JAMA: "Why Are Benzodiazepines Not Yet Controlled Substances?"

This website link offers the first page of this article. If anyone can access the full article, I'd be very interested to see the whole thing. In the meantime, the first page states quite clearly what the issues are, and I know we're all quite familiar with them here on BB.

 

http://archpsyc.jamanetwork.com/article.aspx?articleid=2019953

Another recent article by JAMA! However, I wasn't able to use the "view large" in order to read the full article.

 

I'm elated that info is finally beginning to come in about benzo pills!

 

Thank you for the link, Lapis!

Hey Terry,

I couldn't use that button either, but I've got Mozilla Firefox and I'm able to enlarge the print to read things. If you can't do that, you can always use those cheap reading glasses as magnifiers! Anyway, I hope you can read it, since it's insightful, and it's about time!

Lapis, thanks for the info! I don't know what happened yesterday, but today I was able to read it clearly. I think someone else (Qui?) had posted the article also. Am hopeful that since JAMA has put this article out, more doctors will read it.

I'm told that benzos are now considered a controlled substance in Canada.  Pharmacists require a signature upon pickup.

I'd like to see pharmacists playing an active role in alerting people to possible problems. For instance, if a pharmacist sees that a benzodiazepine prescription is repeated numerous times, perhaps he/she could do some patient education at that point. Perhaps the patient didn't receive that education elsewhere, and the pharmacist is in a good position to provide information about side effects, long-term effects and withdrawal effects. Perhaps that pharmacist could play a key role in saving someone a lot of misery down the road.

Here is the Dr. who wrote the article.

 

http://www.pharmacologie.u-bordeaux2.fr/en/presentation/biographies/Nicholas-Moore.htm

 

 

The text. I OCR'd it into a PDF.

 

Why Are Benzodiazepines Not Yet Controlled Substances?

Nicholas Moore. MD. PhD; Antoine Pariente. MD. PhD; Bernard Begaud. MD, PhD

 

In thls issue of 1AJl1A Psychiatry, Olfson et al' report a very comprehensive

study of the use ofbenzodiazepines in the United

States. This study confirmed what has been found in several

other countries, that benzo-

GI diazepines are used predomi-

Related article _nantl}' in e lderly persons.

mostly women, and for long

periods of time.'" The older the patient, the longer the drug

is used. This would not be a major issue if benzodiazepines

were truly useful (preferably life-saving) and reasonably

risk-free. They have saved many lives by being used to attempt

suicide instead of barbiturates that are much more

toxic•; however, for their main indications of insomnia and

anxiety, benzodiazepines fare little better than placebos after

a few w~ks of treatment. After an initial improvement, the

effect wears off and tends to disappear. At that point, what happens

when patients try to stop taking benzodiazepines is that

they experience withdrawal tnsonmia and anxiety. The usual

conclusion is "you see, they work. When I stop them, I get

worse!' Initially, patients get better before returning to the pretreatment

state and then get worse than before treatment began

when they attempt to stop taking benzodiazepines. After

a few weeks of treatment, patients are actually worse off than

before they staned (or at least not better) and cannot stop taking

the drug.

This might not be a problem ifbcnzodiazcpines were safe

with prolonged use. However, benzodiazepines are far from

safe. They were discovered in the 1950s before the pre- and

postmarketing safety of drugs had fully developed. In 1976,

Marks' wrote, "the level of risk and danger to individuals and

society arc of such a low order with the benzodiazepincs that

no additional controls are necessary!' Times have changed.

Most of the adverse effects ofbenzodiazepines are not the usual

highly visible adverse effects that cause premature removal

of drugs from the market, such as hepatic reactions, skin disorders,

or sudden death. They are quite subtle and difficult to

measure. Among the best known is the association with an increased

risk of vehicle crashes.6•7 There is acute amnesia and

loss of control; for example, triazolam was previously used as

a date-rape drug before y-hydroxybutyrate (GBM).

There is also the association with falls and hip fractures

that increases with age.• The risk of falling has b~n thought

to cause about 3000 deaths yearly in France, 9 which extrapolates

to 10 to 12 ooo deaths per year in the United States.

 

A much greater potential risk is a possible association of chronic benzodiazepine

use with the development of dementia.'""' lftrue,

benzodiazepines could contribute to a significant fraction of

the increasingly larger burden of dementia and the strain it puts

on health care services and costs.

Other medications with potentially more benefits and

less absolute risks have been taken off the market. if benzo·

diazepines were new antidiabetic drugs with even onehundredth

of their burden of harms, they would be i1nmediately

removed. How many hepatic injuries are there with

troglitazonecompared with the several thousand yearly deaths

with benzodiazepines?

Benzodiazepines are drugs that should be used at most for

a few days or weeks in selected patients, carefully monitored,

and stopped as soon as possible, as recomrnentletl in

their summary of product characteristics and in all international

recommendations. Their true targets are acute episodes

of insonmia or transient anxiety in young persons (except

for academic examinations because they induce amnesia).

Benzodiazepines should especially be used only for very

short periods or avoided altogether in elderly individuals who

are susceptible to cognitive impairment or to falls and fractures

(ie, elderly women). bistead, long-term treatment in elderly

women is how most benzodiazepines are currently used.

All this is well known and has been known for years. There

seems to be a strange societal addiction to the use of bcnzodiazepines

in the elderly population, maybe because the elderly

have shorter consultations.

Communication with clinicians and other health care professionals

is not enough to reduce dangerous prescribing. Will

we have to wait for class actions against manufacturers, pre·

scribers, or regulators whenever a patient taking benzodiazepines

dies after a fall or develops Alzheimer disease> There

are other treatments for generalized anxiety'" and insomnia. l3

How seriously do we still need ben1.odiazepines? Are we ready

to pay for them collectively?

It may be time to act, perhaps first by restricting the prescription

of benzodiazepines to psychiatrists. In the Olfson'

study, psychiatrists seemed to prescribe them properly. The

next step is to consider them the same as other dangerous addictive

substances and put them on a tigl1t dispensation schedule

using li1nited-duration prescriptions with no refills. Such

barriers could help the public and prescribers think more about

these risks before prescribing or using benzodiazepines.

 

ARTICLE INFORMATION

Author Affiliations: Department of Pharmacology,

Universityof8ordeaux. Bordeaux. F'raoce.

Corresponding Author: Nicholas Moore. MO, PhD.

Department of Pharmacology. UniversitC Oe

Bordeaux. 146 Rue Lt?o Saignat. Bordeaux 33076,

France (nicholas.moore@u·bordeaux.fr).

Published Online: December 17, 2014.

doi:l0.1001/jamapsythiatry.2014.2190.

Conflict of Interest Olsdosures: None reported.

jamapsychlatry.com JAMA Psychiatry Publtshed onflne Decfonlber 17. 2014

Copyright 2014 American Medical Association. All rights reHf'Ved.

" However, benzodiazepines are far from

safe."

 

We are getting some progress - 17 years late for me, but still, progress!

The text. I OCR'd it into a PDF.

 

Why Are Benzodiazepines Not Yet Controlled Substances?

Nicholas Moore. MD. PhD; Antoine Pariente. MD. PhD; Bernard Begaud. MD, PhD

 

Thanks for doing that - 

I think it's an important piece of writing. It's about time some of the facts were laid out boldly in a medical journal of this stature, and I really hope it's read and UNDERSTOOD in the medical field and beyond.

 

And I quote: "....consider them the same as other dangerous addictive substances...."

 

I say "Thank you" to the authors of this article. It's true that it has come too late for some of us, but if the tide is turning, perhaps others will avoid the same fate.

 

 

Great article. As usual, the Europeans are far ahead. When I was first trying to figure out what was wrong with me, I talked to a German doctor - head of pharmacology at the biggest teaching/research hospital in Frankfurt - when she heard that I was on Klonopin she advised STRONGLY that I get off that "poison."

 

And recently I have found an American doctor who gets it. Took nearly 20 years, but sometimes progress takes a long time.

 

Now it's time to start taking down these big pharma crooks, and drug pushing doctors.

I wish there was something we could do to strengthen the article i.e., Write letters of our personal journeys, to support what they are saying. You said it...now it's time to start taking down these big pharma crooks and drug pushing doctors. I wrote a letter to my doctor telling her that she was no different than a drug pusher on the street. She didn't care about my paradoxical symptoms, she kept telling me to take more kalonapin and didn't know anything about the drug other than its name. It's shameful.

Technically, benzos are controlled substances, but they are in a less regulated class of drugs, being a schedule 4 drug. schedule 1 is the most regulated in the U.S.  Oddly enough, though, even though all benzos are listed as schedule 4 (far as I know), it seems as though the official physician protocols for prescribing benzos varies among each benzo. For example, Diazepam may as well be arsenic as far as many U.S. doctors are concerned because of its longer half-life, making it somehow "stronger." The fact that doctors and even some pharmacists do not grasp that potency and half-life are not the same is disturbing, to say the least.

 

Here's my only issue with strongly regulating or even banning benzos, like some suggest. I don't think these are good drugs, but some people MUST taper in order to not go through what I am told is horrific cold turkey. I didn't last a single day off of alprazolam because I was a sobbing mess, telling my fiance I felt tormented, etc. etc. Maybe I should have stayed off right then and there, but I was vulnerable, didn't know as much as I do now, etc.  In order for a flexible taper, patients need access to benzos. The only regulation I think should be put into place is that of 100% NEW prescriptions. And by that I mean, literally no prior history of any benzo presciptions/use. Illicit use becomes trickier, so even that regulation is a tall order. Patients would have to be strongly encouraged to divulge drug abuse without facing any repercussions. It also comes down to fully informed consent. Doctors need to be informed of tapers and withdrawal symptoms/damage. Patients need to be informed before they even CONSIDER taking these on even a semi-regular basis. The medical protocols need to change more than the legal regulation of the drug, IMHO.

I doubt that banning them is even a consideration, since they do have uses (e.g. pre-op, seizures, alcohol withdrawal -- in hospital), but I agree on many of your other points. Having read numerous articles on the dangers of these medications, and in the absence of any safe and effective way of counteracting the effects, I think that prevention is the way to go. Don't prescribe them so widely! If a prescription IS given, there must be fully informed consent, and the prescriptions should be short-term only. And yes, of course, help people taper off them safely.

Benzodiazepines are in fact Schedule IV controlled substances:

 

http://en.wikipedia.org/wiki/List_of_Schedule_IV_drugs_(US)

The article -- at least, what we're able to see in this excerpt -- is about how the medications should and shouldn't be prescribed, not about a specific Scheduling level (e.g. IV) in the U.S. The authors give some very detailed info about the problems associated with the medications, so even if they're Schedule whatever, they're still being misprescribed and misused. And I think you might agree that item #1 in that Wikipedia description you linked can hardly apply to benzodiazepines.

 

So, even if the rest of the article (i.e. that we can't access) talks about a different Schedule level, the crucial point of it is the need to change what's happening because what's happening now is dangerous and problematic.

 

 

The article -- at least, what we're able to see in this excerpt -- is about how the medications should and shouldn't be prescribed, not about a specific Scheduling level (e.g. IV) in the U.S. The authors give some very detailed info about the problems associated with the medications, so even if they're Schedule whatever, they're still being misprescribed and misused. And I think you might agree that item #1 in that Wikipedia description you linked can hardly apply to benzodiazepines.

 

So, even if the rest of the article (i.e. that we can't access) talks about a different Schedule level, the crucial point of it is the need to change what's happening because what's happening now is dangerous and problematic.

 

Oh I completely agree with you, and I think that they should be raised to Schedule II.  They are definitely much more addictive than the U.S. government thinks.  Hopefully one day they will be changed to Schedule II and these doctors will think twice before prescribing them.  Thanks for the response.   

I'm hoping that whether it's here (Canada) or there where you are (U.S.) or anywhere else in the world that attitudes and prescribing practices change A LOT so that there is PREVENTION of what we're all going through! Prevention is really the key, since as we've all experienced, there isn't really a "cure" except time. And for some of us, it's a very long time.