Email to Baroness Thornton, House of Lords
4 November 2009
Dear Lady Thornton,
May I say that the questions asked by Lord Montagu regarding tranquillisers on 14 October and 3 November 2009, are as relevant today as they were when asked by others over the last two decades or more (including by Dawn Primarolo when she was in Opposition).
It is sad to say that the Department of Health has failed to act in any truly effective way since 1988 when the Committee on the Safety of Medicines, rejecting the very influential Professor John Mark’s view that that the dependence potential of benzodiazepines was so low as to be negligible, sent Guidelines to all doctors. At that time firm figures on the number of patients who had been taking tranquillisers for longer than the CSM Guidelines could have been obtained by analysing doctor records, but it was a chance missed for whatever reason. No such figures have been collected since and it has been left to researchers such As Professor C.H Ashton to obtain reliable estimates of around 180 persons per GP practice – never accepted by the DoH even though it produced no figures of its own
Because clear figures on the number of patients affected by tranquillisers have never been obtained, uncounted numbers of patients have had their health increasingly impacted by continuing prescriptions and indeed their lives generally have been harmed, since the impact of tranquillisers is not merely a medical issue but also a socio/economic one.
You will forgive me, but referring to available levers does not sound too optimistic – Rosie Winterton used that phrase to Heather Ashton and MPs in 2003 as a justification for not doing anything beyond a short note from the CMO to doctors in 2004, a note which achieved little and prompted some doctors to abruptly withdraw medication from patients. Guidance has not protected patients and may well not in the future. Benzodiazepine prescribing has to be controlled in some way – it is controlled when obtained on the street but not when prescribed in the surgery. Many of the estimated one million patients dependent/addicted to benzodiazepines today have been taking benzodiazepines every day (often in large quantities) for years and decades. How that can be seen as safe is beyond most reasonable people. It should be mentioned too that addicted patients are not merely taking one class of drugs which is harming them but as a consequence of the action of benzodiazepines often take a variety of others including codeine – in other words one addiction with side-effects leading to further drugs with side-effects.
The stated intent to commission research into the long-term physical effects of benzodiazepines is of course welcome – no-one has ever done this and as a result the claims of patients have been rejected by doctors and government because there was no evidence, the NERO defence (no evidence of risk is proof of the absence of risk). In the 1980s Professor Ashton made several requests for funding to investigate long-term side-effects but funding was not granted.
Professor Malcolm Lader’s accurate comments have charted a chunk of the history of benzodiazepine prescribing. Psychophamacologist Malcolm Lader was a member of the Committee on the Review of Medicines from 1978–1989:
1978: He described benzodiazepines as the opium of the masses.
1981: He said there was an epidemic in the making.
Prescribing doctors, as he observed, had enthusiastically taken up the ‘use for everything’ message coming from the manufacturers and the result was a huge edifice of state-countenanced addiction.
1988: He said benzodiazepine addiction was the biggest medically-induced problem of the late 20th Century.
Lader was emphasising the crucial role played by medicine and its prescribers in creating not only an addiction problem which should never have existed, but also one instance of its terrible potential impact on physical health.
1991: He said no real attempt was being made to help addicts come off. Government should set aside funds.
Government has not set aside funds and today replies from the Department of Health imply that addicted patients are drug abusers like those who use benzodiazepines on the street and/or they are obtaining their drugs from the internet. The latter is a growing problem but is not the main cause of the problem which was caused by medicine in the vast majority of cases. Today too, Professor David Nutt seems bent on rolling back the CSM Guidelines. For years now he has been pushing the message through lectures that benzodiazepines are not as black as they are painted.
In a recent Newcastle lecture to medical students and other medics he said that tolerance does not develop to the anxiolytic effects of benzodiazepines. Therefore, because they maintain their effectiveness for this action, benzos can be used long term to treat anxiety states. He said that problems only arise if/when the benzos are stopped. He fully acknowledged a withdrawal syndrome, but failed to mention that adverse effects (e.g. increasing anxiety due to tolerance) do actually arise during long term treatment, as well as impaired cognition and memory, traffic accidents, falls and fractures in the elderly, etc. Small wonder then, that patients and their representatives, after 50 years of over-prescribing and decades of evidence that David Nutt now seeks to set aside, do not feel optimistic.
The first two quotes summarise David Nutt’s position – the ones below are far more accurate.
"The (benzodiazepine) withdrawal period lasts between sort of 4 days to a couple of weeks at most I think." Prof. David Nutt, Brain Mechanisms and Treatments of Anxiety Disorders, Lundbeck Institute, November 2005.
“The case for benzodiazepine dependence causing real damage has not been made.” Prof. David Nutt, former chairman of the ACMD.
"If any drug over time is going to just rob you of your identity and be an ironic reaction to early effectiveness. [Leading] to long, long term disaster, it has to be benzodiazepines." Dr John Marsden, Government Adviser on Drug Addiction, Member of the ACMD, Britain's Deadliest Addictions, Channel 4, November 1, 2007
"Withdrawal symptoms can last months or years in 15% of long-term users. In some people, chronic use has resulted in long-term, possibly permanent disability." – Professor C Heather Ashton DM, FRCP, Good Housekeeping, August 2003.
"Some people have been on benzodiazepines for many years, and it is very difficult to get them off because they are very addictive." – Dr Peter Fellows, Chairman of the British Medical Association's prescribing committee, BBC News February 11, 2004.
"It is difficult to defend that we have such a huge problem of benzodiazepine prescription and long-term use and therefore dependence. – Professor Louis Appleby, National Director for Mental Health, The Tranquilliser Trap, BBC Panorama, May 13, 2001.
"It is more difficult to withdraw people from benzodiazepines than it is from heroin. It just seems that the dependency is so ingrained and the withdrawal symptoms you get are so intolerable that people have a great deal of problem coming off. The other aspect is that with heroin, usually the withdrawal is over within a week or so. With benzodiazepines, a proportion of patients go on to long term withdrawal and they have very unpleasant symptoms for month after month, and I get letters from people saying you can go on for two years or more. Some of the tranquilliser groups can document people who still have symptoms ten years after stopping." – Professor Malcolm H Lader, Royal Maudesley Hospital, BBC Radio 4, Face The Facts, March 16, 1999.
"Release and self-help groups all over the country have done wonderful work, but why should people need to form groups for an urgent medical problem? This is drug-induced disease, not drug abuse." Tyrer P. The Benzodiazepine Post-Withdrawal Syndrome. Stress Medicine 1991; 7: 1-2.
"I have started a support through withdrawal scheme for people coming off benzodiazepines. The enormous amount of suffering I see makes me wonder how much information on the toxic effects of these drugs, and illness caused by their withdrawal, reaches the doctors. The pharmacological manuals grossly understate the dangers of tolerance, dependence and withdrawal that have been demonstrated so clearly after the use of these drugs. This is not only after long-term use at high dosage, but also after very short-term use (two weeks), on a normal therapeutic dose.....
Thousands of people could not possibly invent the bizarre symptoms caused by the therapeutic use of benzodiazepines and reactions to their withdrawal. Many users have to cope, not onlywith a frightening range of symptoms, but also with the disbelief and hostility of their doctors and families. It is not uncommon for patients to be "struck off" if they continue to complain about withdrawal symptoms. Even when doctors are concerned and understanding about the problem,they often have little knowledge of withdrawal procedure, and even less about treatment. The drugs newsletter on benzodiazepines issued in this region will help them. Is anything being done elsewhere? Trickett S. Withdrawal from Benzodiazepines. Journal of the Royal College of General Practitioners 1983; 33: 608.
Medical research on Benzodiazepine Injury
Yours sincerely
Colin Downes-Grainger
