The story of Benzos

The fact that Benzos cause physical dependence only unravelled very slowly over a great number of years. The first very definite development probably came out of Esther Rantzen’s ‘That’s Life’ programme in 1984 which launched an awareness campaign about Benzodiazepine addiction. The programme commissioned a Mori Poll. It showed 23% of the population had taken tranquillisers and 35% of those had been on them for longer than four months. This had originally been planned to be only one programme, but grew into a much bigger feature as the response from the public was huge.

In 1988, the Committee on the Safety of Medicines issued a bulletin called ‘CURRENT PROBLEMS: BENZODIAZEPINES, DEPENDENCE AND WITHDRAWAL SYMPTOMS’  This made it very clear that Benzos caused dependency and addiction, should be prescribed for 2-4 weeks only, should not be prescribed for depression or bereavement. It also pointed out that withdrawal would have to be very gradual to be effective and not dangerous.

The BNF (British National Formulary) took this up almost immediately. The Chief Medical Officer produced a further report in 2004 and 2007. Since then there have been many developments, and both the medical profession and the public have become increasingly aware of the problems associated with Benzos.

So have tranquillisers always been around in one form or another?

Well, very similar substances have been around for a LONG time! You will no doubt have heard of:

  • Opium (laudanum)
    • since at least 5000 BC
  • Chloral hydrate
    • Introduced in 1869 … sleep-inducing – became popular for use with children

and

  • Barbiturates; phenobarbital, allobarbital, barbital, butobarbital etc
    • these are derivatives of barbituric acid, first synthesized in 1864

finally

  • Meprobamate (marketed as ‘Milltown’) which was the best-selling minor tranquilliser for a time.

We could think of these as predecessors to Benzos. The reason that Benzos took off so dramatically was that they were considered ‘safer’ – but that means safer in the sense that it’s harder to overdose on them alone, than barbiturates. When the first benzodiazepines were marketed in the early 1960’s it was clear that the overdose safety margin was much higher than for barbiturates. Historically, all substances used or marketed as tranquillisers have had addictive qualities.

It’s very important to know that alcohol and Benzos are more or less interchangeable – that’s why Chlordiazepoxide (Librium – the first Benzo, first synthesised in the mid-1950’s) is still used – appropriately – in alcohol detox.

However it’s also vital to understand that if other ‘downers’ (predominantly alcohol, opiates, methadone) are taken with Benzos they more than double the chances of respiratory suppression and death.

Benzos and celebrities

You’ll remember some of the very famous people who have overdosed in recent years …

  • Michael Hutchence
  • River Phoenix
  • John Belushi
  • Whitney Houston
  • Amy Winehouse
  • Michael Jackson

and more recently

… but what you may not know is that although Benzos were not recorded as the primary cause of death they were present in post mortem toxicology, in addition to other substances.

Celebrities and Benzos have been linked for a LONG time – a Librium prescription to Marilyn Monroe from her GP dated June 8, 1962 sold at a 2011 auction for $3250!

Librium prescription to Marilyn Monroe

The first Benzo …

In a nutshell, was Librium. This was marketed with the tagline ‘whatever the problem…’ Early publicity suggested that Librium made patients ‘more accessible and communicative’

It took a while for it to become recognised that Benzos led to physical dependence and this resulted in the guidelines of prescription for 2-4 weeks use only. Before this, there was no guidance at all which resulted in people being on them for far too long. 2013 was the 50th anniversary of Valium – so it’s not entirely impossible for someone to have been taking Benzos for 51 years …

It is not always understood that the Z drugs (Zopiclone and Zolpidem ) are ‘Benzodiazepine-like’ drugs. In 2004 NICE brought out a report which said that there was little or no difference between Benzos and the Z drugs – and that the cheapest should always be the preferred option for prescribing.

Professor Graham Dukes (World health Organisation) who once presented at one of our AGMs did a talk for us on the history of hypnotics and anxiolytics, pointing out that all of them have caused physical addiction and he guessed, always will.

 

What about now?

What’s happened now is that we are told Benzo prescribing has gone down. Z drug prescription though, has increased enormously. This is probably because of the lack of understanding that they are similar to Benzos, and in fact included in many lists of Benzos, if you ever look for one.

It is increasingly common for Benzos to be used alongside other (illicit) drugs and alcohol. Figures from Scotland (BBC News – 22 February 2013) indicate ‘four out of every five drug or alcohol-related deaths involved benzodiazepines’.

What next?

We continue to try to raise awareness of the Benzo problem, both in the community, among medical practitioners and drug and alcohol workers.

Being armed with knowledge is the best way you can help yourself, or someone else.

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