Fixing the benzo problem: Open the proverbial closet door and look inside

One day back in August of 2020, I was using the shared laundry room in my condominium building when I saw what appeared to be a water stain on the drywall just above one of the baseboards. I pulled out my phone and snapped a picture, emailing it to our property manager with a message: I spotted this on the wall. I touched it and it’s soft and damp, so I think there’s a leak of some kind. Just informing you so you can send maintenance to look. 

Two days later (not having received a response), I sent another email to say I’d discovered the probable source of the problem: a locked water-heater closet out back that had water dripping out the door and lots of water sounds inside. It backed right up to the damp spot on the laundry-room wall. The property manager responded and assured me he’d alert their maintenance guy—let’s call him “Billy”—to have a look.

Not long after, my upstairs neighbor informed me that her bathroom countertop and vanity had started to bow, and the cabinet below the sink felt warm and was showing traces of mold. As a renter, she’d complained to her landlord, who hired his own plumber to investigate. That plumber had come out a few times and found no issues in her plumbing to explain the vanity deformities or the mold. His report was passed on to our maintenance guy, Billy, who (supposedly) checked out my work order and said he found nothing wrong with the water-heater closet—claiming the problem had to be coming from the upstairs rental unit, despite the other plumber finding nothing there.

After about a month of this back-and-forth, another, downstairs neighbor, who travels for weeks at a time, returned home to find that all the framed pictures in his spare bedroom (the one closest to the water-heater closet) had slid down the drywall and crashed to the ground. His bathroom ceiling was also covered with mold. 

Long story short: Billy had never bothered to get a key to unlock the water-heater closet and instead just quickly nosed around, called it good, and continued to blame the nonexistent plumbing issue upstairs. Had the water-heater leak been addressed when I reported it a month before, the fallout might have been minimal. Instead, after so much time had passed, there was extensive damage to multiple units, to the laundry room, to the hot water heater itself, and to its closet. You can imagine, then, how flabbergasted I was to learn that, instead of filing an insurance claim or calling in a professional remediation company, our property manager had just turned around and hired our friend Billy to fix the damage! Let me get this straight: this guy is the cause of the massive expense to our property, then gets to bill the homeowners’ association to fix it?! Unreal.

Every time I think about that story, it reminds me of the benzodiazepine situation. Providers in the medical system—psychiatrists, psychiatric nurse practitioners, PCPs, GYNs and other specialists—prescribe benzodiazepines that ultimately cause big problems. They put patients on the drugs long-term, which creates physical dependence and causes a totally preventable iatrogenic injury (albeit inadvertently and without malice). Often they refuse to acknowledge there is a problem at all, leaving it to patients to find and present the evidence on their own. And in order to fix the problem, patients must pay the same medical system to (painfully) undo it. It feels akin to driving over a spike strip on your way into the bay of an auto shop, then having to pay them to put on a set of new tires to restore your car to what it was when you drove in.

And in order to fix the problem, patients must pay the same medical system to (painfully) undo it. It feels akin to driving over a spike strip on your way into the bay of an auto shop, then having to pay them to put on a set of new tires to restore your car to what it was when you drove in.

I had a similar feeling back in 2010, when a negligent rehab center ripped me off benzodiazepines in a mere week, after I’d taken them for five years—sending me home to suffer the horrors of acute withdrawal on my own. Because I was too ill and nonfunctional from the rapid withdrawal to work, and my prior employer’s COBRA health insurance policy was ending, I needed to pay for private health insurance out of pocket (pre-Obamacare). 

So I applied for individual coverage with Blue Cross Blue Shield (BCBS), the company that had insured me when I was employed—the same company that paid for the five-plus years of psychiatry visits and the prescriptions for two benzos and a Z-drug that had snared me in the nightmarish cobweb to begin with. But because I now had a diagnosis of “benzodiazepine withdrawal syndrome,” BCBS opted to put me in the highest tier of risk, allowing them to charge me the steepest monthly premium to cover the “pre-existing condition” I was afflicted with. In other words, BCBS had funded the creation of the problem that resulted in so much sickness and need for medical services it could now be billed as “high risk.” How does that make any sense?

It is time we get the key, open the proverbial closet door, and look inside to examine what’s really happening. Just like the water heater that’s left to spew hot steam for a month, benzodiazepines in the long term ultimately just cause destruction. The current medical system is creating a chronic illness and is also, distressingly, a requisite for the “fix”— both at the expense of the patient.

It is time we get the key, open the proverbial closet door, and look inside to examine what’s really happening. Just like the water heater that’s left to spew hot steam for a month, benzodiazepines in the long term ultimately just cause destruction. The current medical system is creating a chronic illness and is also, distressingly, a requisite for the “fix”— both at the expense of the patient. You’d think after sixty-some years of this we’d finally understand that the simple solution is to just stop creating the problem in the first place. 

How can we stop creating the problem? 

1. Use safer alternative treatments first. 

2. Follow existing guidelines and heed the black box warning, prescribing/taking benzodiazepines only when absolutely necessary and at the lowest dose for the shortest time possible (two to four weeks maximum, including the tapering off period, as some patients can become physically dependent in a week). Intermittent one-off uses are safest.

3. Always offer and obtain written, informed consent from the patient at the time of benzodiazepine prescription and before any attempts at cessation.

4. More comprehensive medical provider education.

5. Through legislative efforts. Recently, a bill passed in Colorado limiting the benzodiazepine supply that can be prescribed to a patient (with exceptions for those with specific conditions). There are similar ongoing legislative efforts in Massachusetts. Ideal legislation should require informed consent, limit new prescriptions to short term, and grandfather in those already physically dependent on long term benzodiazepines—ensuring that the decision to withdraw from the drug remains theirs, and that they have access to a prescription for as long as needed to complete a safe taper.