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.
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.