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Misery of the tranquilliser addicts forced to go cold turkey by GPs

By Jo Waters
Updated: 02:32 BST, 22 March 2011

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Helen lay shaking and sobbing in the drug addiction detox unit. The 61-year-old businesswoman was racked with such excruciating pain she wasn’t sure she could survive it.

What’s so shocking is that unlike the other patients at the unit, who were struggling with heroin or cocaine addictions, the only  drugs Helen had ever taken were the  tranquillisers prescribed by her GP for depression and anxiety.

‘Seven years ago, my doctor gave me Valium, which I thought would just get me through a rough patch,’ recalls Helen, who is married with a daughter. ‘I had no idea they were addictive.’

Benzodiazepines are commonly prescribed as a treatment for severe anxiety and insomnia – last year ten million prescriptions were issued in England alone

Two years ago, she began to suffer from chronic dizziness — her GP sent her for brain scans and heart tests but these proved inconclusive, so Helen did her own research, and discovered that her symptoms matched the symptoms of the long-term side-effects of common tranquillisers.

‘When I went back to my GP, he said my symptoms had nothing to do with drugs and asked me why I wanted to come off them,’ says Helen.

Even when she did finally get herself into a detox unit, the drugs were withdrawn at a much faster rate than officially recommended, causing her such terrible side-effects she’s had to go back on to the drugs.

Helen is one of an estimated 1.3 million Britons addicted to prescription tranquillisers, also known as benzodiazepines.

These drugs include diazepam (known previously as Valium), Xanax, Ativan, Serax and Librium. They are commonly prescribed as a treatment for severe anxiety and insomnia — last year ten million prescriptions for benzodiazepines were issued in England alone.

They work by boosting the action of a naturally occurring brain chemical called GABA (gamma-aminobutyric acid). GABA tells brain cells to slow down and stop firing, and has a calming effect on the brain, muscles and heart rate, helping to ease the insomnia that often accompanies anxiety.

But the drugs use the same addictive pathways in the brain as illegal drugs such as heroin. Patients often need progressively higher doses as the body becomes accustomed to the drug — these higher doses can cause side-effects including paranoia, fatigue, dizziness, memory problems and dulled emotions.

Because of the high risk of addiction, the UK’s Committee for Safety of Medicines issued guidelines back in 1988 advising GPs that the drugs should be prescribed for no more than two to four weeks.

Despite this, there are huge numbers of patients who’ve been left on the pills long term, even for decades, say campaigners.

The concern now, however, is that over the past year GPs have performed a drastic U-turn and, without warning, are rapidly reducing patients’ drug doses in a short space of time to get them off the drugs.

Campaigners believe this has been prompted by a Department of Health review looking into the number of prescriptions GPs are issuing for benzodiazepines.

But going ‘cold turkey’ in this way can cause severe withdrawal effects, including excruciating pain in the muscles and joints, insomnia, and even suicidal thoughts.

Barry Haslam, the chairman of Oldham TRANX, a support group for patients addicted to benzodiazepines, says the charity is taking calls from people all over the country about being suddenly and abruptly withdrawn from their tranquillisers.

Apart from the crippling side-effects, he points out that, ‘most patients are just left to go on with it on their own.

‘And even if they are offered help it’s usually a referral to a detox unit for illegal drug users, and that is just not appropriate because they bring patients off the drugs in too short a space of time.’

Official advice for health professionals (NHS Clinical Knowledge Summaries) suggests reducing a patient’s dose of benzodiazepines  by five to ten per cent every one to two weeks. Once a lower dose is reached, the reduction should be slowed.

It acknowledges that it may take a year or longer for patients to come off the drugs and stresses a patient must be stable, and willing to come off their tablets — and that the withdrawal plan should be tailored to their individual needs.

Campaigners say it’s the latter point that is crucial; patients should be allowed to proceed at their own pace and have their personal situations taken into account.

Dr Trevor Turner, a consultant psychiatrist at the East London Foundation Trust, says: ‘GPs are caught in the middle between trying to be humane prescribers — after all, some of these patients really do need this medication to function — and following clinical guidelines.

If patients do want to come off their medication they should be offered alternative therapies such as cognitive behavioural therapy, relaxation classes and maybe alternative medication such as anti-depressants.’

One of those affected by the new change of heart about benzodiazepines is Steven James. The  26-year-old writer was shocked when he received a terse phone call from his GP practice six months ago telling him he must quit his prescription tranquillisers.

‘My old doctor retired and a new doctor rang out of the blue last summer and said my pills were addictive and were only a short-term treatment,’ recalls Steven, who lives in Cardiff.

‘I was horrified as this had never been mentioned to me before.

Steven was 14 when he was first prescribed diazepam for panic attacks.

‘I was on a repeat prescription, and if I felt stressed or anxious my GP would put it up a bit more each time. No one ever mentioned I shouldn’t be on them long term.’

But Steven’s new doctor was adamant he must come off the drugs, and reduced his prescription by 2mg a fortnight from his daily 45mg a day. He is now taking 20mg, but although this reduction rate was in line with official advice, Steven has found it hard to function and he suffers from  headaches, lack of concentration and panic attacks.

‘The effects are horrendous,’ he says.

In some ways, however, he’s been more fortunate than patients such as Helen, whose prescription was reduced at a much more brutal rate.

Initially undeterred by her GP’s reluctance to take her off the drugs, Helen had started to follow The Ashton Manual, an online guide to coming off benzos written by Professor Heather Ashton, an expert in benzodiazepines.

‘I gradually reduced my dosage down from 15mg a day to 1.5mg over ten months, but I was in excruciating pain,’ she says.

‘In desperation, I called my GP who said I would have to have my dosage increased to 20mg a day to stabilise my condition — which was higher than when I started out.’

So Helen rang her local drug and alcohol misuse service, who suggested she go to a residential NHS Detox Unit, and made a referral.

‘The problem is that the staff reduced my dosage far too rapidly — from 16.5mg to 8mg in two weeks, which is the speed used for illegal drugs. I was in a terrible state, crying and shaking. After a four week break, I was re-admitted and my dosage was reduced to zero.’

Eight weeks later, the pain was so bad that Helen had to go back on diazepam and is back up to 15mg.

‘I don’t want to stay on the pills — they suppress all your emotions and make you feel like you’re in a parallel universe,’ she says. ‘I will come off them eventually, but it has to be at my own pace and I need support to be able to do this.’

The solution, ultimately, is for psychiatrists, GPs and patient groups to sit down ‘and thrash out a good set of guidelines on monitoring and assessing patients’, says Dr Martin Johnson, a GP and trustee of the Patients’ Association.

A Department of Health spokesman says: ‘GPs should be prescribing benzodiazepines and managing withdrawal from these drugs based on their clinical judgment of their patients’ needs and in line with the guidance available to them.’

However, patients such as Steven and Helen say they can’t come off these drugs alone.

‘All I’m asking for is a GP or psychiatrist to be willing to help me,’ says Steven. ‘And that means more than just stopping the prescription.’

 

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