On February 25, Kristina Fiore published an article on MedPage today. It’s titled Killing Pain: Xanax Tops Charts.
The article is based on a study conducted by Jann M et al, and published in the February 2014 issue of the Journal of Pharmacy Practice. The study is titled Benzodiazepines: a major component in unintentional prescription drug overdoses with opioid analgesics. Here’s a quote:
“During 2003 to 2009, the 2 prescriptions drugs with the highest increase in death rates were oxycodone 264.6% and alprazolam 233.8%. Therefore, benzodiazepines have a significant impact on prescription drug unintentional overdoses second only to the opioid analgesics. The combination prescribing of benzodiazepines and opioid analgesics commonly takes place. The pharmacokinetic drug interactions between benzodiazepines and opioid analgesics are complex. The pharmacodynamic actions of these agents differ as their combined effects produce significant respiratory depression.”
Alprazolam is a benzodiazepine. It was marketed as Xanax in 1981, and has been available in generic form since 1993. It is used by psychiatrists as an anti-anxiety agent.
When the benzodiazepines were first introduced, it was widely claimed, both by psychiatrists and by pharma, that they were non-addictive. This claim was subsequently abandoned in the face of overwhelming evidence to the contrary, and the addictive potential of these products is now recognized and generally accepted. Incidentally, you can find some interesting history on the promotion of tranquilizers, including benzos, on a Medpage timeline published last month. The timeline presents ads gathered from the New England Journal of Medicine and from the Journal of the American Medical Association. It’s tawdry stuff. Thanks to Laura Delano for the link.
Back to Ms. Fiore’s article.
“When a patient comes in with complaints about anxiety, it’s easy to write a prescription for Xanax, Jann said. Like other benzodiazepines, it’s cheap and it’s perceived to be safe.”
She also quotes Daniel Carlat, MD, professor of psychiatry at Tufts:
“Xanax really is a tried and true medication…When patients take it, they feel its effect quickly.”
“It also goes to work fast, which may be a reason why patients show a preference for it…”
Miss Fiore has also interviewed Allen Frances, MD, former psychiatric chair at Duke and architect of DSM-IV:
“And the drug is an easy solution for primary care doctors who are pressed for time, said Allen Frances, MD, a professor emeritus and former chair of psychiatry at Duke University.
Indeed, the majority of benzodiazepine prescriptions in 2013 were written by family practice or internal medicine doctors, totaling some 44 million prescriptions. That’s vastly more than the 13 million written by psychiatrists.
Frances said that if the FDA were to conduct a thorough review of Xanax, it might not be so widely prescribed.
‘The effects of Xanax are much more subtle and dangerous,’ he said. ‘In combination it can be deadly, and for many people it creates an addiction problem that’s worse than the original condition.’
‘I think if there was a careful review of its risks and benefits, it would be taken off the market,’ he added, ‘or it would at least have much more restricted use.'”
Dr. Frances has reinvented himself in recent years as an outspoken critic of DSM-5 and of psychiatric excesses generally. His points are usually cogent and well made, but he remains unreceptive to the fact that his own brainchild, DSM-IV, was an integral step in psychiatry’s spurious and self-serving medicalization of non-medical problems.
The fact is that anxiety is not an illness, and drugs that dissipate anxiety are not medications – they are drugs.
Benzodiazepines have a legitimate use in general medicine, and in that context are indeed medicines in the proper sense of the term. But when prescribed for anxiety on a routine, daily basis, they are drugs. They fall into the class of drugs that addictionologists call sedative-hypnotics, and are similar in their general effects to alcohol and opiates. I worked in the chemical dependency field in the late 80’s – early 90’s, and even then we were admitting large numbers of people addicted to benzos. It was, and is, an extremely difficult addiction to overcome. Withdrawals are typically difficult, protracted, and sometimes dangerous. Monica’s Cassani’s website Beyond Meds goes into this in great detail.
Dr. Frances makes the point – undoubtedly true – that general practitioners prescribe more benzodiazepines than psychiatrists. This is a common cry from psychiatry when confronted with the damage that their products are causing. But the argument is specious, because no practitioners could prescribe these drugs as a daily “treatment” for anxiety if psychiatry had not, in the first place, promoted the false message that anxiety is an illness. No doctor could prescribe these products for these purposes if psychiatry had not invented, packaged, and sold their various anxiety “diagnoses.” When psychiatry embarked on its great mission to medicalize every conceivable human problem, they basically drove the bus off the cliff . Mental health today is still in a state of uncontrolled free fall. And every time we hit an outcropping, or the bus turns end over end, psychiatry says: “Oh dear! How did that happen?” Well it happened because organized psychiatry put money and prestige above intellectual and moral integrity. The damage this has done, and continues to do, is beyond reckoning.
Psychiatry has damaged and killed human beings who came to them for help. They have routinely disempowered people, and have spuriously equated all human distress to their confidently-touted, but fictitious, chemical imbalances, and, more recently to the twitching of aberrant neural circuits. They have arrogantly promoted themselves as the arbiters of normalcy and the healers of emotional pain. They have systematically undermined the notion of self-improvement through effort, and through natural social support networks. They have enslaved millions to their toxic psychotropic chemicals. And we haven’t hit bottom yet.
Anxiety is not an illness. It is a normal human response to ambiguous or potentially challenging or dangerous situations. I’ve written more on this in my post Anxiety Disorders. Modern life is fraught with anxiety-arousing situations. If psychiatry had had the slightest interest in truly helping people, it would have focused on this reality, and developed genuinely helpful concepts and practices in this area. But there isn’t much money in that.
So instead, intoxicated by its customary delusion of infallibility, it did what it always does: issued the self-serving decree that anxiety is an illness best treated by “medications.”
Dr. Frances is correct: benzodiazepines should be taken off the market – not only because they are dangerous, but also because the notion of washing away people’s anxieties and concerns in a drug-induced haze of semi-euphoria is fundamentally disempowering, and makes a mockery of the practice of medicine. The only possible honest response from a physician who is asked to treat anxiety, is to point out that anxiety is not a medical matter.
People who take these drugs as a routine measure to insulate themselves from life’s multi-variate challenges and vicissitudes are not medicated. They are stoned.
And the great irony here is that everybody knows this. The individuals know it; their family members know it; their friends and co-workers know it; the psychiatrists themselves know it. And the street pushers who obtain benzos illegally know it.
But the great fiction has to be maintained. Here’s a quote from Benzodiazepines: A versatile clinical tool, by Bostwick et al in Current Psychiatry, April 2012
“Since the discovery of chlordiazepoxide [Librium] in the 1950s, benzodiazepines have revolutionized the treatment of anxiety and insomnia, largely because of their improved safety profile compared with barbiturates, formerly the preferred sedative-hypnotic.”
And psychiatry and pharma go on making a killing. According to the Kristina Fiore article mentioned earlier, there were 94 million prescriptions for benzos written in the US in 2013. Psychiatry is out of control.