Last updated on January 6th, 2024 at 08:33 am
You don’t have to be a trained physician to know that if a drug or non-drug treatment causes more health problems than it helps the “therapy” should be removed from the market. Despite several Black Box warnings the FDA continues to allow these drugs, and combining these drugs with opioids, to (1) insure that the treated health problem continues and gets worse (2) causes an increasing number of addictions, (3) causes very serious side effects for health problems (anxiety and insomnia) for which the drug gained FDA approval, (4) continues to significantly impair the user’s brain function substantially, (5) and plays a major role in increasing iatrogenic deaths! I know the FDA and the CDC, among others, continue their calls to physicians to only use these drugs short term for anxiety and insomnia and not to increase drug dosages when the dosage is no longer effective. However, after 50 years or so prescribing doctors of these drugs have not listened to these cautionary words. Moreover, why do physicians not take heed of this sage advice? The answer is physicians feel personally responsible for taking care of most of our healthcare problems, including pain. However, their training limits physicians to biophysical solutions such as drugs for anxiety and insomnia (plus as we shall see off-label uses of these drugs) which are best and most safely treated by non-drug therapies delivered by non-physician health professionals.
A little background on this drug class
The drug class includes benzodiazepines, barbiturates, and nonbenzodiazepine (Z drugs), all of which are FDA approved to treat anxiety and insomnia. These drugs impact the GABA neurotransmitter system and help to promote sedation and relaxation and provide a release of tension. Benzos and antidepressants are both addicting drugs but the former are habituating in that for the effects to occur dosages must continue to be increased, which is the principal cause of their dangerousness. The Z drugs (Lunesta, Ambien and Sonata) are now the leader of the three types (barbiturates are rarely used anymore), probably because Z drugs can better target insomnia than the other 2 drug classes. Side effects of Z drugs make the user feel drowsy, dizzy, and unstable while awake. Benzo users have 6 times the fall rate of non-users. Users, while “asleep”, have had sex, made phone calls and even drive cars while “asleep” or half awake. The just mentioned side effects can occur during “waking” hours as well. The Z drugs are said to have advantages over other benzos despite their weird behaviors, better targeting sleep and less likely to become addicted than other benzos. We are told by the makers of Z drugs the user’s memory returns to normal when off the drug but I don’t believe this reassurance is backed up by any evidence of returning memory.
In the U.S. 13.5% of the population use benzos annually (30.5 million persons); 46.3% reported that the motivation for their most recent misuse was to relax or relieve tension, followed by helping with sleep (22.4%) with 11.8 % reported misuse to get “high”. Benzos are prescribed at 66 million office visits annually and OD deaths rose alarmingly from 1,135 in 1999 to 11,537 in 2017!
When I find that any FDA approved drug impairs brain functions I know already that the drug, like most psychiatric drugs, will be used off-label by physicians to treat related or unrelated health problems. The benzos are no exception. These drugs are regularly used in treating chronic pain, either singly or more often with opioids, used as an anti-inflammatory and for night pain and morning stiffness in rheumatoid arthritis. The benzo opioid combination can result in life threatening respiratory depression. 30% of chronic pain patients are taking the combination of a benzo and an opioid, which is of course not recommended by the CDC. It is interesting the benzo adverse side effects (anxiety, restlessness, agitation, fearfulness, sedation, fatigue, somnolence, and confusion) mimic what these drugs are supposed to treat! One wonders why benzo users continue to stay on these drugs, let alone the fact that they are addicting, but I suspect they are part of a very large class of “feel good” drugs. Perhaps many years ago the only “feel good” drugs were the hallucinogenic street drugs but in the past 5 years or so I have noticed that these “feel good” street drugs are increasingly becoming an important part of mainstream medication, especially in the class of psychiatric dugs.
Would healthcare be better off without Benzodiazepines?
As a psychologist having routinely treated patients with anxiety or sleep problems for many years without drugs I believe these and related disorders can be and are treated effectively without drugs by psychologists. Physicians have only one tool to treat pain and that is drug treatment. Is there any need at all for at least some of these drugs? Yes, I believe there is. Physicians in their offices or Emergency Rooms come across patients who are experiencing the health effects of severe trauma and these drugs are justified but only as a short term or stopgap measure. These patients should be immediately referred to health professionals, such as psychologists, who have the training and expertise to treat these health problems. Until this happens the opioid epidemic will continue in years to come. The solution to the problem is not sending these patients to drug rehab—which again is backend medicine—but let’s comprehensively treat the causes of the health problem that confronts society.
One last word on this subject. Benzodiazepines are routinely used in hospitals for patients facing major surgery. This practice reflects medicine’s limited knowledge of pain and how to address patients’ pain. I suspect about 20% of hospitalized patients facing major surgery could be prepped for the surgery with psychological measures and undergo surgery without any anesthetic! Other patients who with assessment are found to be less suggestible than others could perhaps undergo surgery successfully and do well with lower doses of the anesthetic. This last suggest a need for experimentation. It is clear from the literature that when surgical patients are taught to manage their fear (of pending surgery without an anesthetic) these patients bleed less and recover from surgery much faster than those taking an anesthetic for surgery.
