Diazepam, Oxazepam, Lorazepam, Temazepam and other benzodiazepines…involuntary addiction
In accordance with Guidelines set out in the 1980s, and repeated in every British National Formulary since, benzodiazepine drugs should only be prescribed for 2-4 weeks at most, and in the lowest dose possible, for patients with a severe problem (such as acute anxiety in coping with a flight abroad, or dental procedures, or a short-term sleep issue). Such drugs are not recommended for grieving patients, other than as an initial short-term aid to sleep. Benzodiazepines should never be used for mild anxiety.
This is because:
- Patients usually rapidly become tolerant to the effects of the medication. Physical and psychological dependency can develop. Some patients start to take more than the prescribed dose, or may find themselves supplementing the medication with alcohol, or other potentially harmful substances, in order to achieve the same effect;
- Patients can suffer from withdrawal symptoms, during the treatment, without any reductions, due to tolerance and lost drug effect. Patients on short acting agents can also suffer from symptoms in between doses. These are often taken to be related to an underlying condition, rather than the paradoxical effect of the drug itself. As with all withdrawal reactions, these symptoms can be wide ranging. In simple terms, the drug starts to add to a patient’s problems.
- As per Heather Ashton: “When tolerance develops, “withdrawal” symptoms can appear even though the user continues to take the drug. Thus the symptoms suffered by many long-term users are a mixture of adverse effects of the drugs and “withdrawal” effects due to tolerance.”
- Once a patient is dependent the drug should never be withdrawn quickly as patients can experience a very unpleasant withdrawal reactions which cause real difficulties in coping with day to day life. In some cases, this can last several years in duration.
Even for patients suffering from a chronic mental health condition, who may require repeated prescriptions of benzodiazepines this class of drugs should, ideally, only be prescribed every now and again for a short period. This is with a view to helping them to get over an acute episode, to get to the point where therapeutic support (e.g. psychotherapy) can be given.
Patients should not simply be left on a benzodiazepine without a broad range of other therapeutic measures being properly considered.
Management of withdrawal
There are guidelines for withdrawing patients from benzodiazepines, and it can be very dangerous for patients to suddenly stop taking benzodiazepines (the Ashton Manual). Most patients would experience immediate effects of withdrawal but some can feel fine for a few weeks, even months, after stopping such medication, but then go into sudden withdrawal, with very serious consequences upon their day to day functioning.
It is very important that any patient who may have become dependent on benzodiazepines, is withdrawn very slowly and carefully, with regular monitoring. It is equally important to educate the patient in relation to the withdrawal process and the symptoms they may experience, so that day to day functioning can be preserved as far as possible. Each patient’s susceptibility to withdrawal effects can be different.
Our Director, Caroline Moore, has acted in various claims, stemming from mis-prescribing of benzodiazepines and the failure to manage withdrawal reasonably, a few examples of which are as follows:
- £725,000 to a gentleman who was advised to undergo a rapid detox from Clonazepam, and was withdrawn very suddenly, having only been given a few days of phenobarbitone to prevent him from having seizures. He suffered a severe withdrawal syndrome over a period of years to the extent that he could not function normally and had to resign from his job as the CEO of a media business.
- £50,000 to a generally anxious lady who was prescribed a few Oxazepam tablets to cope with her fear of flying when going on a holiday. However, her GP continued to prescribe the medication after the holiday and she became dependent upon the drug.
- £50,000 to a gentleman who had been allowed to take Lorazepam for over 30 years by his GPs; who was then prescribed a large amount of this drug, as well as Diazepam, and allowed to leave the UK to go travelling with this large supply. He was later advised by his GPs to use his travels to, “withdraw slowly”. He suffered an acute withdrawal reaction, from which it took years to recover.
- £50,000 to a gentleman who became dependent upon Lorazepam prescribed by his GP who prescribed outside the BNF guidelines.
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British National Formularies and MIMs for prescribers
The Ashton Manual- http://www.benzo.org.uk/manual/