Benzodiazepine Information Coalition fully endorses Massachusetts Bill H.3954 and implores the committee to pass this legislation. We are a nonprofit organization comprised of physicians, other medical and mental health professionals, and patients serving those who have been injured or disabled by benzodiazepines. We have found that benzodiazepine tolerance and withdrawal syndromes are both frequently misdiagnosed and mismanaged. This is especially prevalent in the state of Massachusetts, where a large percentage of the injured patients we represent reside. Many of those injured in MA are too ill to leave their homes to testify in favor of the bill today.
In 1990, the APA Benzodiazepine Task Force found that 40-80% of patients prescribed these drugs will experience some form of withdrawal upon cessation. Subsequent research has found that one in six people will experience severe withdrawal and disability persisting longer than 18 months. These protracted syndromes consist of a range of distressing and unmanageable symptoms, often leading to the loss of employment, engagement in community, independence, and sometimes loss of life, ultimately resulting in a severe financial burden on caretakers, taxpayers, and the medical system. Current research is limited, underfunded and cannot predict which patients are at risk for developing these severe and protracted symptoms.
Beyond the scope of withdrawal injury, many who do not have excessive trouble stopping benzodiazepines or who remain on them for life will experience falls, serious accidents, cognitive impairment, increased anxiety and depression, the inability to recover from trauma, depression, suicidal ideation, the inability to retain new information, memory loss, insomnia, Alzheimer’s disease, increased risk of cancer, and early mortality simply from taking the drugs as prescribed. Additionally, when taken as prescribed or obtained illegally in combination with opiates, many patients will overdose and die.
We do recognize many prescribers are aptly educated about benzodiazepines. However, 80% of these drugs are prescribed by non-psychiatrists who do not understand their complexities and dangers, including knowledge of the proper tapering of benzodiazepines. Improper tapering may cause the medical phenomenon known as ‘kindling,’ so it is essential for the prescriber to get the cessation right the first time. If they do not, future attempts at withdrawal typically become more severe. In current practice, over-rapid first time cessations are incredibly common, with the physicians leaving patient outcomes to chance. This can have disastrous results, as the prescriber often does not recognize the new problems as benzodiazepine-induced. Benzodiazepine prescribing and withdrawal is an art as well as a science, with no one-size-fits-all approach, but it is often approached as such by well-meaning physicians who do not understand the tricky nuances of the drug.
No one should be prescribed a benzodiazepine without being given full informed consent and without an opportunity to thoroughly consider the risks. Doing the ethical thing will require a minor inconvenience to the small number of informed prescribers in order to safeguard patients against prescribers who are undereducated. A drug class with such shockingly high risks, combined with such a disappointing number of misinformed prescribers, demands action like Bill H.3594 be taken to protect patients from serious harm.