If anyone needs an(other) example of our sacred National Health Service being the problem not the solution, then here it is.
Tomorrow, Public Health Minister Anne Milton will add insult to the injury of years of D o H failure to address the of problem involuntary tranquillizer addiction; years of its refusal to acknowledge responsibility for the estimated 500,000 to 1.5 million NH prescribed ‘benzo’ dependents. She has achieved a double whammy - choosing the All Party Parliamentary Group on Drug Misuse to present inappropriately commissioned Reports that claim, but still fail, to acknowledge or address the scale of prescribed drug dependency.
That she should have been so advised is crass. Why, one sufferer asked me, is she speaking on this issue to a "Drugs Mis-use" APPG? Why indeed, when there is a dedicated APPG on Involuntary Tranquillizer Addiction, chaired by the indefatigable Jim Dobbin MP, who has campaigned tirelessly on this issue for years?
Members of this group think it is because the D o H “abandoned its two year promise to produce a report on addiction to tranquillisers, but instead commissioned reports from the National Addiction Centre and National Treatment Agency - the creators of the methadone system - from addiction psychiatrists who believe in maintenance not withdrawal, who have a concept of drug ‘mis’ users and a view of drug addiction as a ‘chronic relapsing condition’”.
Keeping this ‘tricky topic’ within the safe confines of Department of Health ‘family’ – tasking the National Addiction Centre with an anodyne and euphemistic review of “the changing use of prescribed benzodiazepines and z-drugs and of over-the-counter codeine-containing products in England,” and the NTA with a review of treatment services - may have been strategic. But it was hardly wise.
Neither report title includes the term ‘involuntary’ or ‘iatrogenic’ tranquiller addiction. The NAC and NTA, by placing the problem in the context of drug misuse and illicit drug taking, deflects attention from and responsibility for mis-prescribing. For iatrogenic addiction is due to the action of the physician and to the therapy prescribed. It is a dependency caused by the treatment. That the recipient may or may not have a prior disposition to ‘dependency’ is irrelevant.
So the problem of this once ‘wonder drug’ - the drug that became the UK’s most commonly used medication - is brushed under the carpet once more. Yet, according to guidance that recently was taken down from the SMMGP website, it is accepted that:
o 2 per cent of UK adults have used prescribed benzodiazepine hypnotics or tranquillisers regularly for 5 to 10 years or more.
o 30-50 per cent of long-term users have difficulty in stopping benzodiazepines because of withdrawal symptoms.
o Of the 0.5 and 1.5 million people addicted to benzodiazepines in the UK most are addicted on prescribed medication,
o The number of illicit users is estimated to be 200,000
Also, women outnumber men by 2 to 1; many of the people affected are middle aged and getting older; symptoms are consistent with brain damage; cessation leads to ongoing and severe withdrawal symptoms and to permanent debilitation.
Heather Ashton, Emeritus Professor of Clinical Psychopharmacology, the generic expert in the UK benzodiazepine litigation in the 1980s; author of the Ashton Manual and of some 50 specialist publications on this subject, set up and ran the country’s first benzodiazepine clinic. She studied patients there for over 12 years. She is convinced that long term use causes functional brain changes. MRI scans have shown structural brain atrophy. Cognitive functioning tests also demonstrate damage. But the research that is needed to investigate the national prevalence of such damage has never been undertaken.
All the correspondence I have read on this over the last two years from sufferers reveals an overwhelming sense of abuse, disempowerment, abandonment and fear. Though inadvertent or unintentional on the part of doctors, this is a story of an abuse of trust on a grand scale.
There are cases of adults who were put on these drugs in childhood, one as young as eight. Put on them without choice, now perversely many are finding they are being taken off them with no choice. Their fear is palpable. “I can’t sleep” one wrote, “I have daily panic attacks, diarrhoea, I’m unable to eat. I have a constant metal taste in my mouth, hot and cold sweats, vomiting, numbness in my left thigh, tingling numbness in my forehead. Suicidal thoughts that were not there before I was forced to reduce too fast against my will. I suffer cramps in my body, extreme fatigue, painful muscle tension in my neck – and dread, seeing things that are not there.”
These people are begging for help. There is none forthcoming. The response of one GP was, “what you feel is normal and bearable”.
Denial of the problem is Orwellian. Last night I checked the 2007 Adult Psychiatric and Morbidity Survey to see whether it acknowledged the existence of involuntary or iatrogenic addiction within the list of mental illnesses and dependences it surveyed. It did not.
Also Orwellian was tasking the NTA to contact Primary Care Trusts and treatment providers ‘to investigate prescribing patterns and the help that is currently offered to people who develop problems and contacted its own drug services.’ (my italics). That prescribed benzo dependents do not and would not want to use these primarily methadone prescribing services is ignored. And although specialist benzo services can be counted on one hand, some like The Bristol and District Tranquiliser Project were not even contacted. Nor were any of the small rehabs that can offer a safe and supportive setting for benzo detoxification, withdrawal and recovery.
This latest DoH exercise has been a waste of time and money (a parliamentary question has been tabled to find out who other than the NAC and NTA the Do H considered and what the reports cost). The view of two APPGITA expert members is that they spread misinformation and make inadequate, ignorant and baseless recommendations – notably that the 8-10 week withdrawal schedule and recommendation of a maximum of 6 months cut off disregards current BNF guidelines that state that withdrawal may take up to a year.
On this critical issue NAC appears not to have consulted with any representatives or sufferers.
If they had, they would have heard that ‘Keith’s’ case is not unusual. It has taken him three years to gradually reduce his daily dosage from 30mg to 5.5mg. Even so, “the withdrawal symptoms—including headaches, agonizing stomach pains, problems with swallowing and anxiety have been horrendous.”
Professor Ashton's conclusion is similarly critical:
‘The NAC and NAT have gathered an impressive array of statistics but have shown little understanding of the underlying problems. They have conflated different populations of benzodiazepine misusers and abusers and have largely ignored the needs of the iatrogenically dependent population. Thus the reports fail to provide “a national picture of what is happening in the community or how we can address addiction to pain killers and tranquillisers” as claimed by the Public Health Minister. They are complacent in regard to the further claim that “most areas of the country have services in place to support people who develop problems.” They recognise that there are many gaps in our knowledge for which “more research is needed” but they make no specific recommendations about what particular research is required.”
According to Barry Haslam, founder of the Oldham Tranx, a support group that works with the Addiction Dependency Solution’s specialist treatment centre, the Royal College of General Practitioners are the key to putting matters right. They already know the scale of the problem.
“Big Pharma created these conditions”, he says, “in 1979 31 million benzo prescriptions were issued....prescribing got totally out of control. Doctors could not reign it back in. The Dept of Health, should at this stage, have recognised the scale of the problem and sought mutual understanding on ways to put matters right for patients who were now addicts. Instead they closed ranks and hoped that by maintaining the addiction of prescribed medicine, the genie would not come out of the bottle”.
It has and it won’t go back in.