Benzodiazepines and the Elderly in the UK

Benzodiazepines and the Elderly in the UK

In the United Kingdom, approximately 1.5 million people are addicted to benzodiazepines, a group of sedatives often prescribed for anxiety. Many of these addicts are elderly people who were prescribed the drugs decades ago and may still suffer debilitating side effects such as paranoia, lethargy, fatigue, dizziness, and memory loss. Jo Waters of the Daily Mail UK writes that many people don’t realize the drugs are the problem.

Keith Andrew, 74, has been taking benodiazepines for the last 45 years. “My wife Joan says these drugs turned me into a zombie, but the truth is I wouldn’t know, as I have hardly any memory of the past 40 odd years,” says Keith, a retired electrical engineer. He was first prescribed Valium in 1965.

“We’d bought a new house to renovate and it had a big garden. I became stressed about finding the time to do the work on it as well as my full-time job. It was a change in me, as I wasn’t the anxious type,” says Keith. ‘The tablets calmed me down at first, but within a few months I began to feel nothing at all—they dulled all my emotions and I withdrew into a shell. I lost interest in all my hobbies like watching rugby and gardening.”

Keith says he also felt unable to express any feeling towards his two children, David and Catherine. “Joan did everything for them, I just went to work and fell asleep in a chair when I came home. I then started to have regular panic attacks and insomnia, too, and didn’t want to socialize. My weight also dropped dramatically within a year, from more than 11st to just 7st 10lbs at my lowest. I was in a terrible state.

“What I didn’t realize was that it was the pills I’d been prescribed for anxiety that were actually making me ill. My GP put me on repeat prescriptions and didn’t mention its side effects. I never connected my symptoms with the pills and thought it was just down to my anxiety and breakdown, so I never thought to mention it to him,” Keith continues.

The withdrawal effects of these drugs are severe, but in the UK there is little help available to those who are trying to stop using—unlike the help that is available for people addicted to drugs like heroin and cocaine.

MPs are now so concerned about the lack of help available to these patients they have complained to the Equalities and Human Rights Commission. This is on the basis that they have been discriminated against by not having access to specialist rehabilitation help which users of hard illegal drugs have.

“These people are not drug abusers but victims,” says Jim Dobbin, MP for Rochdale, and chairman of the All Party Group on Involuntary Tranquilliser Addiction. “Many suffer from side effects, and don’t know where to go for help. The Department of Health provides no funding for involuntary tranquilizer addiction, with the exception of a handful of cases. We want the Government to recognize the problem and to help people come off these tablets by providing prescription drug withdrawal clinics in every area.”
Benzodiazepines are a group of drugs which include diazepam (Valium), alprazolam (Xanax), oxazepam (Serax) and lorazepam (Ativan) and chlordiazepoxidex (Librium).
Many have a strong sedative effect, helping to ease the insomnia that often accompanies anxiety, producing drowsiness and slowing down mental activity. They are designed to provide short-term relief, and cannot tackle the underlying causes of anxiety.

In 1988, the UK’s Committee for Safety of Medicines issued guidance to GPs advising that benzodiazepines should be prescribed for no more than two to four weeks, because of the high risk of addiction. This was confirmed by research published last month by the Universities of Zurich and Geneva which found that anxiety drugs such as Valium and Xanax use the same potentially addictive pathways in the brain as illegal drugs such as heroin.

Although UK benzodiazepine prescriptions have fallen since their peak of 31 million a year in 1979, there were still 10.7 million prescriptions for the drugs written in 2008.

“There is still work to be done in getting the message across to GPs that benzodiazepines are not the most appropriate treatment for anxiety and sleep problems in many cases,” admits Dr. David Baldwin, chairman of the Royal College of Psychiatrist’s psychopharmacology group.

‘There are better alternatives for treating anxiety such as psychological therapies such as cognitive behavioural therapy. Undoubtedly, some GPs prescribe benzodiazepines too readily and inappropriate prescribing does happen.”

Five months after Keith was first prescribed the drugs, he felt well enough to return to work. His GP said he could have Valium on repeat prescription, says his wife Joan. “No one mentioned anything about it being addictive—but I suppose they didn’t know back then,” she says. “His character changed, putting a big strain on our relationship, and I admit there were times when I wondered if I should leave. Somehow though, I knew the old Keith was still in there somewhere and I didn’t want to desert him.”

In 1979, Joan persuaded her husband to switch GPs, as she hoped a new doctor would help him wean off the tablets. “Although the practice were sympathetic, they referred him to a psychiatric clinic who switched him to another benzodiazepine called Xanax,” she says. “If anything the side effects—anxiety, restlessness, agitation, and agoraphobia— were even worse, and an hour after taking his pills he was pacing the room waiting for his next dose. We had no idea though, at the time, that his new drugs could be causing these symptoms.”

It wasn’t until his symptoms lead to a breakdown in 2007 that Keith was finally told the drugs were the cause of his problems. Even then help came not from medical staff but a support worker from the Oldham Drug and Alcohol Service.

Joan says: “She was the first person to mention that the drugs that might be causing his problem—it was also the first time anyone offered him help to come off his prescription in 42 years.”

The first step was to change from Xanax back to diazepam (or Valium), which is easier to withdraw from because it is metabolized slower than Xanax, allowing a smooth, gradual fall in drug concentration levels in the blood.

It has taken three years for Keith to gradually reduce his daily dosage from 30mg to 5.5mg. “The withdrawal symptoms—including headaches, agonizing stomach pains, problems with swallowing and anxiety have been horrendous.”

Support is often provided by charities. The group that helped Keith, Oldham Drug and Alcohol Service, was founded by Barry Haslam, an accountant who suffered long-term brain damage due to benzodiazepine addiction. Barry was prescribed Ativan, Librium, and Valium for ten years, after suffering anxiety trying to juggle two jobs alongside accountancy exams. He claims they wiped his memory and left him with brain shrinkage, which was visible on a scan.

“GPs are good at putting people on these drugs but not so good at taking them off,’ says GP Dr. Arun Ghosh, who last year helped set up a private prescription drug withdrawal clinic (the first of its kind) at Abbey Sefton Hospital, Liverpool.

“The biggest users of benzodiazepines are the elderly. As a GP, I feel frustrated there is so little assistance for the profession-to help patients quit these drugs,” he says. “Every city needs one of these clinics—we are getting some referrals from PCTs but it’s a bit hit and miss. The trouble is, the cost of the drugs is cheap and the cost of getting patients off them at a clinic like ours is high, at around £10,000 per patient for four weeks. There just isn’t the financial incentive for them to refer to us.”

Royal College of General Practitioner’s chairman Professor Steve Field says although benzodiazepine dependence is still a problem, the number of prescriptions has dropped dramatically.

“This is a problem we’ve known about for a long time and the teaching at medical schools to trainee GPs covers the problems of drug dependency. GPs are increasingly prescribing alternatives for anxiety such as talking therapies, yoga and relaxation techniques. The problem is not as bad as it was, but there are still too many benzodiazepine prescriptions issued—it’s still not good enough.”

Joan Andrew feels relieved that her husband is nearly off benzodiazepines. “I never thought I’d hear Keith laugh again, but he’s got his sense of humor back and he’s interested in sports again. It’s lovely for our children; they never really knew the real Keith. It’s not a fairytale ending yet, though—he feels he still has a long way to go.
I’m angry no doctor or psychiatrist ever suggested Keith should stop taking benzodiazepines. GPs should be more careful about how long they prescribe these drugs.”

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