Benzodiazepines are prescription tranquillisers used for treating acute cases of such problems as anxiety, amnesia and panic. The principal conditions for which they are used are shown in the table below, as is the class of benzodiazepine used and examples of the drugs which could be chosen to treat the condition.
In fact all benzodiazepines work in much the same way, but they differ in potency and the length of time they remain active in the body. 1mg of Lorazepam, for instance, is equivalent in potency to 10mg of Diazepam. This means that dosage must be managed very carefully to avoid unintentional over- or under-dosing. Different benzodiazepines remain effective in the body for radically different lengths of time. Each benzodiazepine is said to have a half-life, meaning that its effectiveness reduces by half in a stated time. For Lorazepam for example the half-life is between 10 and 20 hours, which means that by the end of a 24-hour period the drug’s effectiveness is much reduced. Diazepam on the other hand has a half-life of between 20 and 100 hours, so it remains effective considerably longer. Both potency and length of active time are very important in withdrawing from their use as will be described in detail later.
Benzodiazepines are very effective when used in the short-term, usually defined as 2-4 weeks. However, they are frequently prescribed for long-term use, sometimes years, for which they are not suitable, and most of the problems associated with them arise from long-term use. When they are prescribed regularly over a longer term, they induce dependence, usually after a few weeks, even on a therapeutic dose. As a result, the person becomes either dependent and cannot give the drug up without very unpleasant side effects, or addicted, in which case they need more and more drug to achieve the same effect.
All this is bad enough, but the drug also produces paradoxical effects where the symptoms for which the drug is prescribed become side effects of the drug itself, notably anxiety and depression, sometimes accompanied by uncharacteristically poor behaviour. Benzodiazepines are sedatives, so slow down reactions, making many everyday occupations more risky, driving for instance. There is a pronounced connection between benzodiazepine use and accidents on the road and at home, and elderly people are particularly susceptible. Mental processes are also impaired, so simple everyday tasks become more problematical and learning new things more difficult. People find they come to depend on the drug even for simple tasks such as shopping. Finally emotions can become blunted, so that both pain and pleasure are not felt as acutely as they would be normally.
History
Benzodiazepines were first introduced in the 1960s and soon replaced the barbiturates, which had previously been used for the same treatments. Barbiturates included among their side effects a tendency towards dependence, from which benzodiazepines were originally thought to be free. They were met with great enthusiasm by the medical profession, and the first two benzodiazepines Librium (Chlordiazepoxide) and Valium (Diazepam) were commercially very successful. Valium was marketed widely as “Mother’s Little Helper” and in 1980 some 29 million benzodiazepine prescriptions were issued. During the 1980s it became apparent that most people do become dependent on benzodiazepines and that withdrawing from them can be a long-winded and painful process. Although apparently some people have withdrawn without any adverse effects, not surprisingly the people I have come across are mostly those for whom withdrawal is or was difficult.
Social Cost
One can only guess at the true cost to society of benzodiazepine use. Added to the cost of the drugs must be such things as the cost of accidents, the loss of earnings revenue, the damage to personal relationships, the costs of caring for the sufferer and many others. I have yet to find even a broad estimate of that cost.
