Good Drugs - Bad Drugs

We turn our attention to a publication found on researchgate.net, titled, "Einsatz von Benzodiazepinen bei akuten Panikattacken" (= use of benzodiazepines for acute panic attacks).

In the present day, discussion of the ethics of benzodiazepine use continues – but over the years, a clear picture has started to take shape. As late as 2023, Elias Bär writes of the harm that benzodiazepines can cause in the treatment of panic attacks, and the lack of lasting good their use promises. He writes of more helpful approaches with no risk of dependency.

This post focuses on a German-language article in the medical journal Suchttherapie (= addiction therapy), released by the Thieme Group. The author D. Wolter titled it, "Verordnungshäufigkeit, Missbrauch und Abhängigkeit von Benzodiazepinen, Z-Substanzen und Opioidanalgetika" (= Prevalence of Use, Abuse and Dependence: Benzodiazepines, Z-drugs and Prescription Opioids).

In Vol. 44 of the Annual Review of Anthropology, W. Garriott and E. Raikhel released their review article "Addiction in the Making". The authors tell us,

"In this review, we draw on a particular slice of this rich literature: work examining how addiction—as an object of knowledge and intervention—is produced, enacted, circulated, and remade through the “looping effects” (Hacking 1986) linking experts and people “living under the description of ‘addict’” (Martin 2013, p. 287). (ibid. 478)"

Prescribing behaviour of benzodiazepines is the focus of this issue of the Hamburger Ärzteblatt (Hamburg, Germany-based doctor's journal). Written by C. Haasen and R. Holzbach, the article in question (ibid. 12-18) explains that while guidelines recommend use of benzodiazepines to be restricted to no more then 4-8 weeks, about 60% of patients are prescribed these medications for longer than this. The medications are to be used for acute and short-term anxiety and insomnia and should be part of a treatment plan that includes a plan for replacing the benzodiazepine(s) during the course of the treatment. Doctors should also inform their patients of the addictive properties of benzodiazepines and clue them in as to the time limit as they are prescribing them (ibid. 12).

The article goes on to explain the three phases of long-term consumption:

paradoxical symptoms: mood swings, insomnia, changed body perception

apathy phase: often followed by dosage increases and accompanied by symptoms like diminuition of energy, cognitive and memory functions, as well as affective (emotional) indifference.

addiction phase: loss of control, increased dosages through "inofficial" means (ibid. 12-13)

In 2002, The Canadian Journal of Psychiatry released an article from F. Curtin and C. Remund on the case study of a woman who started experiencing musical hallucinations on benzodiazepines. "Musical Hallucinations During a Treatment With Benzodiazepine" describes the syptoms that the patient was suffering from as fatigue, intestinal issues, insomnia. Some days after she started taking her newly prescribed medication lormetazepam (known as Ergocalm, Loretam, Noctamid and Sedalam, among others), she began experiencing

M. Thormodsen, P. Hjortdahl, T. Fabrot, O.V. Jacobsen, J.B. Nenningsland and B. B. Nielsen published the Norwegian-language report on their comparative study "From Valium to the happy pill?" in Tidsskr Nor Laegeforen, the Journal of the Norwegian Medical Association.

Their findings may best be described by the last sentence of the English-language Abstract of their study,

Malcolm Lader, the author of the text, "History of Benzodiazepine Dependence" opens with the development of benzodiazepines in the 1950s and their introduction in the 1960s. Lader tells us these drugs have been central to psychopharmacology and psychiatry, with key figures in the field still active today. To him, their history is challenging to recount, as many issues remain unresolved and contributions from individuals are ongoing.

Having worked on a better understanding of benzodiazepines for 30 years, the author notes that his views have become increasingly independent, although the consensus in the U.K. has shifted closer to his perspective. The essay is written from a personal and geographical standpoint, focusing on the U.K., and reflects the inherent biases of someone deeply involved in the topic.

This post deals with the chapter "Die Wirkung der Benzodiazepine auf neuronaler Ebene" (= the effect of benzodiazepines on the neuronal level), to be found in the 1988 book "Schlaf- und Schlafmittelforschung - Neue Ergebnisse und therapeutische Konsequenzen" (= sleep and sleeping pill research - new results and therapeutic consequences) by W.E. Müller.

Germany-based publisher Thieme Gruppe releases a monthly professional journal called "AINS" (Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie) with papers on Anaesthesiology, Intensive Care, Emergency Care and Pain Therapy.

A 1988 paper, written by U. Klotz, released in this journal was "Wirkungen und Nebenwirkungen der Benzodiazepine" (= effects and side effects of benzodiazepines). This paper, like many others, summarizes the positive effects and low toxicity of Benzodiazepines. However, it then leads the reader into the nearly identical list of side-effects that may occur when benzodiazepines are taken.

The earliest report that we were able to find on low-dose dependence in benzodiazepine users is the work of K. Rickels, W.G. Case, E.E. Schweizer, C. Swenson and R.B. Fridman. It was released in Psychopharmacol Bulletin, a scientific peer-reviewed trade paper that was active from 1959 to 2012.

Medical Doctor B. Robert Meyer worked on collecting information on elderly people who were given benzodiazepines. He opens his 1982 article by giving an overview of the widespread use and prescription of these drugs since their initial release, claiming,