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BBC Radio 4, Face The Facts,
broadcast on March 16, 1999
A medical controversy is investigated as
John Waite presents: Face The Facts
JOHN WAITE: This week we investigate a tragedy of growing proportions caused by one of the most widely prescribed drugs in the country. It's a drug that should have been restricted more than a decade ago, but instead is throwing its net ever wider. Taken for granted in homes, it's also won currency on the street where young people not yet out of school are finding it cheap and easily available – sometimes with chilling consequences.
JEAN LAWSON: I thought Leah was asleep. I shook her and I thought she'd got white lipstick on and I opened up her eyes; she was so cold, and... I knew she was dead.
JOHN WAITE: Jean Lawson's daughter Leah was just 13 when she died last month. The drug cocktail she took the night before her death included a drug routinely and liberally prescribed by doctors.
SUSAN BIBBY: Doctors seem to be incapable of reading the warnings or taking any notice of warnings at all. Now children are getting the drug and nobody is doing anything. It is an absolute scandal, a medical scandal, something has got to be done and the Government should be taking notice.
JOHN WAITE: Susan Bibby of the pressure group Benzact is herself a former addict. The drugs she's talking about are benzodiazepines, a group of tranquillisers and sleeping tablets that include household names like Valium, Mogadon and Ativan. They were first introduced in this country back in the 1960s and welcomed by the medical profession as a safe alternative to barbiturates known to be addictive and on which it was all too easy to overdose. Soon benzodiazepines were being widely prescribed for anxiety and sleeplessness arising from anything from bereavement and divorce to redundancy. Robert Kerwin is Professor of Psychopharmacology at the Maudesley Hospital in London.
PROFESSOR KERWIN: Benzodiazepines have been with us for about 30 years and they took off dramatically. There were tens of millions prescriptions certainly in the UK and hundreds of millions around the world. You use the metaphor of 'giving them out like sweets' – it was almost like that, and they were considered panacaeas for many things.
JOHN WAITE: In the early days the scientists didn't understand exactly how the drugs worked but they didn't appear to be addictive and so, for the first time, GPs appeared to have a safe and virtual cure-all, which they began to prescribe widely. At the height of their popularity the number of NHS prescriptions for benzodiazepines reached almost 31 million a year – enough for three out of every four adults in the land to be sedated. At the time neither the medical establishment nor the government appeared concerned that such large numbers of people were regularly being given such large quantities – but by the early 70s some experts had begun to have their doubts. Professor Malcolm Lader, a consultant at the Institute of Psychiatry, was an early dissenting voice.
PROFESSOR LADER: What made me worried was two things, firstly, the number of people who were taking these tranquillisers prescribed by their general practitioners and other doctors, but secondly and perhaps more importantly, the number of repeat prescriptions, that is, patients were coming back, year in, year out and asking for their prescriptions to be repeated. Often they weren't even seeing the doctor, they were just getting the prescription written out, and that was worrying. Such chronic use with drugs known to be acting on the mind could be a signal that there was a dependence problem.
JOHN WAITE: But when Professor Lader and other distinguished colleagues voiced their misgivings they were by and large dismissed. Prescriptions continued to rise into the 80s even as it became clear that the drugs were also causing previously unrecognised side effects. Side effects which included agoraphobia, anxiety, blurred vision and memory loss. It was an uphill struggle, recalls Professor Lader, to persuade the medical profession to put the brakes on prescribing benzos.
PROFESSOR LADER: We were throwing doubts on them as widely prescribed with all the medications. This was a huge industry, so the pharmaceutical industry were fighting an inch by inch retreat and the medical profession itself couldn't believe that these drugs which every general practitioner, every clinician was prescribing so frequently, for such long periods of time, that they could in fact be dangerous. It's like turning an oil tanker at sea, you've got to think about it a long time in advance. It's a very unwieldy manoeuvre to turn the usually accepted medical principles on their head.
JOHN WAITE: It wasn't until 1988 that the government body charged with advising doctors about drugs – the Committee on Safety of Medicines – took decisive action. It issued a direct warning to doctors to cut back their use of benzodiazepines. GPs were told to give the drug only to patients suffering extreme bouts of anxiety or sleeplessness, and at the same time, to try to help wean off those patients who had already become addicted.
NARRATOR: There has been concern for many years regarding benzodiazepine dependence. Such dependence is becoming increasingly worrying. Withdrawal symptoms include anxiety, tremor, confusion, insomnia, fits and depression. It is important to note that withdrawal can occur following doses given for short periods of time. The lowest dose which can control the symptoms should always be used. It should not be continued beyond four weeks.
JOHN WAITE: Around this time a group of 17,000 people who had become addicted to taking benzodiazepines, banded together to take legal action. They were determined to claim compensation for the side effects they'd suffered after becoming involuntarily hooked on the drugs given them by their doctors. When legal aid was withdrawn however, the case never reached the courts.
SUPPORT GROUP MEMBER: I'd like to introduce a new member to the group, I'm Brenda, I'm John, etc...
JOHN WAITE: In the absence of any help from the law, at the Coldhurst Community Centre in Oldham in Lancashire, long-term benzodiazepine users meet to support one another in their ongoing struggle with addiction.
SUPPORT GROUP MEMBERS:
1st member: And would your job depend on memory?
2nd member: Oh yes, without a doubt, yeah.
1st member: Could you do it now?
2nd member: No, because it's affected my memory, my brain.
JOHN WAITE: There are estimated to be as many as a million people prescribed benzodiazepines in the 60s and 70s who remain dependent to this day. They suffer debilitating physical and psychological side-effects: memory loss, agoraphobia, depression, even, ironically, the very symptoms for which they were prescribed the drugs: sleeplessness and anxiety. In all there are 200 recognised side-effects.
Between them, Brian, Millie and Alan have been on the drugs for a combined total of more than 70 years, and yet the Committee on Safety of Medicines advises doctors that beyond 4 weeks, the drugs are no longer an effective treatment.
SUPPORT GROUP MEMBERS:
1st member: I went to the doctors and said: "Do they make you lose your memory?" and he said "No." My memory went down and down and down. I can't remember what I did yesterday and I don't think about tomorrow. There's no tomorrow, all there is is now. You see I can say to my wife: "I saw such a body t'other day", but she'll say : "It's four years since he died," and I think it's a few weeks ago that I saw him. I've been fishing for forty years – now I can't tie a hook. I wanted to be a chef. When I worked, my hobbies were cooking, but now – I can't cook.
2nd member: I used to be a dancer and I got medals for dancing but I couldn't go back to dancing again and I just feel that I couldn't mix. It's just destroyed my social life because I was very much a mixer before. In work, we'd have a crack and a joke and I'd go to see comedians. I liked to repeat jokes. I took notes of the jokes and things like that because I liked socialising. I will never be the same person I was because I just feel I've been damaged.
3rd member: It was one Saturday evening, my dad phoned me up and said: "You'll have to come to the hospital with your mum, she's had a fall." I made an excuse, saying: "I'm going out, but I'll give you a ring back to see how she is". Basically I just couldn't go out of the house. My son who was 21 at the time had to do my shopping for me. I couldn't even go to the corner shop.
JOHN WAITE: Brian, Millie and Alan can at least look to each other to provide some sort of mutual support. Two hundred miles away in Norfolk, Pamela, a professional archaeologist copes with her drug dependency alone. Like her fellow sufferers Pamela is categorised rather starkly by the medical establishment as a 'long-term, chronic user'.
PAMELA: What one has to face, at some point is that one has become a drug addict – that one has gone to one's own trusted doctor and been prescribed a drug, without warning and that one has become addicted to that drug. You can say it in one really, I feel as if my own self, was at some stage – removed – I gradually went missing. My personality gradually went missing.
JOHN WAITE: Like all too many older addicts of benzodiazepines Pamela could well stay on medication for the rest of her life – not because the drugs she's been taking for years are helping her but because their side-effects become truly agonising in withdrawal. At the Maudsley Hospital for the past 30 years Professor Lader has been helping people who are trying to wean themselves free.
PROFESSOR LADER: It's more difficult to withdraw people from benzodiazepines than it is from heroin – it just seems that the dependence 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 that it can go on for 2 years or more. Some of the tranquilliser groups can document people who still have symptoms 10 years after stopping.
JOHN WAITE: Should the likes of Brian and Millie in Lancashire and Pamela in Norfolk stay on their drugs into old age there are even worse problems in store. Benzos increase the risk of falling, or, through lack of concentration, being involved in a road accident for example. Last month a report from the United Nations criticised European countries, including Britain, for relying too heavily on benzodiazepines particularly in the treatment of the elderly. Even so, Charles Medawar of the medical campaigning group, Social Audit, believes there's little immediate hope of change.
CHARLES MEDAWAR: The cost to the NHS of benzodiazepine dependence is not high. The fact is that you can maintain somebody on a prescription of benzodiazepines for 'pence per month'. Given that many benzodiazepines users tend to be elderly people and their life expectation is not all that high, there is no incentive to cut costs by reducing the amount of dependence. I've no doubt that if benzodiazepine dependence were a very expensive social problem, solutions could and would be found.
JOHN WAITE: For a health service creaking at the seams, benzodiazepines, given all their... [break in recording]... Claire became pregnant with her daughter Georgina in 1989, more than a decade after the manufacturers of benzodiazepines had specifically warned doctors not to prescribe the drugs during pregnancy. Towards the later stages of her pregnancy Claire had had stomach pains and a doctor recommended a course of Valium. Claire had heard worrying stories and refused, but when she was then offered 'diazepam', because she was told it was a muscle relaxant, she accepted. Claire had no idea the two drugs were one and the same, nor that the effect on her baby would be so horrifying.
CLAIRE THROWER: Georgie was just lying there, not able to do anything. She was in withdrawal and she was suffering from the effects of the drug. I wouldn't wish any mother to go through what I felt, looking at my baby, to see that there was something that wasn't right.
JOHN WAITE: At Arrowe Park Hospital in Liverpool Dr James Robertson sees babies that are born drug addicts all the time. Most of the mothers are heroin or methadone addicts but all too many are also dependent on benzodiazepines. Dr Robertson specialises in trying to help both them and their offspring, the youngest victims of a discredited drug.
DR JAMES ROBERTSON: Benzodiazepines cause a more significant withdrawal for the newborn baby than either heroin or methadone. When a baby is withdrawing, they have a state of irritability, they are hyper-responsive, which means that they tremor at the slightest noise, even when quiet and they cry with a cry that is very distinctive – it's much higher pitched and it's much more of a distressed cry as if the baby is in discomfort. They basically are miserable, unsettled babies.
JOHN WAITE: During his years of research Dr Robertson has discovered that these so called 'benzo babies' will suffer painful 'cold turkey' from the effects of withdrawal and will require intensive care for up to two and a half months following their birth. Far longer even than babies born to mothers addicted to illegal hard drugs. The suffering to the newborn child can be severe, even life threatening. Professor Kerwin again.
PROFESSOR KERWIN: The developing foetus can be congenitally malformed; it can have heart attacks in the womb. We also know that the newborn baby born to somebody taking benzodiazepines will have difficulty breathing and they would have floppy muscles – what doctors call a 'floppy baby' and they may be unduly cold because the temperature regulation, which is so important to a baby, is disrupted.
JOHN WAITE: What do you think of the fact doctor, that some of your colleagues, some GPs are still prescribing these things to women of childbearing age, indeed to pregnant women?
PROFESSOR KERWIN: Well I think if any doctor is prescribing benzodiazepines to a pregnant woman, he should check his indemnification status because it is in fact illegal prescribing.
JOHN WAITE: What do we in fact know, Professor, about the long-term effects of benzodiazepines on children that have been exposed to them during pregnancy – the long-term effects?
PROFESSOR KERWIN: This is a question which probably shouldn't be answered because it shouldn't be a problem, in the sense that it should never happen, because the drugs should never be given in pregnancy. It's sad to have to address that question but then the answer to the question is very little. There is very little research in this area, probably because the researchers who do this sort of research hadn't realised that there was so much benzodiazepine prescribing in pregnancy. One can hazard a few guesses as to what might happen from what we know about the way the drugs work. We know absolutely certainly that the main effects of the drugs are to reduce vigilance. That's why driving is so bad when people take these drugs and memory – that's why these drugs are now 'date-rape' drugs, they give amnesia.
Now if you could imagine those effects in a baby – reduced vigilance and amnesia, at a very crucial phase of development, in the early few days and weeks, this could have profound effects on the developmental processes for the baby. Theoretically, this would lead to a number of behavioural disturbances in later childhood such as attention deficit disorder, learning difficulties, hyperactivity syndromes. This is a theoretical contention, but it's certainly something which needs urgent research.
JOHN WAITE: In other words exactly the same sort of symptoms that Georgina Thrower (now aged 10) has been demonstrating all her young life. The condition she's suffered from birth remains undiagnosed and she requires special care to this day. Paediatricians searching for an answer admit that the fact her mother Claire was prescribed benzodiazepines during pregnancy cannot be ruled out.
CLAIRE THROWER: I was told that Georgie would be fine in 7 to 10 days time and that was from the point of birth – and here we are ten years later and we're not in the least bit fine – she has no speech, she's in a wheelchair, she walks short distances aided, she's not able to stand up on her own at all – she'd fall straight over. She resembles cerebral palsy but she has not actually got cerebral palsy.
JOHN WAITE: Despite the risks, however, an estimated 25-30,000 babies every year are born to women using benzodiazepines. As recently as 1997, the Committee on Safety of Medicine felt compelled to publish an urgent reminder to doctors to avoid prescribing benzodiazepines during pregnancy and breastfeeding.
ACTOR'S VOICE: Benzodiazepines cross the placenta and there is a risk of adverse effects in the foetus. Since benzodiazepines are excreted in breast milk it should not be given to lactating mothers.
JOHN WAITE: At least one baby has died through drinking such milk and the Committee's warning went on to include all women of childbearing age – they should be informed of the risks. But the Committee on Safety of Medicines has no remit to monitor the prescribing of these drugs and, as we discovered, the warnings have continued to be ignored by some doctors. Whilst researching this programme we've heard from women in their teens, young mothers and 'thirty-something' career women, all of whom have been prescribed tranquillisers and sleeping pills without being warned of the risks they're running. In all the cases too the women were re-prescribed the drug for long enough to become addicted – it doesn't take long.
PAULA: She's gone from a very bright, athletic girl – a very intelligent, attractive girl, into almost a recluse and she looks ill all the time and she says that she feels ill all the time. She doesn't go out, she doesn't do anything, she's no future, she's no career prospects, she's no life.
JOHN WAITE: In a tiny Pennine village, crouched between Saddleworth Moor Paula counts the cost of her daughter's addiction. Last April Susan was given the sleeping tablet nitrazepam after asking a doctor to help her cope with her worsening post-natal depression. She was given repeat prescriptions and as the drug has gained a hold on Susan, her mother Paula has noticed a big change.
PAULA: She would just get up at dinner time, which she still does, sits around in her nightdress all day, looks like death warmed up, she loses her appetite, her concentration is virtually nil, she forgets a lot. What else? She always seems to be tired and she's complained of seeing shadows, or, on occasions, she's complained of seeing creatures run across the room.
JOHN WAITE: Government figures for 1997 – the most recent figures available – reveal that 16 million prescriptions a year are still being written for benzodiazepines. The Institute for the Study of Drug Dependence estimates that 1 in 7 people are taking them at least once a year. Around 1 million people, (it's estimated), will be taking them continuously throughout the year with a correspondingly high risk of becoming addicted. So plentiful are supplies that benzos have become a major part of the 'street drug scene' with more and more youngsters experimenting illegally with the drugs, now commonly on sale by dealers. Those who try them, particularly in combination with other 'harder' drugs, can have no knowledge of the deadly risks they run by dabbling in such drug 'cocktails'.
JEAN LAWSON: I thought Leah was asleep, I shook her and I thought she'd got white lipstick on and I opened up her eyes... she was so cold and I knew she was dead.
JOHN WAITE: At the end of last year Jean Lawson began to have her suspicions that her 13-year-old daughter, Leah, had been dabbling with drugs. Leah's elder sisters had both used drugs and now Jean feared that Leah too had got in with the same bad crowd on the Nunthorpe Estate in Grimsby where they live.
JOHN WAITE: When did you first suspect that something was wrong?
JEAN LAWSON: About four months ago when she started smoking cannabis, then I think she went onto the harder stuff because I could tell by the pupils, (I've seen it, I know the signs and everything). Leah did break down one day and she said she would stop taking everything – she was alright for a while, but that was when she started again.
JOHN WAITE: On the last night of Leah's life her mother had gone to see one of her other daughters and, when the two returned home the next morning, Leah was dead. An inquest recorded the cause of death as methadone poisoning but the investigation revealed that along with the methadone Leah had also taken quantities of two benzodiazepines: nitrazepam and diazepam. On the street they cost just 25p per tablet.
JEAN LAWSON: I was just devastated, I'm just so numb and empty now. I sit and cry every day – I'm just so empty. I can't sleep, I can't cook, I can't think, I'm just staring into space half the time.
JOHN WAITE: What has been the impact of your daughter's death here on the estate?
JEAN LAWSON: Everybody's shocked and sad but there's nothing now that can bring Leah back to me – I wish there was, but there's nothing.
JOHN WAITE: Friends and members of the local community are still reeling from Leah's death. At Winteringham School where she was a 2nd year pupil her headmaster, Andrew Howlett, remembers Leah fondly.
ANDREW HOWLETT: She was a beautiful girl with a big smile and a huge personality – she was fun to be with, children liked her. She had the ability to make other people laugh and she just loved to be the centre of attention. She was a 13-year-old girl in a secondary school in England.
JOHN WAITE: Winteringham School is well aware of the temptation that drugs offer to impressionable youngsters and so in common with many schools, these days, it runs a special drugs programme for all of its pupils. As benzodiazepines have now become a standard part of what might be called the 'routine ingredients' of drug taking, teenagers are taught how to identify the telltale blue, white and yellow tablets that they may well be offered.
ANDREW HOWLETT: Part of our programme is to provide pupils with information about slang names. Things like 'eggs' and 'jellies' and various other names that are used for theses prescription drugs and of course we tell pupils what they are so that when they come across these things they can identify what they are and what the problems might be.
JOHN WAITE: Drugs are now a fact of life in Britain. Last week three 9-year-olds were rushed to hospital (their families say) after taking benzodiazepine tablets they'd been offered in the street. An event which perhaps won't come as a surprise to Bill Geere, the CID inspector who's handling the investigation into Leah Lawson's death. A policeman with 30 years' experience, Detective Inspector Geere's job in Grimsby is to combat drugs and he's seen the problem of benzodiazepines getting steadily worse. Inspector Geere and his officers arrest around 10 drug dealers every month and in the past year they've seized some 1700 benzo tablets. Drawing up in his unmarked car, to park at a discreet distance, he can cast an eye on what's happening on the streets of the Nunthorpe estate, where Leah lived and where she bought the drugs which that led to her death. There's nothing special about the estate and Grimsby is just an ordinary sort of town. The drug related tragedy which happened here could so easily have happened anywhere.
D.I. BILL GEERE: Over the last three years or so there's been about 40 deaths – certainly we average about one a month. That's tragic, and what's more tragic, is that the vast majority of the deaths that we've investigated show a poly-use of drugs – in other words: heroin, benzodiazepines, cannabis and alcohol – all used together. Therein lies the problem, that mixing the drugs, particularly using the benzodiazepines as well, makes something that wasn't fatal, fatal.
JOHN WAITE: What sort of things would they be dealing in and how would they describe them?
D.I. BILL GEERE: Commonly people would be dealing heroin on most street areas of Grimsby and heroin would be known as 'brown' and I'm sure, to most of the public, that sort of terminology would be lost on them. People don't think of diazepam or nitrazepam in that sense and they don't actually reflect that mum or dad or husband or wife usually take Mogadon or Valium and those are the very things we are talking about. On street level if people started talking about 'blues' or 'vallies' or 'moggies', those are the same things they're talking about. It just wouldn't be perhaps picked up by parents or grandparents or sometimes even teachers.
JOHN WAITE: Well they've come out of the bathroom cabinet into the drugs scene?
D.I. BILL GEERE: Regrettably so.
JOHN WAITE: Why has there been this rise, where do they come from these benzodiazepines?
D.I. BILL GEERE: They are prescribed by the family doctor for whatever illness the individual patient may have. What happens after that, of course, is through the person's own greed, for reasons of drugs misuse, whatever, they choose to sell them on or supply them to other people. If we can develop something with doctors to review prescribing after certain dates – cut down the dose, not repeat prescriptions – that might be helpful. It is appropriate to cut down the availability of drugs to young people, that's why we target professional drugs dealers, but to cut down that accessibility, we've got to look at other ways. Certainly recommending voluntary action by GPs could be another way of cutting down on that availability.
JOHN WAITE: When we approached the Department of Health, the Royal College of General Practitioners, the Committee on Safety of Medicines and the General Medical Council, no one was prepared to be interviewed about the problems we've heard of today. Even the written questions we submitted were ignored. Eventually we did manage to speak to a practising GP who is an elected member of the General Medical Council, Dr John McCormack. Dr McCormack, in the absence of any of the official bodies wanting to take part in this programme, you agreed to discuss some of the points made in this programme about the wide variety of problems stemming from the overprescription of benzodiazepines.
DR McCORMACK: Well I think that most GPs are aware of the dangers but having said that, we've all got our long-term users and it's very hard to get people off them. Some of them we inherit from other practices, some of them are old and lonely, maybe widows or widowers and living alone and it's very, very difficult to get the long-term people, who after all, develop a tolerance to them, become dependent on them – get them off, but that, I don't think accounts for the whole problem.
JOHN WAITE: But whose fault was it in the first place that these people, who've become long-term users, got onto the drugs in the first instance?
DR McCORMACK: Well, it's a very complicated picture, because patients do like 'em and do ask for them because they work in the short term – they're a 'quick fix'.
JOHN WAITE: But the first signs came through, didn't they, in the early 70s that these things were addictive and could cause problems? Why 30 years later were there 16 million prescriptions last year?
DR McCORMACK: Well, this is a worldwide problem and I think one of the big factors is that they're cheap. GPs now are under a great deal of pressure to prescribe inexpensive drugs. Now, a thousand 2mg Valium tablets – diazepam tablets – cost around three pounds which is not very much. If you are prescribed 60 and you pay the 6 quid prescription fee, the government makes a nice little profit out of you. If you compare that to the new, 'clean' antidepressants, drugs like the SSRIs – they often cost around a pound per tablet and that gobbles up the GPs' tightly controlled drug budgets like nobody's business.
JOHN WAITE: But even if they are cheap – to know well the risks you run by prescribing these drugs, you shouldn't do it, surely?
DR McCORMACK: Yes, I would fully agree with that and I think 95% plus of GPs would go along with that 100%. We would say we will not start people on tranquillisers, except, there are often cases where in the short term they are useful.
JOHN WAITE: Now I'm not a medical man, obviously – but 16 million prescriptions last year and normally people are prescribed just a single course of these things, that's the safe way of prescribing – so either, 16 million prescriptions mean 'millions' of people are anxious or can't sleep and need something, or, you've got a million or so people who are hooked and long-term dependent and who are prescribed these drugs over and over again. Which is it of those two?
DR McCORMACK: I think it's a mixture of both. I think there are undoubtedly a number of people on long-term medication and they become addicted. They cannot withdraw them – if they try to stop taking the drugs, they exhibit quite marked withdrawal reactions so it's extremely difficult for patients. We have to try and cut them down as gently as possible.
JOHN WAITE: But with 16 million prescriptions last year that message isn't getting through is it?
DR McCORMACK: No, no, I think really the bottom line is that the medical profession have got to go on the offensive and really underline the fact that these drugs shouldn't be used in the great majority of cases in the long-term and we have to get that message across to the public.
JOHN WAITE: Well you see it's a very sad fact that, just in researching this programme, we have come across all too many tragic cases of addicts – we've heard from an 18-year-old who's become addicted after prescription of benzodiazepines for post-natal depression. Would you prescribe this sort of drug for something like post-natal depression?
DR McCORMACK: No, because the problem with these sort of drugs is very often they make depression worse.
JOHN WAITE: So you've got a GP who's prescribed something which very often is going to make the situation worse?
DR McCORMACK: If you're in the surgery with that person, very often they will present in floods of tears, they can't cope and so forth – so a tranquilliser might mask the problem for a day or two but in the long term you really don't want to be treating a patient with severe post-natal depression with that sort of drug. You want, if you are going to embark on drug treatment, to give them the right sort of treatment – which is basically antidepressant medication.
JOHN WAITE: You see I was sitting in a police car with a detective inspector who runs the drugs squad in Grimsby a few days ago and he was explaining to me about the 40 drug-related deaths, just in Grimsby, just an ordinary town, not the drug capital of the North East. In those 40 drug deaths over the last 3 years, benzodiazepines were involved in the vast majority of them. He and his officers recovered hundreds, many hundreds – thousands of these tablets – they're just so cheap and he said quite clearly: "GPS overprescribe them – that's how they get out to the youngsters and are involved in their deaths".
DR McCORMACK: Yes, um, benzodiazepines themselves, very rarely cause any serious reactions and certainly very, very rarely cause death when used on their own – I mean certainly there is a problem. It's well known that drug abusers will go out and get any drugs they can and take them as a 'cocktail'. If you're going on a high, if you're taking something that's going to sort of 'pep' you up and keep you awake, um, then abusers will often use the benzodiazepines to 'come down' afterwards, or to get some sleep.
JOHN WAITE: But whatever they use them for they can easily get hold of them. It brings us back to the central question that they're overprescribed – 'recklessly' one person said, wantonly by general practitioners. If there weren't so many being liberally prescribed there wouldn't be so many that can spill out onto the streets.
DR McCORMACK: Yes, I think there are a multitude of sources to be honest, but certainly a considerable proportion come via general practitioners, but, it's a tiny percentage of general practitioners and those that are discovered to be overprescribing are cracked down on very, very quickly indeed. What basically happens is their prescription pads are taken away, so they cannot abuse the system. It's one thing to have a drug abuser, or someone who's selling drugs, it's quite another thing to have someone in a position of authority, a GP who has a prescription pad, who is abusing the powers that are vested in him or her, as a result of that privilege. The GMC takes that very, very seriously indeed.
JOHN WAITE: I wonder whether you have, as a doctor, any words of comfort to the many people listening to us now, taking these drugs, who can't stop? To the parents of children who've been damaged long term because these drugs have been prescribed, when the mother was pregnant, by her doctor? To the parents of dead youngsters in whose deaths benzos have had a hand? What do you say to these people who've suffered?
DR McCORMACK: Well, I obviously can't speak for doctors who have not stuck to the guidelines that myself and most other GPs consistently stick to in these cases. Clearly we need to get the message across that people have to be aware of the dangers of medication – of this type of medication, any type of medication.
JOHN WAITE: We've known about the problems since 1971. There have been rulings and guidelines issued and yet here we are, and the latest statistics show, prescriptions are on the up again. So far from tailing off prescribing, we seem now to be settling back into the old pattern of – somebody comes in – 'bung them some benzos'.
DR McCORMACK: Yes, I really think that the whole of the profession and all of the regulatory bodies should take this message on board and should do something about it, should construct a timetable for bringing about an improvement in the situation. One major factor, I think, must be to stop trying to persuade GPs to prescribe drugs that are cheap. We all know that there are better and safer preparations available.
PAMELA: There are people out there – people who are perhaps listening to this programme – who are hooked, unknowingly, unwillingly and they feel that society has 'chucked them overboard'. They feel that they no longer belong anywhere. They feel that they've lost such a lot that they can no longer regard themselves as the a full human being.
JOHN WAITE: That's all in this edition of Face the Facts. We'll be back in a weeks' time. I do hope you can join us then.
Face the Facts
Presenter: John Waite
Producer: Claire Burnett
BBC Radio 4
March 16, 1999
Transcription by Susan Bibby, Benzact
BBC Panorama: The Tranquilliser Trap, May 13, 2001