When Benzodiazepines are prescribed for recovering (or active) addicts:
Recovering addicts and alcoholics have far too often fallen into the trap of iatrogenic physical dependence to benzodiazepines (and sometimes other psychotropic drugs or polypharmacy) because the BZDs are irresponsibly prescribed to them with the supposed purpose of “helping” them out of their substance abuse. This happens often at rehab or detoxification centers for people coming off of alcohol, cocaine, heroin, etc. In some cases, the ex-addict takes the benzodiazepine exactly as prescribed and in other cases, the addict continues in their addiction and abuses the benzodiazepine alone or in combination with other drugs of abuse. The latter can prove to be lethal, as warned by the FDA in a recent press announcement.
Professor Malcolm H. Lader, O.B.E., LL.B., D.Sc., Ph.D., M.D., F.R.C. Psych., F. Med. Sci, Emeritus Professor of Clinical Psychopharmacology, Institute of Psychiatry, Neurology, and Neuroscience, King’s College London, UK, is quoted as saying:
It is more difficult to withdraw people from benzodiazepines than it is from heroin.
So one must question then how benzodiazepines prescribed long-term past the recommended 2-4 week period can be considered a logical solution to people facing addiction problems? If the goal in going to a rehab or detox center for an addiction to a substance is to become and stay sober, how does intoxicating the patient further with an, arguably, even more dangerous drug (at least to withdraw from) solve anything? It doesn’t. What it does is just create a new, even bigger problem for the ex-addict and, most of the time, because the benzodiazepine drug is prescribed by a medical professional, the patient has no idea (as they are not given informed consent) of the potential repercussions of the benzodiazepines.
Yes, benzodiazepines can be useful in the treatment of severe alcohol withdrawal, but they are intended to be used short-term for symptom management of the acute alcohol detoxification and then stopped before the patient becomes physically dependent. The two most commonly prescribed BZDs for alcohol withdrawal are chlordiazepoxide (Librium) and diazepam (Valium). Short-acting benzos like lorazepam are less frequently used for treating alcohol withdrawal. But, benzodiazepines are a class IV controlled substance in the United States. The FDA Prescribing information for them clearly states,
Addiction-prone individuals (such as drug addicts or alcoholics) should be under careful surveillance when receiving [benzodiazepines] or other psychotropic agents because of the predisposition of such patients to habituation and dependence.
And some of the withdrawal symptoms from benzodiazepines, once a person is physically dependent on them and tries to stop taking them, can mimic those seen in alcohol withdrawal—although BZ withdrawal can be more severe and persist for much longer. When prescribed long-term for prior addicts, the addicts are just being set up for another physical dependence to (which occurs even when BZ are not abused) and withdrawal syndrome from a drug – only the one from BZDs might be far worse and more long-lasting than the one experienced from their drug of abuse.
Two such cases of former addicts that were prescribed benzodiazepines, Stevie Nicks and Chris Cornell, made headline news as they were famous rock stars. It’s important to remember that this happens to everyday people quite frequently as well.
Seventies-era former lead singer of Fleetwood Mac Stevie Nicks has been very public about how prescribed benzodiazepines, taken as directed after becoming sober from her cocaine addiction, were devastating to her health, life, and career. Nicks says the last time she used cocaine on stage was during a concert at Red Rocks in 1986. It was a turning point for her. Afterward, she went straight to the Betty Ford Clinic. But in an attempt to help herself, she encountered a problem far worse than her cocaine problem—she became iatrogenically dependent on a benzodiazepine prescription. Fresh out a rehab, she reluctantly saw a psychiatrist:
I went to see a doctor just to check in with somebody and let everybody know that I was OK. I guess when most people go off Klonopin they have a very hard time. I wasn’t one of those people, but he didn’t know that. So he suggested that I go on this drug for my nerves, and I just said OK to get everybody to leave me alone. Well, what a big mistake. I really wonder where I would be now, what I would have done if those eight years were full of creativity and love, and good things instead of full of nothing.
That psychiatrist would be the one to put Stevie on the benzodiazepine called Klonopin.
Video Source: BBC
Nicks has described Klonopin as a “horrible, dangerous drug,” and said that her eventual 45-day hospital detox and rehab from the drug felt like “somebody opened up a door and pushed me into hell.”
The only thing I’d change [in my life] is walking into the office of that psychiatrist who prescribed me Klonopin. That ruined my life for eight years,” she said. “God knows, maybe I would have met someone, maybe I would have had a baby.”
“I was really sick,” she says. Even though her years of cocaine abuse left a large hole in the septum of her nose, she claims that the Klonopin did far more damage:
It was not my drug of choice…I’m not a downer person. I was looking for things that made me want to clean the house and shop, write songs and stay up for four days. I was sad and I was sick. I didn’t really understand right up until the end that it was the Klonopin that was making me crazy. I really didn’t realize it was that drug because I was taking it from a doctor and it was prescribed. It just hit me really hard that that was the foundation for why I was completely falling apart.
Stevie says she took the Klonopin for eight years, learning way too late that Klonopin is a dangerous drug that can also carry adverse effects like depression and weight gain:
My woman’s vanity could not deal with that at all. After being a rock ‘n’ roll sex symbol for all that time, and then all of a sudden to be ‘little fat girl’ was just so unacceptable to me. I could see the disappointment in people’s faces when they’d see me walk in…
Writers do not thrive on drugs like Klonopin and Prozac. It takes your soul; it takes your creativity; it takes your love of running home at night and getting out a typewriter or getting out your paper and pencil and writing something that you love. It takes that away. You don’t care anymore. So Street Angel [the album] was all about just not caring. And that’s horrible to me. One of the few things that I’ve never not done in my life is not care. And I didn’t care for a long time…
Doctors are dying to put you on drugs: ‘Feeling a little nervous? Here, let’s mask everything so you don’t have a personality anymore.’…The overwhelming feeling of wellness and calm equals blah, nothing. My creativity went away. The fabulous Stevie everyone knew just disappeared. I became what I call the ‘whatever’ person. I didn’t care about anything anymore. I got very heavy. One day I looked in the mirror and said, ‘I don’t know you.’ And I went straight to the hospital for 47 days…
It took 47 days for Nicks to detox from the prescription drug:
…and it was horrible. My hair turned gray. My skin molted. I couldn’t sleep, I was in so much pain. Legs aching, muscle cramps…The rock star in me wanted to get in a limousine and go to Cedar’s Sinai and say, ‘Give me some Demerol because I am in pain.’ And the other side of me said, ‘You will fight out this 47 days’… [*]
*Note: 47 days is a very rapid taper from benzodiazepines and may be the reason why Nicks suffered so horrifically. Most appropriately slow benzodiazepine tapers take many months and sometimes even years to complete.
More recently, American rock musician Chris Cornell died of suicide by hanging in his MGM Grand Detroit hotel room. His family has spoken out, however, stating that he was not suicidal and instead blame the adverse effects of Ativan (a benzodiazepine) for causing his death. The Soundgarden and Audioslave frontman had a previous drug and alcohol addiction problem from which he had allegedly been sober for four years. Cornell had a prescription for Ativan and, according to his wife Vicky, he was slurring his words when she spoke to him on the phone just prior to his death. In that conversation, he admitted to his wife that he had taken more than his prescribed dose of his Ativan.
We know that benzodiazepines are proven to cause suicidal thoughts and actions in some people. Ativan’s FDA package insert warns that it may worsen or cause new-emerging depression and a possibility for suicide should be “borne in mind” for those patients. We also know that, of all the benzodiazepines, Ativan carries the strongest FDA language on its package insert about the risks of physical dependence and withdrawal, stating:
In general, benzodiazepines should be prescribed for short periods only (e.g., 2-4 weeks). Extension of the treatment period should not take place without reevaluation of the need for continued therapy. Continued long-term use is not recommended. Withdrawal symptoms (e.g., rebound insomnia) can appear following the cessation of recommended dose after as little as one week of therapy. Abrupt discontinuation of product should be avoided and a gradual dosage-tapering schedule followed after extended therapy.
Without his input, why Cornell took more Ativan that he was prescribed can only be speculated to; there could be two reasons—one being that he was abusing drugs again and the second being that he may have developed a prescribed tolerance and/or interdose withdrawal from daily long-term use past 2-4 weeks and he was experiencing pseudoaddiction (where individuals sometimes take more of their BZ drug than prescribed in an attempt to get relief from the tolerance withdrawal, interdose withdrawal, and/or breakthrough or rebound anxiety). If a person is unaware of the ability for benzodiazepines to actually cause anxiety and other adverse effects in tolerance and interdose withdrawal, or they have a false sense of security about the drugs because they are prescribed without informed consent as to their dangers, they are often unable to make the connection between the way they feel and the drugs being at the root of it; they falsely assume that it’s their “underlying condition,” for which the drug was prescribed, worsening and sometimes rationalize taking “a little more” to feel better or to “treat” that.
Dr. Drew Pinsky, a famous addiction specialist, told 95.5 KLOS that, as a recovering addict, Cornell “should never have been exposed to” Ativan. He added that (hear audio below):
Benzodiazepines can make people suicidal. It’s the hidden epidemic. People have gotta remember – we’re getting awareness about opiates. Benzos, over a long term, particularly – and by long term, I mean more than two weeks – are a very dangerous class of medications, and extremely dangerous if you have a history of addiction.
Video Source: 955KLOS
Chris’ death marks another senseless, tragic and preventable loss of a talented man to the irresponsible prescribing of benzodiazepines.
Was Chris Cornell taking ‘the world’s deadliest’ prescription medication? by The Mercury News
Further reading on this topic:
Tragic Death of Chris Cornell is Call to Action For Benzodiazepine Safety by benzoinfo.com
The Violence-Inducing Effects of Psychiatric Medication by Dr. Kelly Brogan
Suicide Of Soundgarden Singer Puts Spotlight On Anti-Anxiety Meds by CBS Los Angeles