Benzodiazepine tranquillisers - facts every patient should
'The world's biggest addiction problem is not teenagers taking hash but
middle-agers taking sedatives. The tranquilliser is replacing tobacco. It will,
perhaps, give us an even bigger problem. It may prove even more dangerous.
Already Valium is said to be taken by 14% of the population of Britain.'
'The habit usually starts insidiously. The patient may have a good
excuse for taking a few tablets. A close friend or relative has died or there is
a rush on at work. And the doctor finds it difficult to refuse the request for a
'The drugs which people take to help relieve their
pressures vary. If he is young the addict may take drugs from a pusher. If he is
older he may take drugs from a medical adviser.'
Quote taken from
'The Medicine Men' by Dr Vernon Coleman, 1975
During the 1950s and 1960s
the type of problem being discussed in the doctor's consulting room changed and
family doctors found that they were expected to deal with mental and
psychological problems as well as physical problems. They were, for the first
time, consulted by patients who wanted comfort, support, encouragement and help
with social and personal problems. As the link between stress and disease become
better and better known so more and more patients went to their doctors wanting
help with dealing with the stress in their lives.
But there was a big
problem. Doctors had never been trained to cope with psychological or stress
induced problems. Most physicians had been taught more about tropical diseases
than they had about anxiety or depression.
So, when the benzodiazepines
were introduced and described as safe and effective drugs for the treatment of
anxiety and a wide range of stress related disorders doctors welcomed the new
pills with open arms and prescribed them in huge quantities.
is that for years now the biggest drug addiction problem in the world today has
involved legally prescribed benzodiazepine tranquillisers and sleeping tablets
which are widely and regularly prescribed for long periods for men, women and
children suffering from stress and stress related symptoms.
hard to believe but I first wrote about the dangers of tranquilliser addiction
back in 1973. Over the decades that I have been campaigning to get these drugs
controlled more effectively - and to persuade doctors to prescribe them more
carefully - I have received tens of thousands of letters from tranquilliser
addicts all over the world. In one month alone I counted over 6,000 letters.
After hundreds of articles and TV programmes my campaign to warn
patients and doctors about the dangers of these drugs eventually forced the
politicians to take action in Britain.
In 1988 - after 15 years of
campaigning - doctors were warned of the hazards of handing out drugs such as
diazepam, lorazepam, nitrazepam and temazepam for long term use.
(`Dr Vernon Coleman's articles, to which I refer with approval,
raised concern about these important matters,' said Edwina Currie, Parliamentary
Secretary for Health, in the House of Commons in 1988. She was referring to the
introduction of new controls relating to the prescribing of benzodiazepine
The simple truth is that the benzodiazepine
tranquillisers can cause all sorts of problems if they are taken for more than
two weeks or so. Long term use can cause all sorts of very real problems. And
patients who have been taking the drugs for more than a week or two need to cut
down slowly if they are to avoid withdrawal symptoms.
Here are some of
the warnings given by the manufacturers of a well known benzodiazepine:
* Symptoms such as anxiety, depression, headache, insomnia, tension and
sweating have been reported following abrupt discontinuation of benzodiazepines.
Other reported symptoms include tinnitus, involuntary movements, confusion,
convulsions, muscle cramps, abdominal cramps and vomiting.
taking the drug may become dizzy or drowsy and should be warned against driving
or operating machinery.
* Elderly patients may need to be given smaller
doses. They may be more sensitive to the drug.
* The use of
benzodiazepines may release suicidal impulses in depressed patients.
Behavioural effects of the drug include excitement, aggressive outbursts and
confusion. Loss of memory may occur.
* Other reported side effects may
include: hangover, headache on waking, dizziness, blurred vision, nausea,
depression, changes in appetite, sleep disturbance, blood problems, visual
disturbances, low blood pressure, intestinal disturbances and skin rashes.
For well over twenty years now I have repeatedly warned that drugs in
the benzodiazepine group are being wildly overprescribed and can cause
tremendous problems. (For most of that time I was abused and attacked by many
members of the medical establishment who maintained that there were no
And I have on many occasions warned that drug abuse experts
have told me that getting patients off these drugs is frequently more difficult
than getting patients off heroin.
Sadly, it seems that although some
doctors now accept that these drugs can cause problems there are still doctors
in practise who do not understand the problems the benzodiazepines can produce.
If you see a doctor who tells you that the benzodiazepines never cause
problems, don't cause addiction and can be stopped suddenly without danger my
advice is simple: change doctors fast.
Here, for the record, are some facts about
tranquillisers which many doctors still don't seem to know. Look at the dates
In 1961, just a short time after
chlordiazepoxide (the first widely prescribed benzodiazepine) had been
introduced into clinical practice a report was written by three physicians from
a hospital in California. Entitled 'Withdrawal Reactions from Chlordiazepoxide'
the paper described very dramatically how patients who had been taking the drug
suffered from withdrawal symptoms when the drug was stopped. The authors
described how eleven patients who had been taking fairly high doses of
chlordiazepoxide for up to six months were quite suddenly taken off the drug and
given sugar tablets instead. Ten of the eleven patients experienced new symptoms
or signs after the withdrawal of the chlordiazepoxide. Six patients became
depressed, five were agitated and unable to sleep, two had major fits.
Testifying to a US Senate Health sub committee in
Washington in 1979 a psychiatrist claimed that patients could get hooked on
diazepam in as little as six weeks. The same committee heard testimony that it
is harder to kick the tranquilliser habit than it is to get off heroin.
In 1975 three doctors from the Drug Dependence
Treatment Center at the Philadelphia VA Hospital and University of Pennsylvania,
Philadelphia, published a paper in the International Journal of the Addictions
entitled 'Misuse and Abuse of Diazepam: An Increasingly Common Medical Problem'.
The three authors of the paper referred to papers published as far back as 1970
which had documented instances of physical addiction to chlordiazepoxide and
diazepam and reported that since the end of 1972 they had noticed an increasing
amount of diazepam misuse and abuse. Their paper concluded: 'All physicians
should know that diazepam abuse and misuse is occurring and careful attention
should be given to prescribing, transporting and storing this drug.'
In 1972 the American Journal of Psychiatry
published a paper in which two doctors described how patients on diazepam had
exhibited a cluster of symptoms which included tremulousness, apprehension,
insomnia and depression. The patients had all been previously emotionally stable
and the symptoms, which started suddenly, were quite severe. When these patients
were taken off their diazepam their symptoms disappeared.
In 1968 the Journal of the American Medical Association described a
series of eight patients who had been given diazepam. The patients became so
depressed that seven of them had suicidal thoughts and impulses and two of them
made serious attempts to commit suicide.
reports published in the 1960s and 1970s showed that the benzodiazepines seemed
to increase hostility, aggressiveness and irritability. The benzodiazepines have
also been associated with baby battering.
paper published in 1979 researchers found a 'highly significant association
between the use of minor tranquillisers and the risk of a serious road
accident'. The conclusion was that a patient's risk of being involved in a
serious accident was increased five fold if he or she was taking a
Back in 1982 the Committee on
Safety of Medicines advised doctors that the benzodiazepines should be
prescribed for short periods only and that withdrawal symptoms could be avoided
by withdrawing medication slowly.
75-year-old lady was admitted to a British hospital in the early 1970s she was
unable to walk or speak clearly and was confused and incontinent. She had been
taking a benzodiazepine sleeping tablet for a year. When her pills were stopped
she made a physical recovery in three days.
The sad truth is that for
years any doctor who has studied the medical journals has known that the
benzodiazepines cause problems.
But doctors are still prescribing these
damned pills by the lorry load.
If you are hooked on a benzodiazepine
tranquilliser or sleeping tablet you will need to wean yourself off your drug
Here are some vital tips to help you.
1. Before doing
anything visit your doctor and ask for his or her help. If he is unhelpful, if
he tells you to cope by yourself or if he insists that you don't need to worry
and that withdrawal is easy then I suggest that you find yourself a new doctor.
There are plenty of good doctors around who understand the problem and who are
prepared to help. Talk to friends and neighbours to find the name of a good
2. You may experience unpleasant symptoms (see list). The
most common withdrawal symptoms include: tremor and shaking, intense anxiety,
panic attacks, dizziness and giddiness, feeling faint, an inability to get to
sleep and an inability to sleep through the night, an inability to concentrate,
nausea, a metallic taste in your mouth, depression, headaches, clumsiness and
poor coordination, sensitivity to light, noise and touch, tiredness and
lethargy, a feeling of being 'outside your body', blurred vision, hot and cold
feelings and a burning on your face, aching muscles, an inability to speak
normally, hallucinations, sweating and fits.
3. Remember that you can
minimise your symptoms by reducing your dose slowly. The rate at which you
reduce your pills will depend upon the size of the dosage you have been taking
and the length of time for which you have been on the pills. As a rule of thumb
you should not go faster than to halve your dose every two weeks until it can no
longer be halved. Some patients insist that this is much too fast. Others say it
is too slow. Many seem to think it works well. For example, if you are taking
six tablets a day then reduce to five a day for four days then to four a day for
another four days, then to three a day for four days. That will mean that you
will have halved your initial dose in your first two weeks.
that the benzodiazepines cure nothing. But they do cover symptoms up. If you
originally took your tablets for anxiety then the chances are that your original
symptoms will return when you stop taking the tablets. Be prepared for this.
5. Warn your family and friends that you are likely to be going through
a difficult time. Tell them what to expect and explain that you would welcome a
little extra support, guidance, sympathy and patience. If you know someone else
who wants to kick the habit then plan to do it together. Ring one another up,
keep in touch, share your problems and keep your determination alive.
Do not try to give up these pills if you are going through a tricky patch at
home or at work. Wait until things are more settled before you try to give up
7. Do not be tempted to try carving your tablets into tiny
pieces. Break them into half by all means. But carving pills into fractions
tends to make the whole procedure more difficult. It also makes everything more
dramatic. Ask your doctor to prescribe the lowest dose of pills available so
that you have the maximum amount of flexibility.
8. Do not despair if
you reach a plateau and have difficulty in reducing your pills any more. Do not
even despair if you have to increase your pills temporarily. You must stop these
drugs at a rate that you find comfortable.
9. If you are taking a drug
like lorazepam (which many experts believe is particularly difficult to come
off) then your doctor may recommend that you substitute diazepam for part of the
lorazepam and then cut down both drugs gradually. This MUST be done under
medical supervision. Some people find that this helps cut down the withdrawal
10. If you want to try a really gradual cutting down technique
your doctor may suggest that you try the 'staging' technique. If, for example,
you were taking three tablets a day to start with your routine would look
something like this:
day one: three tablets
day two: two tablets
days three to seven: three tablets
day eight: two tablets
to twelve: three tablets
day thirteen: two tablets
days fourteen to
sixteen: three tablets
day seventeen: two tablets
days eighteen and
nineteen: three tablets
day twenty: two tablets
day twenty one: three
days twenty two to twenty six: two tablets
day twenty seven: one
days twenty eight to thirty one: two tablets
day thirty two: one
days thirty three to thirty five: two tablets
day thirty six: one
days thirty seven and thirty eight: two tablets
day thirty nine:
day forty: two tablets
days forty one to forty five: one
day forty six: no tablet
days forty seven to fifty: one tablet
day fifty one: no tablet
days fifty two to fifty four: one tablet
day fifty five: no tablet
days fifty six and fifty seven: one tablet
day fifty eight: no tablet
day fifty nine: one tablet
day sixty: no
The procedure can then be continued in the same way with a
reduction to half a tablet. The advantage of this system is that it gives your
body plenty of time to get used to each new step down. Obviously, the same
technique can be adapted to suit any patient on any starting dose.
question tranquilliser addicts ask most often is: `How long does withdrawal
last?'. And it is the question that causes most controversy.,
experts claim that withdrawal should take no more than a few weeks. One expert I
know says that it can last for 10% of the time for which pills were taken. Some
former addicts claim that it has taken them years to get off their pills.
The truth is that there is no fixed time for withdrawal. Some people can
do it in days. Some take months.
But one reason for some of the
confusion is that doctors and patients are sometimes talking about two quite
separate things when they talk about withdrawal.
When drug addiction
experts talk about the length of time it takes to come off tranquillisers they
are talking about the period of time over which physical withdrawal needs to be
spread. To keep physical withdrawal - the symptoms produced by the body being
deprived of the drug - to an absolute minimum, the drug needs to be cut down
'But,' say these experts, 'it is important not to spread the
physical withdrawal over too long a period.' If the pills are cut down too
slowly then the patient will be taking the drug for longer than is necessary.
'The quicker you stop the pills,' the argument goes, 'the quicker you will
recover. Spread the withdrawal over too long and your recovery will be slow.'
Patients sometimes respond to this by pointing out that although they
cut down their pills in a matter of weeks they are still getting side effects
But this does not necessarily mean that these side effects
are withdrawal effects.The whole picture is confused by several other factors.
First, it is important to remember that the benzodiazepines do not cure
anything. If you were put on a tranquilliser ten years ago because you were
feeling anxious and unhappy then the pills will have numbed your mind for ten
years - but they will not have stopped your initial problem. When you stop the
pills your anxiety will still be there. While you were taking the pills you may
not have noticed the anxiety symptoms.
If you were given your pills
fifteen years ago to cover up the unhappiness of a bereavement then you will
once more have to endure the unhappiness of that bereavement. The
benzodiazepines will have put your emotions into a sort of pharmacological 'deep
Second, although the benzodiazepines do not cure anything they
do numb the mind. They seal you off from the world and prevent you from
experiencing the normal highs and lows of everyday life. Taking these drugs is
like having your brain wrapped in a thick layer of cotton wool. While taking the
drug you are immune to many of the pressures of everyday living; the world will
be uniformly grey; you will be permanently anaethetised.
Once you stop
your pills your mind will suddenly be exposed to a whole range of stimuli. The
anaesthetic will 'wear off' and you will 'wake up'. It can be a frightening
experience. The world will suddenly appear a good deal brighter. Noises will
seem louder and joys and sorrows will seem more acute. So, in addition to having
to cope with old, half forgotten emotions you will find that your nerve endings
are raw and easily stimulated.
Since all these symptoms occur
immediately after stopping or cutting down the pills you will probably assume
that the symptoms have developed because you have stopped your drug too quickly.
I don't think that this is necessarily the case. The symptoms are an inevitable
part of coming off tranquillisers but they will be there however slowly you
reduce the dose. Extending the withdrawal period doesn't always affect the end
result at all - it may merely prolongs the agony.
Finally, it is
essential that anyone planning to give up tranquillisers should spend a lot of
time and effort learning how to relax and how to deal with stress.
withdrawal symptoms should tranquilliser addicts expect?
Some people are
lucky. They can stop taking one of these drugs with relatively few - or even no
- side effects. Others are less fortunate. Here is a fairly comprehensive list
of the side effects that patients have complained of while coming off
benzodiazepine tranquillisers and sleeping tablets.
loss of appetite
difficulty in swallowing
metallic taste in the mouth
difficulty in breathing
altered blood pressure
swollen hands, face or feet
tremors and shakes
corners of mouth
sexual desire changed (reduced or increased)
increased vaginal secretion
difficulty in passing urine
lack of initiative
despair and depression
wanting to commit suicide
lack of confidence
a fear of going insane
aggression and rage
lack of a sense of humour
being demanding and giving other people a hard time
having destructive thoughts
tension in the head,
neck and shoulders
pins and needles
hot and cold shivers
fatigue and exhaustion
feeling of having a
tight band around the head
numb hands and feet
reliving the past
around the mouth
hypersensitivity to touch, smell, light or noise
in the ears (tinnitus)
a feeling of unreality
feeling of being unreal in one's own body)
visual disturbances - objects
seeming smaller or larger
blurred vision and other visual problems
Using tranquillisers or sleeping tablets to
combat the effects of stress is like wrapping a blanket round a fire alarm
because you don't like the noise. But do not stop taking tranquillisers or
sleeping tablets or try cutting down without getting professional help from your