Have you heard about the next looming drug crisis after opioids? It appears not all physicians have. According to a recent study in JAMA, while doctors are sharply curbing prescriptions for opioids, benzodiazepine prescriptions are rising at an alarming rate.
Benzos are fiendishly addictive. Dependence takes hold after only two weeks, requiring more to get the job done, which can ultimately lead to a fatal overdose. It’s not recommended that doctors prescribe this class of drug for longer than a month. Yet prescriptions often do run much longer.
Mine did. Ativan was my poison. My primary doctor had prescribed it to me for a sleep ailment, to solve the fallout of not sleeping, the minefield of anxiety and panic attacks I navigated during the day. I’d started off on Xanax, a marvelous mood enhancer because the cavalry shows up really fast. The only problem for me was, it didn’t stick around long enough.
Ativan, however, was in no rush. It would hang around for six hours. It didn’t render me dopey or drugged up—that was the beauty of it. With Ativan, it was more a case of very precisely erasing whatever was bothering me.
I took it daily, first half a milligram, climbing the ladder eventually up to four. Then when my medical team finally uncovered what was preventing me from sleeping, I was left with a withering addiction under doctor supervision.
Nobody told me to get off of the pills or even suggested that I should. I’d still be legally on them were it not for a balky new year resolution. My insurance company was no help in my withdrawal either. Thanks to their auspices, Ativan cost pennies per pill, yet footing the tab for rehab was apparently a bridge too far.
I was left to make that passage by myself. Perhaps my carrier was already aware of a nasty fact about benzos: the typical model of rehab doesn’t work for them. First off, withdrawal takes a lot longer than 28 days. Also, the usual cold turkey methodology isn’t applicable because of the danger of seizures, heart attacks and strokes.
Lucky for me, my wife is an inquisitive sort. Janet will study her computer screen with a pouty face until locating the information she needs. In this case, she returned from her online spelunking with the Ashton Manual, a systematic approach for withdrawing from benzos, developed in England, at Newcastle University, by Professor Heather Ashton.
My primary doctor had never heard of it. Neither and the rest of the professionals at his practice. Only when consulting a psychopharmacologist did I find a doctor familiar with Professor Ashton’s pioneering work.
Ashton’s withdrawal strategy involves a gentle tithing rather the usual abrupt farewell. It’s still hell, except, following the Ashton Manual, it’s a much smaller plot in the neighborhood. Each week, a bit more of the pill is sliced off until you eventually dwindle down to nothing.
After four months I was drug free. Then it took another couple of months for my GABA receptors in my brain to begin reliably kicking in again. My primary doctor by then had become secondary: I no longer saw him. Over-prescribing Ativan for me was only part of the reason. The bigger one was that he’d prescribed a medication that he had no clue how to withdraw from.
Perhaps this is just my OCD nature shining through, but it seems drugs should obey a certain law of symmetry. For every pill prescribed, there should be a prescribed exit path. And don’t just leave it to doctors. It wouldn’t hurt for Big Pharma to include that information, too. As should insurance providers, who seem to have one big greasy handshake going on with drug companies.
Beyond that, perhaps the rehab model should be expanded to better handling benzodiazepine withdrawal. Some pills can take an awfully long time to exit. That’s just how drugs of the mind are. After the party’s over, the unwanted guests hang around for a while.
But maybe we shouldn’t take so long coming up with answers. Benzodiazepines are number two with a bullet in drug overdoses, behind heroin, in Scotland. Ireland is witnessing a similar tragic uptick, as is Canada and Australia.
With benzos, it’s only a matter of time. The crisis is here and patients shouldn’t be left to their own devices like I was to find the best way for safely withdrawing from them.