Friday, 27 April 2007

Benzos Decoded

How do benzodiazepines work?

Benzodiazepines are used to treat anxiety and sleeping problems. (They are also important for treating epilepsy, for sedation in minor surgery, and before general anaesthetics, but this is not covered here.)

Although these drugs are often called 'minor' tranquillisers, the term is misleading because they differ markedly and in many ways from the so-called 'major' tranquillisers (antipsychotic drugs), and their use is by no means minor.

Benzodiazepines work by quietening the activity of the brain. They act on all areas of the brain, including those responsible for rational thought, for memory, for the emotions, and essential functions, such as breathing. They are very effective for treating anxiety, as well as acting as sedatives, as sleeping pills, and to reduce the memory of unpleasant events, such as operations. But their widespread action is also responsible for their many unwelcome effects. They may also cease to be effective after about four months.

Dependence and withdrawal
The first benzodiazepine was chlordiazepoxide (trade name Librium), which came into use in 1960. The best known is diazepam, or Valium, which followed in 1962. Reports of people becoming dependent on benzodiazepines began to emerge as early as 1961, connected mostly to their use in treating anxiety or insomnia. It was not until 1980 that the Committee on the Review of Medicines expressed concern, although they believed the risk of dependence was low.

In the 1980s, it was generally recognised that dependence and withdrawal were serious problems with these drugs, and their use should be limited. By the end of the decade, it was estimated that half a million people were addicted to benzodiazepines, and in the 21st century the problem still affects a large number of people, many of whom have been taking these drugs for 20 or 30 years.

However, benzodiazepines are still the drugs most commonly prescribed for anxiety and as sleeping pills, and in 2001 the number of prescriptions written was 12,648,900. Many people are prescribed them while they are in psychiatric wards, and are discharged from hospital still taking them.

When should benzodiazepines be prescribed?

Because of the problems of becoming dependent on these drugs, and finding it difficult to withdraw from them, benzodiazepines should be used only for the short-term treatment of severe anxiety or severe insomnia. They are not for long-term use.

According to the British National Formulary (BNF):

  • Benzodiazepines are indicated for the short-term relief (two to four weeks only) of anxiety that is severe, disabling or subjecting the individual to unacceptable distress, occurring alone or in association with insomnia or short-term psychosomatic, organic or psychotic illness.
  • The use of benzodiazepines to treat short-term 'mild' anxiety is inappropriate and unsuitable.
  • Benzodiazepines should be used to treat insomnia only when it is severe, disabling, or extremely distressing.

A report by the Royal College of Psychiatrists suggests that the drugs should not be prescribed regularly for longer than one month and, ideally, should be taken only as required and with a gap every few days. Treatment should always be at the lowest possible dose, for the shortest possible time.

Although benzodiazepines are effective in treating anxiety states, it's clear that there are situations when their use is not justified. In bereavement, for example, tranquillisers may stop people from grieving properly. Children should only take benzodiazepines for acute anxiety or insomnia caused by fear.

Benzodiazepines are often used together with antipsychotic drugs to treat schizophrenia, or similar conditions. They may be prescribed, short-term, to help with over-excitement, agitation and severe psychotic disturbance, to aid rapid tranquillisation. It's better than giving a high dose of antipsychotic drugs, which have a risk of severe side effects.

Benzodiazepines used for anxiety

Chlordiazepoxide (Librium, Tropium)
Normal dose: 10mg three times per day, increased, if necessary, to a maximum of 100mg per day
Half-life: 5–30 hours (36–200 hours*)
*This refers throughout to the half-life of the active metabolite, the substance the drug turns into, in the body, which has the therapeutic effect.

Clorazepate (Tranxene)
Normal dose: 7.5–22.5mg per day
Half-life: (36–200 hours*)

Diazepam (Valium, Tensium, Dialar, Diazemuls, Stesolid, Valclair)
Normal dose: 6mg per day, increased up to 30mg per day. For children (for night terrors and sleep-walking) the dose is 1–5mg. Available in tablet form in doses of 2mg, 5mg and 10mg. Doses vary, according to the condition
Half-life: 20–100 hours (36–200 hours*)

Benzodiazepines used for anxiety

Alprazolam (Xanax)
Normal dose: 0.25–0.5mg three times per day, up to a maximum of 3mg per day
Half-life: 6–12 hours

Lorazepam (Ativan)
Normal dose: 1–4mg per day
Half-life: 10–20 hours

Normal dose: 15–30mg, three to four times per day. Maximum dose 50mg
Half-life: 4–15 hours

Benzodiazepines used as sleeping pills
Flunitrazepam (Rohypnol)
Normal dose: 0.5–1mg at bedtime, up to a maximum of 2mg
Half-life: 18–26 hours (36–200 hours*)

Flurazepam (Dalmane)
Normal dose: 15–30mg at bedtime
Half-life: (40–250 hours*)

Nitrazepam (Mogadon, Remnos, Somnite)
Normal dose: 5–10mg at bedtime
Half-life: 15–38 hours

Benzodiazepines used as sleeping pills
Loprazolam (Dormonoct)
Normal dose: 1mg at bedtime, can increase to 1.5 or 2mg
Half-life: 6–12 hours

Normal dose: 0.5–1.5mg at bedtime
Half-life: 10–12 hours

Normal dose: 15–25mg at night. Maximum dose 50mg
Half-life: 4–15 hours

Normal dose: 10–20mg at bedtime. Exceptionally, 30–40mg
Half-life: 8–22 hours

Sunday, 25 March 2007

Benzo Addiction advertisement

An advertisement published in The Independant on October 27th, 2006

Saturday, 17 March 2007

Why Do Drugs Affect Us The Way They Do - A Simple Guide to the Chemistry Involved

Lets consider this - A young girl spins round and round in circles and falls down giddy and sick on the floor. A moment later she jumps up and continues to spin happily. Similarly, a boy gets very nervous and awkward while asking a girl out on a first date. Nonetheless, he then immediately rushes home excitedly to tell his friends that the girl accepted.

If you have noticed these two examples, you would have understood that both these involve people doing a particular activity in a particular way and then immediately there is a change in both mood and feeling - the girl was first happy and then giddily sick; the boy, anxious at first but ecstatic later. Both these mood alterations took place in a matter of a few seconds. THIS is what drugs do to you.

Biologically, our body is conditioned to maintain homeostasis or "balance" at all times. When there is an imbalance in our chemical proportions, we get sick. Legal drugs like stimulants, depressants etc., work by either stimulating or depressing natural brain chemicals called neurotransmitters. Neurotransmitters are naturally occurring brain chemicals that are necessary in transmitting the nerve messages in the nervous system. They are responsible for the normal activity of the brain like emotions, feelings, thinking, perception and behaviour. When some foreign substance messes up their natural balance, they mess us up.
Drugs are responsible for affecting these neurotransmitters and hus have an effect on our emotonal and physical balance.

Types of drugs most commonly used are psychoactive drugs. Psychoactive drugs are chemicals, medicines which can rapid affect on peoples mood, emotions, and thinking. For example, changes in mood include stimulation, sedation and euphoria. Behaviourial changes include acceleration or retardation of movement. Changes in thinking include speeding up or slowing down of thinking processes as well as hallucinations, delusions, illusions.

Some medications like antidepressants are able to change people's mood over days. They are not considered psychoactive because they do not cause euphoric swings. These are therefore termed as mood regulators.

Thus we can see that seeing the effects that drugs have on the neurotransmitters, they can be classified and dealt with. this makes the study of drugs easier.

Tuesday, 13 March 2007

Charting it All Up - To Pill or Not to Pill?

Legal drug addiction could be affecting anyone in your neighbourhood - your elderly grandmother, your history teacher at school and even your religious uncle.

It is important to understand that in most cases, the addicted individuals are literally unaware
of the degree of reliance their body is on the drugs. It is also important to understand that addiction is not just a chronic use of the drug; it includes the initial compulsion to consume the drug, followed by a continued consumption crave, even after being aware/affected by negative consequences.

These adverse consequences can include speech impairment, physical deformity, emotional distress, psychological and cognitive effects as well as a handicap in spiritual health. Even though
drug addicts are aware that excessive drug usage can do harm, they are not informed enough to know to what extent long term internal and external bodily damage can be done. Obviously, the danger is subjective depending on the drug, dosage, method of consumption, age, extent of use and other environmental and medical factors.

The following is a link to an informative chart published by the National Institute of Drug Abuse, United States, and is complete with all the medical jargon, street names and intoxication effects that different classes of legal drugs can have on the body. It is a must read for educating yourself on the dangers that are involved in overusing prescribed medication.

NIDA National Institute of Drug Abuse

A Dummies Guide to Drug Addiction

Before i go into the details of the different drugs that are addictive, i thought I should clear a few myths about drug addiction. The following is a complied list of common myths about addiction. It's important for every person to understand drug addiction without any prejudices or pre-conceived notions.

Common Myths about Prescription Drug Abuse

  • Myth The abuse of prescription drugs comprises only a small part of the nation’s drug problem.
  • Truth Fourteen of the twenty most abused mood-altering substances in this country are prescription drugs.

  • Myth There is no such thing as becoming an addict innocently.
  • Truth Many people become “unwitting” addicts. These are often individuals with noprior history of drug abuse, who first started using a prescribed drug for a legitimate medical problem. Then at some point they started increasing the dosages on their own because the drug made them feel better. Gradually the abuse became full-blown addiction.

  • Myth Physiological dependence is the same as addiction.
  • Truth One can become physically dependent on a drug, say a pain medication, over time.If the drug were stopped, the body would experience withdrawal symptoms. However, this type of dependence is not addiction. A patient with physiological dependence can quit the drug, usually by being tapered off it gradually with medical supervision and without admission into a drug treatment program.

  • Myth You can quite drugs cold turkey if you really want to.
  • Truth Most addicts require professional help to quit. The side effects from withdrawal from certain prescribed medications can be dangerous, leading to coma and even death.

  • Myth Once you have been treated for an addiction to a narcotic, you can safely take other addictive medications.
  • Truth Unfortunately, relapse often occurs when recovering drug addicts believe they are immune to other substances. Once addicted to a mood-altering substance, addicts have the brain chemistry that predisposes them to dependency. This puts them at risk for relapse from something as innocent as an over-the-counter cold medication or a glass of wine.

  • Myth The use of opioids such as OxyContin for chronic pain inevitably leads to addiction.
  • Truth Studies show that the incidence of addiction is low among patients who are treated for legitimate pain.

There are many myths about addiction and I would like to quote Dr. Phelps, who is the Clinical Professor at the Medical School of the University of Washington and is a self declared recovering addict. These myths are:

i. Addicts are criminals.

ii. Only illegal drugs are addictive.

iii. Problems, pressure or stress can turn somebody into an addict.

iv. Addiction is immoral and addicts have weak characters.

v. Addiction is a psychological problem - belief in this leads to treatment of peripheral symptoms which doesn't work and both patients and doctors come to believe the trouble must be in the patient’s mind.

vi. There are different kinds of addiction - this leads to doctors differentiating between physical and psychological addiction and insisting that there are addictive personalities which lead to addiction. In fact, addiction causes an addictive personality (if there is such a thing). As is frequently the case for benzo problems the medical profession puts the cart before the horse. I wonder why they do not suggest that the diabetic personality causes diabetes, or the hypoglycaemic personality causes low blood sugar problems.

I do not believe the medical profession has more than its fair share of members with personality disorders, defects or problems. There are other reasons why it is high in the league of addiction with 5% - 6% of its members addicted to either prescribed drugs, alcohol or hard drugs. Indeed some sections of the medical profession have higher rates e.g. 10% - 12% for anaesthetists in the USA (Aust. Journal of Addiction).

Monday, 12 March 2007

A Basic Introduction to a Complicated Addiction

What is a prescription drug? A prescription drug is a licensed medicine that is regulated by legislation to require a prescription before it can be obtained. In the United States, the other terms for “prescription drugs” are legend drugs, or Rx-only drugs, after the requirements of Federal and State laws that all drugs should bear a “legend” prohibiting sale without a prescription. In the United Kingdom however, they are only referred to as Prescription Only Medicine or POM.

Prescription drugs can fall into many categories like opiods, narcotics, depressants, stimulants, pain relievers. The following is a list of the popular prescription drugs:

  • Drug Type - Opioids/narcotics/ pain relievers -
  • Common Brand Names - Dilaudid, Lorcet, Lortab, OxyContin, Percocet, Percodan, Tylox, Vicodin
  • Drug type - Depressants (benzodiazepines, tranquilizers, barbiturates, sedatives)
  • Common Brand Names - Librium, Valium, Xanax
  • Drug Type - Stimulants, pain relievers
  • Common Brand Names - Adderall, Concerta,Ritalin

The main reason that individuals abuse them is because they are accessible very easily as they are available in any chemist. Also, they are an inexpensive way of altering the users mental and physical state; their effects varying according to the drug and dosage. The term is used to distinguish it from over-the-counter drugs which can be obtained without a prescription. Different jurisdictions have different definitions of what constitutes a prescription drug. As a general rule, over the counter drugs are used to treat conditions not necessarily requiring a doctor's care and will have been proven to meet higher safety standards for self-medication by patients. Often a lower dosage of a drug will be approved for OTC use, while higher dosages will remain the province of a doctor's prescription; a notable case is ibuprofen, which has been widely available as an OTC pain killer since the mid-1980s but is still available in doses up to four times the OTC dose for use in cases of severe orthopedic pain.

Dispensation of prescription drugs often includes a package insert (in Europe, a Patient Information Leaflet or PIL) that gives detailed information about the drug. Unfortunately, these leaflets are rarely read by the customers.

Monday, 5 March 2007

Say Hello to Addiction

In a world where an alarming number of people rely more on drugs than Sunday church for strength to carry on their complex lives, my blog will serve as a database that examines, stores and creates a basic awareness of the addiction to legal, prescribed drugs. Drug addiction is not all about rebellious teenagers and their desperation to scrounge up green bills for buying their daily fix of crack, it penetrates much deeper than that. “Drugs” not only includes doses of illegal substances that need to be smuggled into the country, concealed cleverly in drug paraphernalia and sold in dodgy neighbourhoods, by dodgy people at even dodgier prices, it also includes perfectly legal, over-the-counter medication prescribed by our very own trusted GP’s. And since it is in man’s nature to be tempted, what was first prescribed for assisting him in carrying on with his life slowly becomes his life. At this stage he has finally said 'Hello' to Addiction.
Thus, I hope that through my postings, I will be able to unmask this hidden endemic and help eradicate the very disease that society gave birth to. Please feel free to leave comments :-)