The first benzodiazepine, Librium, came on the market in 1960, followed three years later by Valium. By the late 1960s the benzos were selling in vast amounts. In the 1970s Valium became the best selling drug on Earth. While Leo Hollister and others put forward suggestions that you could get hooked to them as early as 1961, the main concern in the early years was their huge usage – it just didn’t seem right. Adolf Jahn the President of Hoffman-la-Roche the makers of Librium and Valium, in a response strikingly reminiscent of Adolf Hitler’s famous rant in the movie Downfall, brushed aside all suggestions that there was any reason for concern.
But in the mid 1980s the waves of controversy broke over company defenses and the benzos rather quickly became one of the greatest threats to civilization. They ended up being viewed as more addictive than Heroin. An untold aspect of this story is the role that companies making new drugs active on the serotonin system, from Buspar to Prozac, played in fueling this controversy. Valium ultimately became so stigmatized, Roche retired the brand name and you can only now get diazepam.
A complex picture
Everything happened astonishingly fast in the end. As Margrethe Nielsen has pointed out, as late as 1980 the British regulator estimated that there were 28 people dependent on benzos in the UK. Not much of a cause for concern. Only a few years later there were major lawsuits with thousands of people involved were launched against the makers of the benzos.
Despite this, when the the controversies were at their height, the regulator came out and said that they had warned people about the problems with benzodiazepines many years earlier – the 28 people. This is classic regulatory behavior – when convenient they will say that barely perceptible hints they issued previously were in fact warnings. They have no doubt been warning about the risk of birth defects from antidepressants and the cognitive problems on statins for decades.
The picture is complex. Benzodiazepines are in many respects a lot safer than the barbiturates that killed Marilyn Monroe in 1962 or thalidomide that was one of their main competitors in 1961. In contrast the withdrawal problems they give rise to seem, for some, to be even worse than with opiates or most other illegal drugs.
What would GPs choose?
Today, if forced to choose between having Diazepam or Prozac for a year, nine out of ten of the general public would likely pick Prozac. In contrast nine out of ten mental health professionals would like pick Diazepam. The key group are primary care physicians who dish out most SSRIs. Which group do they think are worst?
Where the benzos are seen as dark drugs and the SSRIs are much better, there is a good case for saying the SSRIs are at least as dark and perhaps more so.
Health warnings
The data for the benzodiazepines below has gaps in it. We are missing a number of drugs, especially sleeping pills (temazepam). We are also missing data on some European only benzodiazepines (zopiclone). We have however European Medicines Agency data which we hope to make available soon – the only site that will offer both US and European data.
But the key point is this. The heyday of benzodiazepine adverse event reporting was in the 1980s. The data in this table and the data that other FDA portals offer is from 2004. We have however all FDA data from 1969 and hope to be able to make this available through a research portal soon. At this point it will become possible to get a truer picture of the scale of the problems the Benzos have caused.
| Drug | SoS | Abuse | Addiction | Dependence | Intoxication |
|---|---|---|---|---|---|
| Alprazolam | 782 | 1261 | 805 | 562 | 853 |
| Bromazepam | 0 | 0 | 0 | 0 | 0 |
| Chlordiazepoxide | 11 | 17 | 4 | 2 | 55 |
| Clobazam | 9 | 0 | 3 | 3 | 13 |
| Clonazepam | 436 | 285 | 256 | 204 | 492 |
| Diazepam | 300 | 756 | 403 | 239 | 786 |
| Lorazepam | 368 | 153 | 205 | 153 | 386 |
| Nitrazepam | |||||
| Temazepam | |||||
| Zopiclone | |||||
| Eszopiclone | 35 | 11 | 32 | 27 | 26 |
| Zaleplon | 8 | 9 | 12 | 7 | 2 |
| Zolpidem | 339 | 414 | 395 | 264 | 423 |
Gill says
We are too keen to take what is offered and find it hard to wean ourselves off what we become dependant on – perhaps GPs etc need to remind people that they are simply not expected to take the medicines prescribed indefinitely – they do actually have the option of coming off them!
Johanna says
It could be there’s a real bias in Britain against benzos – or at least a level of caution that is out of sync with their relaxed attitude towards SSRI antidepressants. Here in the US, I think the “rehabilitation” of benzos is complete – as is the rehabilitation of speed. Just check out this 2012 article from New York Magazine, which even includes profiles of four archetypal hip New Yorkers and the pill that best matches each of their anxieties. Xanax? Ativan? Klonopin? Or good ol’ Valium?
“If the 90s were the decade of Prozac, all hollow-eyed and depressed, then this is the era of Xanax, all jumpy and edgy and short of breath.”
http://nymag.com/news/features/xanax-2012-3/
I have a friend whose kid made it into an Ivy League college, joining the golden boys and girls of the East Coast. “These people start every day with an Adderall and end it with Xanax,” she says. It’s a way of life, both for the youth and their parents. She’s trying to get her kid to stop messing around with the stuff, reminding him his future employers will drug-test. But he could just as easily solve that problem by getting prescriptions. Way, way too easily.
There are a lot of younger folks, I’m guessing, who could be invited to tell their benzo stories here — as well as older people who have come to grief with these drugs in recent years rather than being addicts since the ’70’s. Till then this interview with rock star Stevie Nicks, on how she lost the 1990’s to Klonopin addiction, is pretty good:
http://www.benzo.org.uk/nicks.htm
Sandra Villarreal says
Xanax is the # 1 selling drug in America. In my belief after having Klonopin induced anxiety destroy 10 years of my life including my 18 year marriage that it is the most dangerous drug on this planet. Only I can deal with losing 10 years and living in pure hell while taking this drug, it was the withdrawal that forced me into a chaotic, psychotic state of mind where putting a gun to my head to blow my brains out was my only escape. I did not have experience being totally, 100% disconnected from reality while enduring anxiety & abject terror every single second for weeks at levels I didn’t know the human mind was able to tolerate. It was equivalent to taking 10-15 hits of LSD. I ended up in the psych ward for a week followed by a trip to the Emergency Room with hallucinations, panic attacks, I could barely walk, I was practically catatonic, elevated blood pressure, heart rate and uncontrollable body shaking. You may ask why did I cold turkey from this drug? Because my drug and alcohol counselor informed me it was ‘just fine’ to do after 10 years on it. Not one withdrawal symptom that I may experience ever fell from his lips. Not one. And I am not an isolated case by no means. I have read so many personal stories of horror from going off their benzo. There is a court case going on in California right now over Cymbalta withdrawal syndrome but I have never, ever heard of our personal suffering from benzo withdrawal ever making it anywhere. In fact, none of my mental health care workers even believed me when I tried to tell them what I went through withdrawing at my home, alone. They didn’t want to hear it and they certainly didn’t want me talking about it. They silenced another patient, so they can continue doing it to others.