1. They prescribe benzodiazepines long-term without informed consent.
A long-term (2-4 weeks or more) benzodiazepine prescription should be accompanied with informed consent.Ā Prescribed benzodiazepines carry short and long term risks.Ā Studies past a few months are lacking, but evidence of tolerance, physical dependence, withdrawal syndromes, and a worsening of the initial condition with long-term use are known.Ā Prescribers who do not inform patients of these common major risks, while highlighting only the very short-term benefits, are skipping one of the greatest patient safeguards in medicine.Ā
2. They think benzodiazepines help anxiety and sleep disorders long term.
There are no long-term studies on benzodiazepine safety, but a 14-week study conducted by Upjohn resulted inĀ patients who were much worse off than the placebo group; more anxious, had more panic, doing worse on a āglobal scaleā assessing overall well-being, while forty-four percent were unable to get off the drug.Ā Benzodiazepines have been shown to impair the effectiveness of therapeutic interventions and are contraindicated for use in PTSD.Ā Hypnotics have also been found to be ineffective long term in aiding insomnia.
3. They only disclaim about addiction, not physical dependence.
Many prescribers do disclaim about addiction but rarely about physical dependence. Benzodiazepines can be addictive, but physical dependence is more common. A substantial percentage of non-addicted patients will experience withdrawal with attempts at discontinuing a benzodiazepine. Disclaiming only about addiction provides a false sense of security, failing to inform patients of their risk for physical dependence.
4. They tell patients they are on a ālow dose”.
Compliant patients can become physically dependent and experience severe withdrawal from any dose.Ā The lowest available prescribed dosage for any commercially available benzodiazepine can subject a patient to physical dependence and a withdrawal syndrome.Ā When prescribers make the ālow doseā claim, they are often falling prey to clever marketing techniques, completely unaware that 0.5 milligrams of benzodiazepines like Ativan, Xanax, and Klonopin are equivalent to 5-10 milligrams of Valium (equivalency charts can vary, depending on source).Ā āLow doseā misleads patients into believing that so long as they stay below a non-existent threshold, they are safe.
5. They downplay or fail to recognize adverse effects.
Patients can spend years suffering and chasing āmystery symptoms,ā that ultimately are caused by the drug, often resulting in unnecessary testing, medical expense, misdiagnosis, and sometimes polydrugging.Ā During this time, because diagnostic testing will often come back negative, the patient is often assumed mentally ill, and, ironically, their benzodiazepine dose is sometimes increased as a result. Ā
6. They donāt understand tolerance or interdose withdrawal.
Benzodiazepines quickly lose their effectiveness.Ā As a result many end up experiencing interdose withdrawal, where they are actually withdrawing in between doses, and tolerance withdrawal, where they have become tolerant to the therapeutic effects at that dose and require higher dose to achieve the same initial effects.Ā Because interdose and/or tolerance withdrawal is often confused with āaddictionā or ācraving,ā prescribers often refuse to increase the patients dose or frequency of dose, even when that can provide the patient more comfort and stability.
7. They think one benzodiazepine is unsafe but another is safe.
All benzodiazepines are not the same. The notion that the newer benzodiazepines or āanxiolytics,ā like Klonopin and Ativan, for example, are āsafeā and Valium āunsafeāĀ is an old wives tale deriving from the original pharmaceutical marketing around the time Valium got a bad rap and was brought under scrutiny for the destruction it caused in the 1960s and 70s.Ā Because of this, it is common to think of Valium as ādangerousā or ādeadly,ā but Klonopin as āsafe.ā But that wasnāt true then, and it isnāt true now.Ā While it is true that benzodiazepines with a shorter half-life, like Xanax or Ativan, can put patients at greater risk for interdose withdrawal than their longer half-life counterparts, all benzodiazepines carry the same potential for causing physical dependence, tolerance, withdrawal syndromes, disability and sometimes death when prescribing guidelines are ignored.
8. They think other drugs can alleviate benzodiazepine withdrawal.
The studies on adding medications to benzodiazepine withdrawal are paltry and unconvincing, perhaps explaining why the British National Formulary benzodiazepine guidance states, āthe addition of beta-blockers, antidepressants and antipsychotics should be avoided where possible.ā Usually the severity of a patientās withdrawal can be effectively managed and minimized through slow and proper tapering as opposed to complicating matters with the addition of more medications.
9. They donāt know how to safely withdraw a patient from benzodiazepines.
Patients are often either over-rapidly tapered, cold turkeyed, or inappropriately sent to detox centers.Ā If a withdrawal is initiated at a rate that is faster than 5-10% from the current dose every 2-4 weeks (or less), excluding special circumstances like paradoxical reactions, it is usually too fast.Ā Where a prescriber can also go wrong with withdrawal is:
- Too rapid or underdosing during a crossover to a longer half-life from their current benzodiazepine for the purpose of tapering.Ā
- Refusing to be flexible when a patient reports requiring the slightly-higher (compared to some other sources) Ashton Manual Valium equivalence, leaving the patient underdosed, destabilized, and suffering. Ā
- Unreasonable timeline expectations for tapering (tapers have been reported to take many months and sometimes many years, depending on the patient).
10. They think all patients will have similar benzodiazepine experiences.
While a percentage of patients will have no problems with long-term benzodiazepine prescription, many prescribers assume that this applies to all of their patients. As a result, prescribers often miss properly diagnosing benzodiazepine problems for what they are because the potential for them isnāt even on their radar or in their differential.Ā The end result of this is that many patients do not get the support, validation, recognition, or help they need around a very real and serious iatrogenic medication-induced illness.Ā Also, aside from the FDA warnings against prescribing benzodiazepines to patients with an addiction history, which are also frequently ignored, there is no way to predict in advance which patients will develop physical dependence or experience severe withdrawal reactions.Ā Every patientās experience will be unique and should be treated as such.Ā
Hello, I was prescribed benzos, primarily Xanax, for 15 years. They decided I had taken enough a few years ago. The resulting prolonged withdrawal has made my life hell. When will I find a doctor that won’t give me a nasty look if I mention Xanax? It’s the only thing that made my life bearable. I don’t care how many times a doctor tells me “The xanax wasnt helping you, it sounds more like an addiction.” then throws a blood pressure pill, hydroxyzine, or buspar, none of which help, at me. Anything that can possibly lead to euphoria is considered”bad” now, and anyone who’s using one of these drugs is doing so “because they’re an addict.” But then I read about the blood pressure medication I’m offered in replacement, and stopping usage of it can straight up cause death. If I choose to take this blood pressure med, I’m still tethered to taking a pill every day. It’s ridiculous. I lost everything. It’s been almost five years now. When will someone listen & provide me a form like the one on your website so I can have my life back?
I am experiencing these problems now. I went through a 5 day detoxification for alcohol abuse. While there, they talked me into ‘relinquishing’ my benzo (clonazepam). I have been wanting to stop the clonazepam, so I took their word that since the benzo detox is the same as the alcohol I could be done with both. They said nothing about needing any further time to withdraw completely.
I then went to a place that deals with addiction issues, as well as primary care. The woman who did my intake also said nothing about any further needs concerning the benzodiazepines. Several days later the withdrawal symptoms became so bad that I was essentially disabled. I went to the doctor at the facility I mentioned above. She reluctantly prescribed 7 days of 0.5mg of clonazepam. I had been on 1mg daily for 10 years. She, like the previous two people didn’t talk about the need to taper.
Today, I saw a psychiatric APRN at the same facility to talk about my benzo problem. She also didn’t seem to know about the need to taper. She also said she hadn’t heard of Dr. Ashton when I mention the manual and showed her a tapering plan that I had written based on Dr. Ashton’s manual.
I am mystified that nobody so far has seemed to have any knowledge about benzos except that they’re bad and I should stop taking them. I don’t think differentiate between addicts that abuse or misuse the drugs and people who are physically dependent but have followed the prescribed amount for months or, like me, years.
It is ironic because the facility is the methadone clinic for my area. They know about long tapers for opiates, but not benzos? I just don’t understand how people in the medical field, especially at a facility that is focused on treating drug use, are so poorly informed about these drugs. Especially when it would only take a couple days of research to learn a lot. But of course the universities are the authority on everything and other sourcing of info are not trustworthy, right? To me that seems to be the case.
I appreciate this article and the website as a whole. I intend to get involved with the benzo misinformation problem once I work through my own path to a benzoless life.
Hi Jesse, I read your story, and it is just like mine. I went through detox and treatment at an inpatient center, it is very respected, and even I still respect it and the care staff and doctor. I was taken off Klonopin, cold turkey, after taking it for 10 years for sleep. I was addicted to alcohol, I’m an alcoholic, and that is why I went in for treatment. I was told that I could no longer take klonopin, and I was perfectly happy with that, as I was wanting to be off anything addictive, prescribed and used for only sleep, or alcohol, which I started overusing because I had terrible insomnia. My treatment was in August 2019.
While I was in the facility, I reported back to the staff that I felt “stupid,” Not really funny, but it was kinda funny at the time. I was told, I was just withdrawing from the Klonopin, I would be fine soon. I looked forward to that time. I still was feeling pretty “stupid” as I left there, but so happy to be off of alcohol that I sort of let everything be as I TRIED to get on with my life.
It didn’t take long for me to realize, after getting back to work, that my concentration and memory were impaired. I was having terrible cognitive difficulty. I, at times, can’t remember the times tables or how to spell words. Like “What is 6×8, or how do you spell “junction.” Additionally, sensitivity to light and sound (I work in a call center, a lot of noise, and overhead fluorescent light), and sometimes ice cold skin that came from nowhere. I had visual problems and other things. But, the biggest thing is not being able to THINK or REMEMBER. I didn’t have this problem before treatment.
I have had a multitude of tests, thank goodness my alcohol treatment took care of my max out of pocket expense. EEG, MRI, EKG, neurologist, eye doctor, ENT, vestibular migraine testing, etc…. I went back to my regular doctor today, everything was reported back negative, or fine. I am fine. NOT.
Luckily, my regular PCP is open minded. I told her that I thought this was related to my benzo withdrawl a few months ago, but we had to rule out things. I am going to see an addiction psychiatrist soon.
I don’t think there’s anything to be done, but WOW, I have really felt like a crazy woman who is making up symptoms to get attention or something. I’m also finally at a point where I’m going to contact the doctor I saw at the treatment facility I mentioned earlier, to get his input. I adored him, I still admire him, but I have to wonder, “WHY.” Well, really, “Why the Hell?”. I’m pretty upset. It’s been 5+ months of feeling awful, missing work, short term disability, unpaid, going broke. Even though he is a great doctor, he should have taken precautions and known of the benzo withdrawal syndrome, especially since I had been taking it for over 10 years.
I have felt so alone. I’m sorry you’re going through this, too. I want to make sure, to the best of my ability, that nobody else has to go through this.
Please reply if you’d like to make contact. I’m not sure how this works on this sight, so I’m not giving out my contact info, but at some point, I’d love to connect with you. Having someone else who is going through this craziness could only help both of us.
All the best,
Cathy
Iāve been taking colonzapam for 31 years. My dr. May start to take me off of it because Iām having memory issues. Iām 73 years old. Iām sure this could cause way more problems if he does that. What can I do to keep him from doing that?
JC Curle, what a Godsend you are! The work you’re doing educating the public about benzo’s is just amazing. Yes, it’s very difficult surviving a cold-turkey Klonopin withdrawal without committing suicide. I wrote a book describing what it’s like to be prescribed psychiatric drugs for 35 years w/ECTs, barely surviving that, detailing my c/t withdrawals (that almost killed me), then recovery/ freedom from all psych drugs. Psychiatric drugs, benzo’s being the worst, destroy lives & take lives.
Thank you for the work that you do JC. The world needs to hear it, and they’d better start listening because there’s far too many lives on the line. It’s just sad that it is legal to murder for profit in America, just ask any pharmaceutical company, and in Psychiatry the Hippocratic Oath to First Do No Harm – Does Not APPLY.
I was prescribed Clonazepam, Olanzipine and Venlafaxine after becoming suicidal on Gabapentin. I was left on these drugs for over a year (I was taken off Gabapentin abruptly) but started to get movement problems which was diagnosed as Functional Dystonia 3 years later even though Drug-induced Dystonia is a known condition. My life virtually ended with withdrawal from these drugs, mostly from an abrupt enforced withdrawal programme initiated by my GP. He gave me 2 weeks to get off Benzodiazepine. I had spent 8 months withdrawing from the two other drugs but the Benzo was a nightmare (even though I was trying in my own (uneducated) way by splitting drugs. 5 years on I am still suffering. I now have heart problems (Long QT Syndrome) because, my normal 50mg dose of Nortryptiline that was prescribed (successfully) for 30 years for pain was doubled to āhelpā with withdrawal. I was also on 3 other drugs linked to Long QT but my GP still kept me on it despite being told to take me off. I also had raised liver enzymes, kidney and bladder problems. Worst of all has been a 3-fold increase in pain. I have ME and Fibromyalgia. I am now allergic to almost every drug I take and am currently withdrawing from Tramadol because of this. I cannot even tolerate Tylenol or even my prescribed heart drugs! I believe I now have MCAS, am allergic to chemicals, perfumes and many foods. I had been managing my ME and Fibromyalgia reasonably well for 30 years before this nightmare began. Polypharmacy, has ruined my life. I believe I have PAWS, after researching on the Internet and joining support groups and sites such as this one. I am 65 and too sick to go out of my house, because of weakness, overwhelming fatigue, breathing problems and chest pains, dizziness and a plethora of other alarming symptoms, mostly neurological. My doctors are consistently ignoring me. I have been discharged from every consultant I have seen after just one visit, I suspect, because they just donāt want to get involved!
I would add that there is never any mention a higher risk for brain damage, Alzheimerās, mitochondrial damage and dementia. All mentioned in credible valid research papers.
Thanks, Tamra:
Can you help by linking to some of these credible and valid research papers I’ve been collecting theses, too. Some studies used invalid structure. This, of course, discredits the conclusions.
J.Hill
The risk of Alzheimerās disease has been contradicted by numerous meta-analyses.
Gary,Yet another jaw dropping story. I am so sorry for your journey. Prescribing for 31 years is bad enough, but just stopping your prescription is another issue that needs to be addressed. Maybe a conformed consent should not just be given to the patient to sign, but a separate one given to the doctors. In general, it should say, if a doctor prescribes these benzos or any drug for that matter, that they must be willing to help their patient taper too, via finding them an expert on tapering to go too before canceling the patients prescription. Hawkins
31 years con’t. Sorry but it posted mid comment. As you can imagine it has not been easy after 31years. But I still consider myself lucky as I had to take 1.5 years off work and then went back, but still have symptoms as I continue to heal. It has been the hardest thing I will ever do. All along I have went through horrible stuff and have done this all myself. It feels like I am having to drag any drs along I need anything from. All my family does not get it, does not believe it and will not help at all. Friends do not understand and have all gone except for 3 in other parts of the US. just amazing how bad this nightmare can be. Still have quite a few symptom every day with ear fullness and pressure being the worst and get a lot of motion type sickness every day. Also just starting to break out of suicidal thinking now. Before this took place I never abused my prescription, always took it as directed and was so against any other drug use that I did not even drink alcohol. Never took any recreational drug in my life and now I end up with a drug problem that screws up my whole life! But so far still is going along well compared to others on these sights. Just very hard to go this all alone with no help. Just insane how challenging this whole journey is. And I wonder if I can make it all the way back and heal. Sorry this is so long but it is a very long journey. Never posted about this ever, just did it and so far have been able to keep going.
Gary:
I know that your experience is true. Would you say that you are in Post-Acute-Withdrawal or are your symptoms those of actual damage to your body?
What sort of taper method did you use? How was that experience?
J.hill
It is amazing to me how these benzos are prescribed. I was put on one for 31 years! I had no warning what it was or that it could be addictive. Back then you trusted your doctor, and there was no internet to check meds out. I have never been sick from anything else except from benzos. My doctor was a specialist from Chicago, Il. He was only prescriber that wrote a new prescription re refill every month. This went on for 31 years! I guess I am lucky the way this has played out so far. The Dept. of Transportation put it on the watch list. He got nervous about liability and one day had his nurse call me up and said that he did not want to be my doctor anymore and would not fill any more prescriptions. This was with only 2 weeks left on my current prescription! Luckily my I found another dr that would prescribe, and would work with me to taper. Then the real work started. Tapered for about 1.5 years and then had to go to a rehab in Florida to get off the last of it. As you can i
So what do I do now, I went to fast from 6.0 to 4.0 of Xanax, and the side effects are horrible, I donāt want to go back up,I read the Ashton manual and she says to covert to a long acting drug?? Any help would be appreciated
Thanks
Dacid
The Inner Compass Initiative’s withdrawal project may also be a good resource for you, David
My girlfriend was prescribed Zoloft and Xanax 3 years ago, for anxiety-attacks. She wants to taper from them, one at a time. We were on a gentle, symptom-free taper from Zoloft, and had reduced her Zoloft dose by 43%, but then her doctor retired, and was replaced by a doctor who instead,imposed an abrupt 50% hard-withdrawal from the Xanax.
We’ve been look for another doctor who will allow us our gentle symptom-free taper, but all the doctors we go to insist of a retributive involuntary hard-withdrawal.
How can we find a doctor who will allow our gentle and symptom-free taper?
I donāt know of a website to go to. You can ask Benzo buddies but people live all over US. So you probably need to call local Drs and ask them the ?. I assume youāve read Ashton Manual which tells you how to taper. There are compounding pharmacies that can give you exact amounts instead of you cutting pills in halves and quarters.
Years ago I believed that a compounded benzo was reliable. It also relieved the benzo-patient of the responsibility to measure correctly. First one patient because severely symptomatic after picking up and using her compounded benzo. Bottom line: she had been dispensed someone else’s prescription.
Then I began to see people having unexpected problems after using compounded benzos. A look into compounding revealed one answer. Compounding pharmacists usually compound a drug into a more easily swallowed drug. Compounding to put a nearly exact number of milligrams into a liquid ( or capsule) is not an issue when only a more easily swallowed for is required. Compounding that casually is a disaster for those benzo-patients who require a very small limit of error.
Perhaps a compounder who comprehends the need for accuracy would eliminate that problem. I, myself, would not place that trust in anyone. I want to be sure that my benzo-containing liquid is correct so I insist that I mix it, myself.
Another issue is this: We need to know how many milligrams of benzo are in a milliliter of benzo-liquid. This requires the liquid to be homogenous. Suspensions are unreliable. Their solute begins to separate from the liquid phase immediately. Only a benzo in solution is reliable. So using the correct liquid is essential. Even today, people are placing a fat soluble benzo in water and believing that the benzo is dissolved. It is not. Therefore the tapered amount is a guess. So why the mystery about the cause of failure? And why do those popular help sites instruct people to just use water? Water-titration was debunked over ten years ago.
We have given away our responsibility to think. Is medicine really scientifically derived? Does science belong to medicine? No, science belongs to every one of us. We are the ultimate decision makers. Medicine can advise, but we must vet medical orders.
A simple example: I was in a C/T state. My HMO instructed me to take the prescribed amount and cut by 50% every week for six weeks. Then I would be well? This is a prescription for disaster. What was the science behind that? It did not exist in theory or in practice. Yet this is preferred to our own critical thinking?
Many taper ideas are promoted. Where is the evidence?
There is this list: https://www.benzoinfo.com/doctors/
Also, join some of the FB support groups and/or BenzoBuddies.org and ask for anyone in your area that can recommend a “benzo wise” prescriber that allows for a slow taper.
I just posted but have to add this ….Number 4 in the aforementioned post on uninformed benz perscribers, is so true . Five mg of Valium almost killed me after only taking for 1-2 months. The doctors had no idea what was wrong with me. They said “It cant be the Valium it is only 5mg” I was literally crawling in my apartment and my tongue is a muscle so i could not talk and went from one 115 lb to 103lbs. It was hell.
OH my Gosh This is spot on and hit every aspect of the issue. Every one of these issues mirrored my experience that lasted over 6 years. Thanks again JC Curle.
The same psychiatrist prescribed Klonopin and restoril to me since 2007. I stopped both April 2018, little over 2 months ago. I am in hell. How do we stop psychiatrists from ruining lives in their pursuit for money. How do we make every prescription of a benzo come with a informed consent that must be read and signed by the patient. When will pharmacies stop the long term selling of these drugs? Why aren’t insurance companies red flagging these drugs instead of quietly paying for them for months and years and decades for the same patient. Why aren’t the prescribers losing their licenses?
I was prescribed Valium 2.5 mg daily for 4 weeks prior to spinal surgery in July 2017. The dr told me that I would not become dependent as it was “only” a low dose and for a short duration, I was given no warnings as to any adverse effects and when I asked was told there weren’t any. After my surgery I ceased the valium (basically I accidentally cold turkeyed) and about a week afterwards experienced sudden horrific withdrawal symptoms. My dr was clueless as to how to deal with this and in fact told me that I must be “too sensitive” as she had never had this problem reported before. She told me to reinstate to 5 mg and then decrease by 1mg every 3 days. I did some research and found her “advice” to be faulty and commenced a taper with only myself and the internet as a guide. I had a horrific taper (I realise now that I cut too large doses but I kept being told that “it’s only a small dose”) My heart rate soared to 160 and my blood pressure skyrocketed to 220/120. I am 63 years old. When I presented to this dr with these symptoms I was told “withdrawals will end soon and you just have to tough it out”. The end result was that in November 2017 I had a stroke which the hospital attributed to the severity of the withdrawals, the cortisol storms had damaged my blood vessels causing a clot and the glutamate storms had caused cardiac excitation resulting in atrial fibrillation and hence the clot travelled to my brain. I had a clean bill of health prior to my surgery undertaking many cardiac tests to ensure I was fit for anaesthesia, in fact every precaution was taken to ensure that I came through the surgery ok. I now have to take powerful anti-coagulants for the rest of my life. I Was still tapering with horrific withdrawals and finally jumped off the valium at a dose of 0.125mg on 28/12/17. I am now 6 months post-withdrawal and I am still experiencing severe symptoms. I have been severely affected in other ways, I live in Australia and my daughter (in USA) had a baby 3 weeks ago, I am too ill to visit, my mother (in the UK) had a stroke herself at the same time and I am unable to visit her, at 89 she may not survive. I was fit and healthy before I was prescribed this poison and my dr refuses to take any accountability for what has happened to me. I am seriously debilitated and can do little being mostly housebound. How on earth can a dr who swore an oath to “First do no harm” seriously believe that benzo’s are ok to prescribe. When are dr’s going to stop “blaming “their patients. I am still told that I must be “overly sensitive” or “I can’t believe this, valium withdrawal doesn’t last this long” etc etc I have no faith in any dr anymore and firmly believe that any dr who prescribes this poison should be struck off.
all very good points…I’ve recently published a book called The Benzo Devil of my personal story and a large section in my book is dedicated
on a lot of what you’re saying above..well done..every bit of awareness helps!
How can we effectively stop these doctors from overprescribing if the patient is an adult? Our family has tried to stop the prescriptions from being written, but are always never allowed to put our thoughts and input into the decision. Weāve reported one doctor for overprescribing, there was no response. Iāve taken it upon myself to write reviews on the doctors websites and the hospitals websites to make myself feel like Iām helping.
I plan on printing out this article and sending it to the various psychiatrists who prescribed for my daughter. Or if you can, send it to all the psychiatrists you know.
Yes!! I as will will print this and distribute it. I, too suffered a 3 and half year injury from prescription benzos. I am since rebuilding my life, but have lost so much!
When will this madness end???
Expose the doctors by name! Stop the global phych drug holocaust Now!
Can you wait until I’m finished with my Taper?
Alright L ron hubbard, go sit in a sauna
One way is to report practicing outside of the standard of care in your location. In my state,
this is the Colorado Department of Regulatory Agencies. One report may not do it, but these reports accumulate. Then the offender must answer.
This is not a panacea, though.