Physician Assistant Commentary on Jordan B Peterson Update – Feb 2020 Transcript

Before starting, I should point out that nothing in this video should be construed as medical advice. I do not know the Peterson family personally. I’ve never spoken to them. I’ve never examined Jordan Peterson, I’ve never seen his medical records and so anything in this video is purely informational and educational and based on the contents of the video that was posted by Mikhaila Peterson.

Mikhaila Peterson:

The last year has been extremely difficult for our family. Dad was put on a low dose of ta benzodiazepine a few years ago for anxiety following an extremely severe autoimmune reaction to food.

So right off the bat we’re given a couple of important pieces of information. We know that Jordan was taking the benzodiazepine for a couple of years and Mikhaila mentioned that he was on a “low dose.” This term is often misleading when it comes to benzodiazepines. People think that they’re taking a low dose of benzodiazepine because on the bottle, for example, Klonopin it might say 0.5 milligrams or 1 milligram. This sounds incredibly small. However, what people don’t realize, and a lot of medical professionals don’t realize, is that Klonopin is 20 times as potent as its Valium counterpart. So 0.5 milligram of Klonopin is equal to 10 milligrams of Valium and one milligram of Klonopin is equal to 20 milligrams of Valium. These aren’t low doses. This is marketing 101 by the pharmaceutical companies. People are deceived and their physicians are deceived into thinking that they’re taking less than they actually are.

Mikhaila Peterson:

He took the medication as prescribed last April when my mom was diagnosed with terminal cancer, the dose of the medication was increased. It became apparent that he was suffering from both a physical dependency and a paradoxical reaction to the medication. A paradoxical reaction means the drugs do the opposite of what they’re supposed to. These reactions are rare but not unheard of for the last eight months he’s been in unbearable discomfort from this drug, made worse when trying to remove it, because of the additional withdrawal symptoms stemming from physical dependence.

So moving on, she states that her dad took the medication as prescribed. This is important for what we’ll discuss later. And then when her mother was diagnosed with cancer, Mr. Peterson’s dose of benzodiazepine was increased. We see this all the time in people who are started on benzodiazepines and left on them chronically. They start at a certain dose and then after a couple of years the dose is increased by their doctor. Sometimes it’s due to a phenomenon called tolerance. Tolerance to the many effects of benzodiazepines develops with regular use over time. The original dose of the drug progressively has less and less effect and a higher dose is required to obtain the original effect. This is one of the risks of taking benzodiazepines long term for more than a couple of weeks. Another common risk is physical dependence, which Mikhaila mentioned that her father developed. Physical dependence is a physiological neuroadaptation by the body to the chronic presence of benzodiazepine in the body and so the body learns how to function only with the benzodiazepine present.

Another hallmark of the development of physical dependence is that people will experience withdrawal symptoms if they try to reduce or stop taking the dose of benzodiazepine. So Mikhaila goes on to say that she also believes her father developed a paradoxical reaction to the benzodiazepines, and that this is a rare outcome. This is true paradoxical reactions are rare. However, she’s not saying that physical dependence is rare. Physical dependence is an expected outcome in patients who take benzodiazepines for more than just a few weeks. We don’t know due to lack of studies, what percentage of people will actually go on to develop physical dependence. But the estimates that we do have are anywhere between 30% and 100% of people who take the drugs anywhere beyond a few weeks to six months or so. 

So what is the paradoxical reaction? It is when the drug has an opposite effect of what it is intended to do in benzodiazepines that may look like anxiety, agitation, hallucinations, aggressiveness, hyperactivity, irritability, insomnia, exacerbation of seizures, and people with epilepsy. So the true question here is whether Mr. Peterson was actually having a true paradoxical reaction, which is possible, or if he confused the symptoms of tolerance and perhaps interdose withdrawal, which is when people taking benzodiazepines, they develop tolerance and then in between doses they start to have withdrawal symptoms like severe anxiety, agitation, restlessness. So did he confuse the symptoms of tolerance and interdose withdrawal with a paradoxical reaction, or, when he was dosing the benzodiazepine, was he truly having the opposite effect? And a paradoxical reaction? One way to tell would be usually when people have paradoxical reactions, the dose of benzodiazepine is increased and attempt to control the symptoms, and if it is a true paradoxical reaction, a dose increase would make the person worse, more agitated, more anxious, whereas if the person was having tolerance or interdose withdrawal, it could relieve some of the symptoms that they were experiencing. True paradoxical reactions in one study were shown to occur in about 1- 2% of patients who received an administration of benzodiazepine, so it is truly a rare effect. Again, I have not spoken to Mr. Peterson or examined him or seen his medical records and so there’s no way for me to know if he truly had this adverse paradoxical effect or if he was just experiencing the tolerance and interdose withdrawal. 

Okay, So she goes on to say for the past eight months, Mr. Peterson has been experiencing unbearable discomfort. Whether that was from tolerance and interdose withdrawal or from a paradoxical reaction, we don’t know, but she said it was made worse because he tried to withdraw from the medication and he developed withdrawal symptoms. So this is important to note. We know that he has had in the past eight months attempts at withdrawal. If he was truly having paradoxical reactions this is a horrible place to be because you take the drug and you are having a paradoxical reaction to it, but you’re also physically dependent on it and so when you try to stop taking it, you develop withdrawal symptoms, so you’re trapped, and the task becomes how to navigate withdrawing from the medication in a way that doesn’t cause such severe withdrawal that it’s unbearable, but continuing to take the medication so that you can withdraw slow enough while you’re having these paradoxical reactions to ingesting the benzodiazepines.

Mikhaila Peterson:

He experienced terrible akathisia, which is a condition where the person feels an incredible, endless, irresistible restlessness bordering on panic and an inability to sit still. The reaction made him suicidal. 

So Mikhaila goes on to say that her dad developed akathisia. This is a disorder usually brought on by medications, including benzodiazepines that causes a person to experience intense inner restlessness. The suffer is often driven to violence or suicide. They have an intense urge to move or pace. It is often described as agony. Death can be a welcomed result from akathisia. It is an incredibly serious movement disorder. I’ll put a link in the description below to a great resource for akathisia information for anyone who wants to learn more. Benzodiazepine-induced akathisia often manifests as a result of attempts at over rapid tapering or cessation where people try to remove the benzodiazepine too quickly so it shows up as a manifestation of withdrawal. 

Mikhaila Peterson:

After several failed treatment attempts in North American hospitals including attempts at tapering and micro tapering. 

Next, Mikhaila goes on to say that Mr. Peterson had several failed treatment attempts in hospitals. She states that tapering and micro tapering also failed. Now, it’s important to note that tapering and micro tapering are two preferred methods of discontinuing benzodiazepines— they are the safest recommended method across the board for getting off of benzodiazepines when you are physically dependent. That said, one of the reasons why tapering and micro tapering may have failed for Mr. Peterson is because as I mentioned before, she said that he had tried to reduce his dose previously. He developed withdrawal symptoms, he developed akathisia. Sometimes, and for reasons unknown, when people reduce their benzodiazepine dose to hastily they go into a withdrawal syndrome, they destabilize their nervous system, and if they increase the dose of benzodiazepine back to the original dose in attempt to stop the withdrawal, it doesn’t always work. So now you have someone who has a destabilized nervous system, who’s experiencing terrible withdrawal syndrome and they’re on the benzodiazepine, but it’s not working anymore to stop the syndrome that has started.

Sometimes a higher dose will alleviate the withdrawal syndrome, other times that doesn’t work, either. There is a psychopharmacologist out of the United Kingdom by the name of Dr. Heather Ashton. She is a benzodiazepine expert. She has a manual on benzodiazepine withdrawal that she wrote called The Ashton Manual, and there is a section in that manual where she discusses why this phenomenon happens where people try to reinstate or updose their dose and it simply does not work, so I will link that below in the description for anyone who wants to read more about that. 

Anyhow, this is why it is extremely important for people who are already physically dependent on benzodiazepines from taking them chronically to before they ever attempt at reducing the dose or any withdrawal whatsoever that they become very educated on the process, that they read The Ashton Manual, which is a great guide for tapering and that they get as prepared as possible, because sometimes once you start the ball rolling, you can’t stop it, you can’t undo any mistakes that you’ve made, and so it’s best not to make the mistakes at all, and to start from a place of being fully educated and having a really solid plan for discontinuing the benzodiazepine. 

Mikhaila Peterson:

We had to seek an emergency medical benzodiazepine detox, which we were only able to find in Russia.

At this part of the video, she goes on to say that out of extreme desperation, they made the decision to take Mr. Peterson to an emergency medical benzodiazepine detox in Russia. Now I don’t know anything about this detox center or what type of procedures they offer there, but I can certainly understand the extreme desperation that Mikhaila talks about. A lot of times what happens is, as I described, people make an attempt at over rapid reduction of the benzodiazepine, they destabilize their nervous system, they’re having severe withdrawal effects, they have tried everything to try to restabilize but they’re not, and they panic. So they are calling hospitals, they are going to detox centers, they want this drug out of their system because they realize it’s harming them, but sadly, these detoxes often make things worse because the problem is when you reduce the drug too quickly and you’re physically and physiologically dependent on it, you put the body in an acute shortage of GABA. GABA is an inhibitory neurotransmitter in the body. It is calming. It is the brakes for your nervous system, and so when you cause an acute shortage of GABA, you get the opposite. You get anxiety, you get panic, you get terror, you get this akathisia, this over excitatory response of the nervous system. A lot of these detox centers and hospitals do not know what they’re doing and so they are happy to take thousands and thousands of dollars from people. A lot of times they admit them, they rip them rapidly off of the benzodiazepine. Sometimes they label them as a drug addict because these detox and rehab centers are 12 step programs and they have a hammer and so they make everything a nail. So anyone who comes through the door who’s having withdrawal effects is a drug addict. So people are subjected to 12 step programs and things when really this is just a physical and physiological neuroadaptation that has happened from taking medications as prescribed. We know Jordan took them as prescribed. That was mentioned earlier in the video. We have an article on our site called Why Prescribed Benzo Patients Shouldn’t Go to Detox or Rehab, and so I’ll link that below for anyone who wants to read further. 

Mikhaila Peterson:

It was incredibly grueling and was further complicated by severe pneumonia, which we’ve been told he developed in one of the previous hospitals. He’s had to spend four weeks in the ICU in terrible shape, but with the help of some extremely competent and courageous doctors, he survived. The decision to bring them to Russia was made in extreme desperation when we couldn’t find any better option. The uncertainty around his recovery has been one of the most difficult and scary experiences we’ve ever had. 

At this point, Mikhaila mentions that her father’s situation was further complicated by the fact that he developed pneumonia and had to spend four weeks in the ICU. Two things I want to mention about this. The first is that pneumonia is often treated with a class of antibiotics called the fluoroquinolones antibiotics, if possible, and people who are taking benzodiazepines, the fluoroquinolones drug class should be avoided. These antibiotics displaced benzodiazepines from their binding sites, and this can precipitate acute withdrawal. So if Mr. Peterson was given fluoroquinolones antibiotics, which I do not know, and he was still on the benzodiazepines, this could have exacerbated his condition. Secondly, benzodiazepines are respiratory depressants. They can put people at significant increased risk of developing things like pneumonia, so these are things to possibly consider. 

Mikhaila goes on to state that the uncertainty around the recovery of Mr. Peterson was one of the most difficult and scary experiences their family has ever had. This is something we hear all the time from the families and the people who are enduring benzodiazepine adverse effects and withdrawal syndromes. This is why our organization advocates for informed consent. These syndromes are often severe, they are life altering, they are disabling, they are scary, they cause financial ruin and patients deserve to know that this is a risk before they ever take these medications. They are overwhelmingly, however, not being given this information at the time of prescription, and so it comes as a shock and a surprise and it is frightening and life altering for everyone involved. The person having to endure it and there are family members and friends and employers and it casts a wide net of harm.

Mikhaila Peterson:

So finally, dad is on the mend even though there’s a lot of physiological damage that he needs to recover from. He’s improving and is off of the horrible medication. His sense of humor, his back, he’s smiling again for the first time in months, but he still has a long way to go to recover fully. It appears that we’re going to get through this by the skin of our teeth.

So at this point in the video we’re told that Mr. Peterson is off the medication. He seems to be on the mend, although he still is enduring some physiological damage that he needs to recover from. We don’t know what the damages, or the symptoms that he’s enduring. It was not mentioned. However, this is common. It can take many months and sometimes even years for people to recover from the injury, the insult, the damage to the brain and nervous system that the medications and the withdrawal from them inflicted. This is often referred to as a protracted withdrawal syndrome, although that is tricky because medicine doesn’t really recognize withdrawal that lasts for more than two weeks, so a lot of times patients who are having these neurological and physiological and psychological symptoms after stopping benzodiazepines go to their doctors and their doctors say that’s not possible, tt doesn’t last this long, and so a better term for it is a neurotoxicity or damage or injury to the nervous system.  Whatever we settle on calling it. It’s real, it does happen, it is not as rare as people want to make it out to be. I think the estimates are somewhere around 15% of everyone who experiences withdrawal will go on to have a protracted syndrome. The people who are most at risk for developing it came off the medications too quickly. They either over rapidly tapered or they cold turkeyed. 

So onto some better news, Mikhaila says that her dad is on the mend, that he’s off the medicine, hos sense of humor, his back, he’s smiling  and it appears that they’re going to get through this by the skin of their teeth. And that is how if you ask anyone who has been through benzodiazepine injury and withdrawal, that is how they would describe most of the time, that they got through this barely hanging on. Surviving is what they call it. This can be long, it can be arduous, it can be torturous inhumane, and some people will tell you they don’t know how they survived. They barely survived. Not everyone experiences this severe of an experience, however, the people who do it is real and there are very little supports and resources for these people available, and that has to change, especially for something that is caused by medical treatment. This is an iatrogenic  problem.

Mikhaila Peterson:

So let me make a couple of things clear. Neither our family nor the doctors here believed that this was a case of psychological addiction. Benzodiazepine physical dependence due to brain changes can occur in a matter of weeks. It can be made even worse by paradoxical reactions that are difficult to diagnose and can be extremely dangerous.

So now at the close of the video, Mikhaila wants to make a couple of things clear. The first one is really important and it seems to be one that all of the media outlets overlooked. She states “neither our family nor the doctors believe that this is a case of psychological addiction.” So, when you go however, and you search the internet for all of the news stories about this, there are stories and stories and stories talking about Mr. Peterson has an addiction problem. Mr. Peterson does not have an addiction problem, he developed a prescribed physical dependence. If he had a paradoxical  reaction, he also had an adverse effect to a medication. Neither of these things are synonymous with addiction. Physical dependence and addiction are two distinct phenomena. They are not synonymous with each other. Addiction is a behavior. It involves abuse, it involves drug seeking, whereas people can become physically dependent simply by taking their medications as prescribed by their doctor and they have no behavior of abuse or drug seeking. Below, I will put a link to an FDA document where they define the differences between these two terms, physical dependence and addiction, so anybody who wants to learn more can read that article. 

So Mikhaila tweeted in response to these libelous media claims that her father has addiction. We’ll put the tweet up. It says there is a reason it’s called benzodiazepine physical dependence and she tagged the media outlet, “Clearly you do not understand this drug and the least,” and unfortunately this is a very common thing. A lot of people do not understand the differences, including medical professionals between these two terms, and some might think that it’s just semantics, oh, what does it matter if you call it addiction or physical dependence? Well, it matters because if we continue just saying that everyone who has a withdrawal syndrome or adverse effects to this medication is a drug addict, then everyone taking the drug as prescribed by their doctor gets this false sense of security— they see these media stories and they think, oh well that only happens to drug addicts and I’m not a drug addict, I’m just taking this medicine just like my doctor told me to, and so they think that they’re safe when the reality is we need the general public and physicians and everyone to that you are at risk for prescribed physical dependence. Even if you take these medications exactly as prescribed and you take them for more than just a small few weeks of time. 

So another problem with labeling this addiction when it is not, is that patients who are physically dependent on benzodiazepines require repeat prescriptions in order to slowly and safely taper off of the benzodiazepine to discontinue it. If medical providers think falsely that their patients are addicts, they will not prescribe repeat prescriptions of the benzodiazepine and the person will be forced into dangerous cold turkey or over rapid tapers. Also, while myself and our organization does not condone the stigma of addiction, when you are not an addict and you are falsely labeled as one and subjected to this stigma,that is wildly unfair. When somebody like Jordan Peterson is labeled an addict, falsely, perhaps this is not as big of a deal because he’s wildly successful. However, when you are just the average Joe, this could have detrimental consequences to your life. 

Mikhaila Peterson:

We’ve been told and hope the dad will recover fully, but it will take time and he still has a ways to go. We’re extremely lucky and grateful that he’s alive. The next update will come from him directly. Thanks again for all the support. 

Mikhaila says that they should, I’m told and they hope that Mr. Peterson will recover fully, but that it will take time, and this is true. As I stated earlier, people can take months, they can take years to recover. How long is truly individual, it can’t be predicted from person to person. Mikhaila states that her family is lucky and grateful that her dad is alive. And as I stated before, most people going through benzodiazepine injury and withdrawal syndromes and adverse effects feel the same way, they feel incredibly lucky to be alive. A lot of people hear the term withdrawal and it’s just so misleading, people think it’s like, you know, cigarettes cause withdrawal. It’s not just withdrawal, this is so much deeper and more complicated and much more suffering is involved when it comes to the benzodiazepines. And again, it can be injury, it can be damaged, it can be long lasting and it can be horrific suffering that people feel takes them to the brink of death. 

And by takes them to the brink of death. I don’t always mean that the withdrawal syndrome was going to kill them, although it can, benzodiazepine withdrawal syndrome can cause seizures and death, but I mean that people feel like the suffering was so severe that they were going to have to end their own lives because they could not endure the duration and the severity of what it took to rid themselves of this medication, and sadly, sometimes people do die. They do have seizures and die coming off of this medication and they do commit suicide. We have a handful of suicides in our withdrawal support communities every month. 

So in closing, you know, whether we agree with Mr. Peterson’s teachings and philosophies, whether we like Mikhaila’s carnivorous ways, I think we can all agree, especially if we’ve been through benzodiazepine withdrawal, that we never wish this suffering on anyone. Although, if I’m being honest, I wish I had super powers sometimes when I was going through it myself that I could just touch someone and let them have what I had inside of my body for just 10 minutes, especially other medical providers, so that they could really fully grasp and wrap their heads around what this entails. For the purpose of just of understanding, because a lot of medical professionals will gaslit patients in benzodiazepine withdrawal, they will disbelieve them, they will not understand how torturous the syndrome is or, or akathisia is, and so if we could just have a way to transmit this so that we could have some better understanding it would be wonderful. By speaking about this medical caused harm and injury the Peterson family is doing a public health service. We are grateful for their transparency, we wish Mr. Peterson and his family speedy, full and complete healing. We do hope he’ll continue to update us on how he’s doing, continue to tell his story, and when he’s well enough in the future, we really do hope he’ll continue to advocate around this issue. It is so important, it is such a misunderstood and underrepresented problem and we need more information, education, and change around the way these drugs are being negligently over prescribed and prescribed for longer periods of time than they are truly indicated for. Thank you so much for listening.