a benzo to lead a normal, functioning lifestyle. Due to the actions of abusers it seems the public is starting to distrust medication.
- jnovek 8y ago
  A similar situation has already played out with people who deal with chronic pain and opiods. Stricter laws may reduce abuse but they have a chilling effect on prescribing physicians.
  - TylerE 8y ago
    I don't think the laws even reduce abuse. If anything, they move people from prescribed, professionally manufactured drugs with some degree of monitoring to the black market.
- XalvinX 8y ago
  as is plainly stated by the literature and companies that make them, benzos are not supposed to be used for long lengths of time. these people you talk of are abusing them by definition.
mnm1 8y ago
I've seen plenty of doctors who prescribed benzos and not a single one had any idea how to taper off their patients properly. Nor was a single one interested in it. This is a money-making machine for them and they have no interest, regardless of what's best for the patient. On the other hand, I've gone to doctors who wanted to stop these cold-turkey risking seizures and death. Those doctors clearly never heard of the hippocratic oath. I have never seen a doctor willing to work with a patient to taper off properly. Until we get to that point, talking about reducing prescriptions is akin to signing possible death sentences for patients or pushing them to the black market / pill mills. My own withdrawal took a few months and I did it on my own. It wasn't pleasant, but it wasn't as horrible as some others' experiences. Basically, the medical establishment says 'fuck you' by putting you on these meds long-term, and another 'fuck you and die,' by not knowing how to taper you off properly or even knowing when it is appropriate. We have a long, long way before solving this problem, and reducing prescriptions by itself is an incredibly stupid and cruel way to go about this. I can see why it's being done this way. Once you become dependent on something like benzos, most doctors and most of society does not think your life is worth living and they try their hardest to make it so.
qwerty456127 8y ago
Taking 1/4 pill of Xanax occasionally together with 1200 mg piracetam + 3 mg sunifiram + another 1200 mg piracetam pill some hours later is amazing for concentration (but that's my personal experience, just sharing it, I don't recommend this to anybody, also neither piracetam nor sunifiram are approved by the FDA). Almost cures my ADHD and anxiety altogether and makes me happy and super productive (as compared to my baseline which is severely hindered by untreated ADHD and anxiety). And no addiction ever (perhaps people that take higher doses get addicted but I don't). God save the black market and the grannies who don't mind sharing a pill. I really believe people should stop this witch hunt and embrace the BLTC (better life through chemistry) philosophy and start developing ways to fight the bad effects (physiological addiction, withdrawal syndromes, tolerance development, liver/kidney harm, receptors disregulation etc) instead of outlawing substances that improve quality of life. A person mood/attitude and performance is 99% chemistry and demonizing the very idea of seeking to improve it (even above what is considered a norm) is madness.
- throwaway77384 8y ago
  I'm with you here. The problem is that you look like someone who has done their research, is knowledgeable and self aware, and trying to (seemingly successfully) address a problem. Lots and lots of people are nothing like that. They just want to get high. Escape reality at all costs, no matter the damage to themselves or others. This isn't the drugs' problem or fault, obviously. Those people will use alcohol and other means to get fucked up and they will obtain the drugs they want illegaly anyway. THE THING IS: While it's illegal to get those drugs, society can demonise those people and politicians can run with that as their platform. Should drugs be made legal, all it will take is one idiot killing themselves or others while on drugs and suddenly it's the drugs' fault again, and the next politician running with a 'tough on drugs' stance will win. People will look for blame and they will not do so rationally. Self-driving cars will be dragged through the press for every accident there is, even if they are 10,000x less likely to crash. People are afraid of flying. Videogames are the reason for killing sprees, etc. etc.
- GyYZTfWBfQw 8y ago
  "approved by the FDA" Is that a requirement? Haven't you heard that FDA used to and still approves medications that were responsible for the death of thousands, if not more people? No, it's not a requirement, nor it should be. FDA serves its own interest and not yours [or the people's], because it can. Nothing happened to the FDA after they approved lethal medications, and nothing prevents them from doing just that again, or banning actually useful plants, such as: hemp, and kratom. They enjoy it, but do you? I recommend listening to: 1) https://tomwoods.com/ep-1124-death-by-regulation-the-truth-about-the-fda/ https://tomwoods.com/ep-1124-death-by-regulation-the-truth-a... 2) https://tomwoods.com/ep-1196-a-market-alternative-to-the-fda/ https://tomwoods.com/ep-1196-a-market-alternative-to-the-fda... 3) https://www.nytimes.com/1989/09/10/business/exposing-the-fda.html https://www.nytimes.com/1989/09/10/business/exposing-the-fda...
code_duck 8y ago
I’m pleased to see this getting more attention. I find the memory-erasing drug of these effects to be unpleasant, and duration disturbing. If you take three of them, the next day 24 hours later or you may still have blood plasma like one pill or more, depending on which benzo it is. Most people don’t understand drug half life and are unaware of that. Then if you mix in cannabis or alcohol, things start to get really dangerous memory-wise. These drugs are prescribed fairly casually to people who don’t have any serious medical or psychological conditions, and in my observation are treated equally casually by consumers.
- tnecniv 8y ago
  > If you take three of them One should note that "three of them" is (probably) a lot. Even half a pill is often sufficient to quell panic attacks.
  - code_duck 8y ago
    They are widely abused recreationally, too, typically in higher doses. Half-life of Xanax varies between 6 and 29 hours, averaging 11.5 hours. A “pill” is an arbitrary amount and that’s not what I’m referring to. It’s the proportion that still affects you hours later and how long it lasts that matters, including that dosages can overlap. It’s also important to note that tolerance develops of these drugs. Half a pill to you might be two for someone who is taking them every day for years. Tolerance to various effects develops to different extents, and perceived, subjective tolerance to dosages and impairment may be exceeded by measurable motor skill and judgment reduction. If you take half a pill, you’re still on more than a quarter of a pill when you wake up the next day. If you take another half pill, you will be on more than a half pill.
seancoleman 8y ago
For anyone looking to quit benzodiazepines, the Ashton Manual is the canonical resource: https://www.benzo.org.uk/manual/ https://www.benzo.org.uk/manual/
- winstonsmith 8y ago
  The Ashton Manual is good resource, but the state of the art taper method as far as I know is the liquid titration (via suspension, not solution) micro-taper. See, e.g., https://www.google.com/search?q=benzobuddies+micro+taper+liquid https://www.google.com/search?q=benzobuddies+micro+taper+liq... .
XalvinX 8y ago
this class of substances is the worst of all the drug problems, except possibly alcohol...
GABAthrowaway 8y ago
GABA receptor modulation is no joke. I was prescribed Xanax for panic attacks. My PC kept increasing my dosage, until I decided I had had enough. Withdrawal was nightmarish, but luckily I hadn't been using it that long (only for two weeks or so). My brain chemistry was never quite the same. I ended up looking for substitutes like Phenibut and Etizolam. With these I was addicted to the confidence they gave me in approaching women, so not quite physiological like Xanax. What finally cured my anxiety was a macrodose of LSD-25 (111-150 ug). Even then I wouldn't recommend it. Meditation is the best tool - our bodies naturally produce Anandamide. In my case, due to certain traumas, LSD-25 allowed me to see the beauty of this World and Universe once again. It is a powerful catalyst that allows one to See with clarity.
- person_of_color 8y ago
  That's enough to trip
  - ssijak 8y ago
    That is why he called it MACROdose and not MICROdose.
- toomanybeersies 8y ago
  Etizolam isn't really a substitute, it's a benzo as well (technically an analog), it just has reduced negative effects from chronic use and tends feel more mild. And since we're LSD as a potential therapeutic tool, as always I'm going to tack on this disclaimer: if using psychedelics as a therapeutic tool, make sure to take them in a positive environment (which your house might not be) with people you like and ensure that you have somebody with experience in psychedelics to guide you and assist you. It is a very powerful tool for healing though. I know people who have used it (with the above precautions) to essentially overwrite negative memories and experiences. As always though, everybody has a different experience and it isn't as effective for some as for others, and people should be always careful with anything that fucks with your psyche in such a powerful way.
rincebrain 8y ago
It seems like benzos, while sometimes quite powerful, can have really nasty side effects that some doctors irresponsibly don't disclose, including the rapid tolerance, rebound properties, and withdrawal in general. It also seems that, like opiates, it can vary a lot from person to person. I've been fortunate, and the few times I've had occasion to try taking benzos for a non-hospital interval, they didn't do anything for me - positive, negative, or otherwise, without any sort of visible withdrawal effects when we stopped. Conversely, there are people I know who have reported nasty side effects and dependency issues rather rapidly (in my own family, even). I really think the way to move forward and minimize this see-sawing of public opinion on necessary evil versus unnecessary tool will be gaining better insight into people's personal response profiles to these things before and after giving them the drugs, so you can try to notice "huh, that's a lot higher concentration of those metabolites than I expect, I guess they process it fast" or "well that opioid sure is lighting up the reward parts of the brain, guess they're at decent risk for addiction." (Unfortunately, I'd speculate we're at least 20y out from anything like that being ubiquitous/useful, so ...)
daeken 8y ago
I take 1mg xanax up to once a day (typically every other day) and it has completely changed my life for the better. In conjunction with propranolol taken regularly (20mg twice a day, roughly), my anxiety is finally in a fairly well-controlled state. Unfortunately, getting benzo prescriptions -- even for the low dosage and frequency I'm on -- is hard and getting harder. Ordering it online is possible but rife with scams and risks. I understand that some people abuse these medications but for me they're life-saving; in cracking down on benzo prescriptions, my anxiety medication is becoming a source of anxiety in itself.
- peteretep 8y ago
  Have you tried a medication that targets chronic rather than acute anxiety? You're going to start tolerating the Xanax sooner or later, so you need a plan for when that starts to happen. Escitalopram has worked great for me, in addition to propanalol as needed.
Ftuuky 8y ago
My mother had insomnia and her doctor prescribed some benzo (can't remember which) 3 times per day. She would take one in the morning and spend the rest of the day sleeping or calling random people with super weird conversations. I went back to the doctor with her demanding why he prescribed such a strong medicine 3 times per day when her problem was having difficulties falling asleep, and he says "oh she looked like she has anxiety". I wanted to punch him in the face. These doctors prescribe whatever the pharma marketeers pay them to prescribe.

Dirt cheap, "synergizes" with alcohol, street presses being incredibly overdosed, it is weird seeing the writing on the wall then watch it be inked into existence.

maxander 8y ago

What is the thesis here? Benzodiazepines are commonly prescribed and have the potential for abuse; these things are both true; I hadn't heard the rate of prescription was rising, but I'd believe it. There doesn't seem to be any evidence presented for a trend or rise in benzodiazepine abuse, or evidence of general harm from the use of the drugs. It highlights parallels between the existence of this prescription drug class and another class that is associated with significant issues, and makes it sound as if there were an issue here... and then leaves it at that, the literary equivalent of a wink and a nudge. Are they arguing that prescription of drugs with abuse potential is inherently a problem? Because that would be a very extreme position, one which would challenge a sizable fraction of the medications available to modern psychiatry. And this is a "journalist's resource," one associated with the Harvard Kennedy School? No wonder journalism is garbage these days.

lmpostor 8y ago
>A study published in 2016 in the American Journal of Public Health finds that from 1996 to 2013, the number of adults in the United States filling a prescription for benzodiazepines increased 67 percent, from 8.1 million to 13.5 million. The death rate for overdoses involving benzodiazepines also increased in this time period, from 0.58 per 100,000 adults to 3.07. In the first link in the article >the quantity of benzodiazepines they obtained more than tripled during that period, from 1.1-kg to 3.6-kg lorazepam-equivalents per 100,000 adults.
- maxander 8y ago
  That's all prescribed doses, though. So, yes, the use of benzodiazepines is going up, which obviously carries with it the associated rise in side effects and drug-related deaths. It's not reasonably comparable to the narcotics epidemic, where illegal use is driving mortality rates.
  - benbreen 8y ago
    I see how that's true on a legal level, but if we're just talking about social and public health impacts, I don't see why the distinction between prescription and illegal use matters here. A three-fold increase in a category of drugs with major health impacts seems newsworthy to me. After all, the boundaries between legal and illegal use are far from fixed. Methamphetamine was once widely prescribed by physicians for weight loss, for instance (and is indeed still legally available as a prescription medicine) [1]. Presumably we can agree that a world in which prescriptions for methamphetamine have tripled might be a cause for concern, right? It's debatable whether this class of drugs has the same abuse and health risks, but based on my own reading and anecdotal experiences, I think they're pretty comparable. [1] https://resobscura.blogspot.com/2012/06/from-quacks-to-quaaludes-three.html https://resobscura.blogspot.com/2012/06/from-quacks-to-quaal...
snowwrestler 8y ago
When I was prescribed a benzo a decade ago, my doctor told me it was safe, non-habit-forming, and I could take it whenever I wanted to feel less nervous. There was no warning whatsoever about addiction, tolerance, or the serious side effects that were possible. Luckily I am generally skeptical of pharmaceuticals, at least to the extent that I try to educate myself about them. So I did my own reading up about it. But even then, while online sources did indicate that benzos could be habit-forming, I did not see the strong language and terrible stories that are coming out now about benzo addiction. So hopefully that illustrates the newsworthy issue: a lot of doctors, and even online medical info sites, did not adequately appreciate the risks of benzos, or warn people about those risks.

UpshotKnothole 8y ago

A friend of mine got hooked on heroin and ended up on methadone maintence. He’s since managed to get off that and is clean, but he had horror stories of people on methadone abusing benzodiazepines like crazy. Apparently mixing methadone and high doses of drugs like Xanax produce effects similar to heroin, but benzos are really hard to get off. He talked about a woman who couldn’t get her Xanax fix, and she started having seizures. Benzodiazepines take months to titrate off safely, and higher doses associated with abuse do unpleasant things to your seizure threshold and memory. Bad stuff unless you must have it.

ghostbrainalpha 8y ago
There is a pretty large community on Reddit just dedicated to recovery just from Benzo's. https://www.reddit.com/r/benzorecovery/ https://www.reddit.com/r/benzorecovery/
deleted 8y ago
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stryk 8y ago
It is incredibly, incredibly dangerous to mix benzodiazepines (Xanax, Ativan, etc.) with Methadone. This is common knowledge amongst opiate addicts, at least everywhere I ever went in the US back in my wilder days. I have 3 close friends whom I grew up with that all died before age 30 from abusing that exact combination of narcotics, and know of countless more just in my home state alone. Benzos are a respiratory depressant, and when combined with Methadone it amplifies it to the point where you stop breathing in your sleep and never wake up from respiratory failure, lack of oxygen to the brain, or your body freaks out and has a coronary episode, etc. it's really really risky -- no joke & no exaggeration. If alcohol is in the mix too then it's even worse. And I'm not going to pretend like it's not enjoyable -- because it is. It's a great fuckin' buzz if downers are your thing. IMO it's better than heroin (no 'rush' to it, but the effects hit you like a ton of bricks and it lasts all night long. And it's a cheap buzz too), but it's also asking for your life to end. methadone clinics know this and every one that I've ever seen, heard of, or been to personally Benzos are their one big 'no-no' [as in: if we find it in your Whiz Quiz we kick you out, some won't even give you a second chance and most clinics have mandatory urine screening twice a month, some every week]. You can test positive for damn near anything else -- and they expect you to test positive for opiates -- but if you have benzos in there then you kick rocks.

piazz 8y ago

I was taking 3mg Lorazepam nightly for almost three years. Weening off of it safely took almost an entire year of miserable work, and the final stages I had to do while I had no other significant life responsibilities because of the incredible rebound insomnia and background anxiety you experience withdrawing off benzodiazepines. The only upshot is that when you finally do manage to get yourself off of a drug like this, you sort of feel like you can tackle most other challenges life throws your way. So yeah, this stuff is serious. And of course, my Lorazepam was prescribed legally, by a responsible, well regarded psychiatrist, with very little warning regarding how quickly one builds both tolerance and physiological dependence on this chemical.

tnecniv 8y ago
> And of course, my Lorazepam was prescribed legally, by a responsible, well regarded psychiatrist, with very little warning regarding how quickly one builds both tolerance and physiological dependence on this chemical. Sorry to hear that. Mine told me to take at most 1mg no more than once a week for that reason. Seeing what that quantity does to me, I can't imagine dosing at that quantity or frequency (obviously you acquire a tolerance, but still).
icantdrive55 8y ago
I really think most Psychiatrists know how addictive Benzodiazepines are, but Americans are very stressed out. In my case, I busted a gasket in my twenties. I went from the most capable person in the room, to the trembling guy who could barely leave his room. I can honestly say it ruined my life. I was given a benzo with a long half life. It worked a bit, but I never fully recovered. I think we all know the drug. 40 hour half life. I tried all kinds of medications over the years, and nothing worked except benzodiazepines , and alcohol. Yes--alcohol hits so many different parts of the brain, but is horrid on the body. I really tried to avoid alcohol, but some days the anxiety susptoms we just unbearable. I've been on the long half life benzodiazepine for decades. I take the same dose low dose, and try not to drink. I've never even asked my doctor, but he knows my low dose isn't going to cause physical problems. They are better than alcohol, if you're self-medicating. I belive his thinking is I need the drug. I've been on it forever. Why put him through a misserable detox, at this stage of the game? There are a few big studies done on patients whom were on opiates, and benzodiazepines for long periods of time. They didn't necessarily need to increase their dosages. I believe the studies were done on rest home geriatric patients. I feel at my age, what's the point of a long withdrawal. It's easy to say for myself because my doctor has reasonable rates. He is getting close to retirement, and that has me very worried. The last thing I want is a long misserable detox. I don't like the way this drug problem is playing out. I don't like blaming doctors. All their patients are very different. My wish is we let, especially Psychiatrists, make these hard calls concerning what's best for their patients. That's what they went to school for. I don't know why we are even discussing it here. I don't want to live in a world where doctors send their patients home a mess because they are afaird of being accused of some sinister reason for keeping a patient on a addictive drug. In all reality, so many doctors just don't prescribe certain drugs. Probally, one of the main reasons why former patients go to the streets, or liquor stores. (I would further like to see a governmental bill that would allow patients, whom have been on addictive drugs for years, the ability to authorize their own scripts. The Same dose, and any increase would require a doctor's visit. At this point my office visits are pointless. There is a bill that is in congress now I believe, but it's for drugs that aren't addictive. I doubt the AMA will ever let it pass though.)

jnovek 8y ago

Serious question: as we make opiods and now bezos increasingly difficult to prescribe, what are the alternatives for people with chronic pain or chronic anxiety? I have friends and family members with chronic pain and, through them and their communities, have become aware of many people who use opiods on a long-term, occasional basis to manage their pain. A family member of mine who suffers from chronic migraine lives in fear that she won't be able to get an opiod which she uses as a last-ditch rescue treatment before she ends up at the ER (not to mention that she gets treated like a drug seeker when she does end up there). I don't really see an alternative for acute intense pain; likewise an alternative for acute, intense anxiety. Meanwhile the crackdowns on these drugs also create a chilling effect for physicians. What do we do for people who fall in those categories? (Edit: not to claim that abuse of these drugs is not a problem... It just seems like the people these drugs are inteded to help are being sidelined in the dialog on the topic.)

OldSchoolJohnny 8y ago
Cannabis in both cases works well for a great many people.
- jnovek 8y ago
  Cannabis derived treatments do seem promising... someday. Imagine that marijuana is (at a minimum) federally rescheduled to schedule 2 in the US. How long will it take to research canniboid-based painkillers once drug companies can legally do so? How pong for FDA approval? It will be a long time until there is an alternative that is taken seriously by anyone other than the most progressive physicians in the realm of cannabis, unfortunately.
  - penagwin 8y ago
    I agree with this. I'm personally rather upset that it's schedule 1, meaning it has no medical benefit whatsoever, which is clearly BS and it makes it hard to research.
- Karrot_Kream 8y ago

qubex 8y ago

According to my psychiatrist (whom I turned to when I realised that I had an addiction problem I had to deal with) were it not for some highly unusual metabolic pathways my sixteen-year benzodiazepine habit would have had a chance to end my life multiple times (as it is I just ended up in ER once after inadvertently combining a hefty dose of Valium in the morning with a few celebratory margaritas at midday). Said pathways have also given me the privilege of being able to quit cold turkey (in the se se that I suffered no crippling withdrawal symptoms or rebound effects, but man is it difficult to break the habit). I count myself amongst the very lucky.

cc-d 8y ago

GABAergenics (the class of drug which benzodiazepines fall under) in general are pretty much the sole class of popular recreational drug which have a very real possibility of lethal withdrawals. In the case of alcohol, it often takes years for addicts to reach a point where withdrawal becomes lethal. In the case of short acting benzodiazepines/barbiturates, this point can be reached in less than a month. Of course, benzodiazepines are in schedule IV, which means they are viewed as being rather benign with no/low potential for abuse. In the eyes of the federal government, alprazolam (xanax) is far less dangerous than marijuana/the traditional psychedelics. Just another data point demonstrating the utter absurdity of US drug legislation and regulation.

endianswap 8y ago
You mean GABAergenic, right?
- cc-d 8y ago
  I had copy-pasted a typo from a section of my other comment, good catch.
subleq 8y ago
You have your schedules mixed up. All controlled substances have a potential for abuse. Schedule IV drugs only have a 'low' potential for abuse 'relative to the drugs or other substances in schedule III', not low overall. You could argue that it should be schedule III, but all controlled substances, regardless of their schedule, are more tightly controlled than any other unscheduled prescription-only drug. Omeprazole is not a controlled substance and is OTC in the United States.
- cc-d 8y ago
  https://www.health24.com/Medical/Meds-and-you/Medication/Omeprazole-Client-20120721 https://www.health24.com/Medical/Meds-and-you/Medication/Ome... You're right, the website that had showed up in google that I had used for my prilosec example is either incorrect or using some non-DEA scheduling sytem. I'll use another comparatively ridiculous example and re-edit my comments with the correction.

maddyboo 8y ago

I have battled with severe anxiety and panic disorders for years. At my worst, I was often unable to get out of bed for days at a time due to fear of having a panic attack outside the safety of my home. Taking an SSRI has helped a lot, but there are times where I can feel a panic attack coming and know the only way to stop it is with a Xanax. I regard benzodiazepines with a lot of respect. Their power is a blessing and a curse. Used responsibly, I believe they can be a very effective and safe tool to live a normal life free of panic attacks. At this point, I rarely take them - one dose every month or two at most. But the knowledge that I have a tool to quell a panic attack, should I need it, has actually done more for me than the pills themselves. Knowing I’m not powerless gives me the strength to overcome the panic attacks on my own. Recently, I’ve noticed doctors becoming more and more apprehensive about prescribing benzodiazepines. This is definitely a good thing - I think they should be reserved for severe cases as a last resort. But I also worry about a future where people who could have benefited greatly from them without abuse are denied a prescription.

psergeant 8y ago
Beta blockers have been a great SSRI top-up for me after I lost a year to a benzo problem
jnovek 8y ago
I'm similar -- thankfully, when I panic I can frequently get through it without taking a benzo, but I do have clonazepam on hand for the situations where it might be very useful. There are times where I would've likely made poor decisions during an acute panic attack that was aborted quickly by benzos. The ability to say "stop now" -- hell, even the security of know there's a way to say "stop now" -- is important to coping with anxiety.
- antvei 8y ago
  I was like you and started keeping a clonazepam with me for situations where I might need it. Turned out to be the worst decision of my life. Pretty soon I was always carrying the pill with me. I felt safe having the pill with me even though I never used it. Pretty soon I couldn't go anywhere without the pill. In fact, my anxiety increased even more because I now had to make sure the pill was always with me. Activities such as white water rafting become impossible because the pill might get wet and dissolve. My advice, be careful. For ten years I kept a pill with me and was limited on what I thought I could do. I finally got help and have been pill free for around 6 months now. Everyday is a exposure but man it feels great not having to worry about that dang pill. And once you learn to deal with anxiety, you will never feel better. ps. You are not coping with anxiety.

honksillet 8y ago

Fun facts, in county jails (and I'm sure in hospitals) there are 3 classes of drugs that you will get detox medication for: opiods, benzos and alcohol. The detox meds for alcohol is benzos. The detox med for bezos is more benzos (although is a controlled, tapered manner). Both these two are much more dangerous to detox off of than opiods, with alcohol being the most dangerous. Everything else, cocaine, meth, etc is not particularly dangerous to withdraw from and usually these patients will not get specific detox medications.

toonervoustosay 8y ago

I've found Hemp-based CBD flower a viable alternative to benzos. There are a few farm-to-customer websites where you can order it for a much more reasonable price than full-spectrum cannabis. If anyone out there wants to rid a benzo dependency, try CBD flower. The effects are rather immediate (due to inhalation).

Karrot_Kream 8y ago

I feel for the patients that actually need a benzo to lead a normal, functioning lifestyle. Due to the actions of abusers it seems the public is starting to distrust medication.

jnovek 8y ago
A similar situation has already played out with people who deal with chronic pain and opiods. Stricter laws may reduce abuse but they have a chilling effect on prescribing physicians.
- TylerE 8y ago
  I don't think the laws even reduce abuse. If anything, they move people from prescribed, professionally manufactured drugs with some degree of monitoring to the black market.
XalvinX 8y ago
as is plainly stated by the literature and companies that make them, benzos are not supposed to be used for long lengths of time. these people you talk of are abusing them by definition.

mnm1 8y ago

I've seen plenty of doctors who prescribed benzos and not a single one had any idea how to taper off their patients properly. Nor was a single one interested in it. This is a money-making machine for them and they have no interest, regardless of what's best for the patient. On the other hand, I've gone to doctors who wanted to stop these cold-turkey risking seizures and death. Those doctors clearly never heard of the hippocratic oath. I have never seen a doctor willing to work with a patient to taper off properly. Until we get to that point, talking about reducing prescriptions is akin to signing possible death sentences for patients or pushing them to the black market / pill mills. My own withdrawal took a few months and I did it on my own. It wasn't pleasant, but it wasn't as horrible as some others' experiences. Basically, the medical establishment says 'fuck you' by putting you on these meds long-term, and another 'fuck you and die,' by not knowing how to taper you off properly or even knowing when it is appropriate. We have a long, long way before solving this problem, and reducing prescriptions by itself is an incredibly stupid and cruel way to go about this. I can see why it's being done this way. Once you become dependent on something like benzos, most doctors and most of society does not think your life is worth living and they try their hardest to make it so.

qwerty456127 8y ago

Taking 1/4 pill of Xanax occasionally together with 1200 mg piracetam + 3 mg sunifiram + another 1200 mg piracetam pill some hours later is amazing for concentration (but that's my personal experience, just sharing it, I don't recommend this to anybody, also neither piracetam nor sunifiram are approved by the FDA). Almost cures my ADHD and anxiety altogether and makes me happy and super productive (as compared to my baseline which is severely hindered by untreated ADHD and anxiety). And no addiction ever (perhaps people that take higher doses get addicted but I don't). God save the black market and the grannies who don't mind sharing a pill. I really believe people should stop this witch hunt and embrace the BLTC (better life through chemistry) philosophy and start developing ways to fight the bad effects (physiological addiction, withdrawal syndromes, tolerance development, liver/kidney harm, receptors disregulation etc) instead of outlawing substances that improve quality of life. A person mood/attitude and performance is 99% chemistry and demonizing the very idea of seeking to improve it (even above what is considered a norm) is madness.

throwaway77384 8y ago
I'm with you here. The problem is that you look like someone who has done their research, is knowledgeable and self aware, and trying to (seemingly successfully) address a problem. Lots and lots of people are nothing like that. They just want to get high. Escape reality at all costs, no matter the damage to themselves or others. This isn't the drugs' problem or fault, obviously. Those people will use alcohol and other means to get fucked up and they will obtain the drugs they want illegaly anyway. THE THING IS: While it's illegal to get those drugs, society can demonise those people and politicians can run with that as their platform. Should drugs be made legal, all it will take is one idiot killing themselves or others while on drugs and suddenly it's the drugs' fault again, and the next politician running with a 'tough on drugs' stance will win. People will look for blame and they will not do so rationally. Self-driving cars will be dragged through the press for every accident there is, even if they are 10,000x less likely to crash. People are afraid of flying. Videogames are the reason for killing sprees, etc. etc.
GyYZTfWBfQw 8y ago
"approved by the FDA" Is that a requirement? Haven't you heard that FDA used to and still approves medications that were responsible for the death of thousands, if not more people? No, it's not a requirement, nor it should be. FDA serves its own interest and not yours [or the people's], because it can. Nothing happened to the FDA after they approved lethal medications, and nothing prevents them from doing just that again, or banning actually useful plants, such as: hemp, and kratom. They enjoy it, but do you? I recommend listening to: 1) https://tomwoods.com/ep-1124-death-by-regulation-the-truth-about-the-fda/ https://tomwoods.com/ep-1124-death-by-regulation-the-truth-a... 2) https://tomwoods.com/ep-1196-a-market-alternative-to-the-fda/ https://tomwoods.com/ep-1196-a-market-alternative-to-the-fda... 3) https://www.nytimes.com/1989/09/10/business/exposing-the-fda.html https://www.nytimes.com/1989/09/10/business/exposing-the-fda...

code_duck 8y ago

I’m pleased to see this getting more attention. I find the memory-erasing drug of these effects to be unpleasant, and duration disturbing. If you take three of them, the next day 24 hours later or you may still have blood plasma like one pill or more, depending on which benzo it is. Most people don’t understand drug half life and are unaware of that. Then if you mix in cannabis or alcohol, things start to get really dangerous memory-wise. These drugs are prescribed fairly casually to people who don’t have any serious medical or psychological conditions, and in my observation are treated equally casually by consumers.

tnecniv 8y ago
> If you take three of them One should note that "three of them" is (probably) a lot. Even half a pill is often sufficient to quell panic attacks.
- code_duck 8y ago
  They are widely abused recreationally, too, typically in higher doses. Half-life of Xanax varies between 6 and 29 hours, averaging 11.5 hours. A “pill” is an arbitrary amount and that’s not what I’m referring to. It’s the proportion that still affects you hours later and how long it lasts that matters, including that dosages can overlap. It’s also important to note that tolerance develops of these drugs. Half a pill to you might be two for someone who is taking them every day for years. Tolerance to various effects develops to different extents, and perceived, subjective tolerance to dosages and impairment may be exceeded by measurable motor skill and judgment reduction. If you take half a pill, you’re still on more than a quarter of a pill when you wake up the next day. If you take another half pill, you will be on more than a half pill.

seancoleman 8y ago

For anyone looking to quit benzodiazepines, the Ashton Manual is the canonical resource: https://www.benzo.org.uk/manual/ https://www.benzo.org.uk/manual/

winstonsmith 8y ago
The Ashton Manual is good resource, but the state of the art taper method as far as I know is the liquid titration (via suspension, not solution) micro-taper. See, e.g., https://www.google.com/search?q=benzobuddies+micro+taper+liquid https://www.google.com/search?q=benzobuddies+micro+taper+liq... .

XalvinX 8y ago

this class of substances is the worst of all the drug problems, except possibly alcohol...

GABAthrowaway 8y ago

GABA receptor modulation is no joke. I was prescribed Xanax for panic attacks. My PC kept increasing my dosage, until I decided I had had enough. Withdrawal was nightmarish, but luckily I hadn't been using it that long (only for two weeks or so). My brain chemistry was never quite the same. I ended up looking for substitutes like Phenibut and Etizolam. With these I was addicted to the confidence they gave me in approaching women, so not quite physiological like Xanax. What finally cured my anxiety was a macrodose of LSD-25 (111-150 ug). Even then I wouldn't recommend it. Meditation is the best tool - our bodies naturally produce Anandamide. In my case, due to certain traumas, LSD-25 allowed me to see the beauty of this World and Universe once again. It is a powerful catalyst that allows one to See with clarity.

person_of_color 8y ago
That's enough to trip
- ssijak 8y ago
  That is why he called it MACROdose and not MICROdose.
toomanybeersies 8y ago
Etizolam isn't really a substitute, it's a benzo as well (technically an analog), it just has reduced negative effects from chronic use and tends feel more mild. And since we're LSD as a potential therapeutic tool, as always I'm going to tack on this disclaimer: if using psychedelics as a therapeutic tool, make sure to take them in a positive environment (which your house might not be) with people you like and ensure that you have somebody with experience in psychedelics to guide you and assist you. It is a very powerful tool for healing though. I know people who have used it (with the above precautions) to essentially overwrite negative memories and experiences. As always though, everybody has a different experience and it isn't as effective for some as for others, and people should be always careful with anything that fucks with your psyche in such a powerful way.

rincebrain 8y ago

It seems like benzos, while sometimes quite powerful, can have really nasty side effects that some doctors irresponsibly don't disclose, including the rapid tolerance, rebound properties, and withdrawal in general. It also seems that, like opiates, it can vary a lot from person to person. I've been fortunate, and the few times I've had occasion to try taking benzos for a non-hospital interval, they didn't do anything for me - positive, negative, or otherwise, without any sort of visible withdrawal effects when we stopped. Conversely, there are people I know who have reported nasty side effects and dependency issues rather rapidly (in my own family, even). I really think the way to move forward and minimize this see-sawing of public opinion on necessary evil versus unnecessary tool will be gaining better insight into people's personal response profiles to these things before and after giving them the drugs, so you can try to notice "huh, that's a lot higher concentration of those metabolites than I expect, I guess they process it fast" or "well that opioid sure is lighting up the reward parts of the brain, guess they're at decent risk for addiction." (Unfortunately, I'd speculate we're at least 20y out from anything like that being ubiquitous/useful, so ...)

daeken 8y ago

I take 1mg xanax up to once a day (typically every other day) and it has completely changed my life for the better. In conjunction with propranolol taken regularly (20mg twice a day, roughly), my anxiety is finally in a fairly well-controlled state. Unfortunately, getting benzo prescriptions -- even for the low dosage and frequency I'm on -- is hard and getting harder. Ordering it online is possible but rife with scams and risks. I understand that some people abuse these medications but for me they're life-saving; in cracking down on benzo prescriptions, my anxiety medication is becoming a source of anxiety in itself.

peteretep 8y ago
Have you tried a medication that targets chronic rather than acute anxiety? You're going to start tolerating the Xanax sooner or later, so you need a plan for when that starts to happen. Escitalopram has worked great for me, in addition to propanalol as needed.

Ftuuky 8y ago

My mother had insomnia and her doctor prescribed some benzo (can't remember which) 3 times per day. She would take one in the morning and spend the rest of the day sleeping or calling random people with super weird conversations. I went back to the doctor with her demanding why he prescribed such a strong medicine 3 times per day when her problem was having difficulties falling asleep, and he says "oh she looked like she has anxiety". I wanted to punch him in the face. These doctors prescribe whatever the pharma marketeers pay them to prescribe.