Benzo Blunders: CTV News Montreal “Why people shouldn’t take benzos for long periods”

Following the recent release of Radio-Canada Enquête’s Cauchemar Sur Ordonnance (Prescription Nightmare), an exposé that featured two members of our medical advisory board—Nicole Lamberson, PA and Dr. Jim Wright—there has been an increase in the Canadian media about the potential harms of benzodiazepines. While we welcome accurate reporting on benzodiazepine risks and harms, we’ve encountered yet another “Benzo Blunder” that missed the mark. The one in question is a four-minute CTV News Montreal segment that aired on February 21, 2024, titled Why people shouldn’t take benzos for long periods. It featured Dr. Christopher Labos interviewed by host Mutsumi Takahashi. The misinformation shared could put Canadian lives at risk. As is so unfortunately common, the terminology used may lead patients to erroneously believe that as long as they don’t abuse their benzodiazepine, they will be safe from harm. Moreover, the piece suggests that effective help is readily available if problems arise with benzodiazepines, which is, sadly, not always the case.

What the segment got right

Dr. Labos appears to genuinely want to help in this situation, and it’s only fair to acknowledge that he was just given a few minutes to discuss a highly complex issue. He did note that patients should be tapered slowly, and it’s true that most providers lack the necessary skills to assist. Dr. Labos’ explanation about ‘medical inertia’ also rings true—where uncertainty about discontinuation methods and the anticipated difficulty in stopping benzodiazepines leads to patients being left on them for years.

Host Mutsumi Takahashi shared a concerning statistic: an estimated 1 out of every 10 people in Canada has a benzodiazepine prescription. She rightly emphasized that these medications are meant for short-term use but are often taken for longer periods, which can be dangerous.

An estimated 1 out of every 10 people in Canada has a benzodiazepine prescription

At the end of the segment, Dr. Labos suggested, as a solution, not prescribing these drugs as widely as they are. I agree with reducing casual prescribing, but with a strong stipulation that we are referencing reducing the incidence of new long-term prescriptions, not forcing those already physically dependent on long-term benzodiazepines off their medication. 

Most patients who have problems with benzodiazepines are not addicted to them

When asked by Mutsumi Takahashi what the consequences were for using benzodiazepines for months or years, Dr. Labos answered that the biggest consequence are that patients “can become addicted” and that “these medications are addictive, they are habit forming, and once you start, it can become very very difficult to stop.” The real reason benzodiazepines are hard to stop is that, for many patients, physical dependence and subsequent withdrawal syndromes can develop with exposure beyond a week or two. Beyond that, in some patients, long-term benzodiazepine-induced neurological dysfunction (BIND) occurs, causing protracted symptoms. 

Host Mutsumi Takahashi also interchanged the terms ‘dependence’ and ‘misuse’ throughout the segment, which is confusing to viewers as they are distinct phenomena and not synonyms. Making the distinction between terms is so important because the treatment approaches for each condition are entirely different. Conflating physical dependence, misuse and addiction can result in further patient harm and death. For example, when detox, cold turkey, and abrupt cessation are employed because a clinician thinks they are treating addiction, the result can be severe withdrawal, BIND, seizures, death and even suicide.

Conflating physical dependence, misuse and addiction can result in further patient harm and death.

Nicole Lamberson, PA, who appeared in the Radio-Canada Cauchemar Sur Ordonnance, piece mistakenly sought “detox treatment” herself, due to this confusion in terms, despite being a compliant, prescribed patient. This decision made her suicidal and left her trapped in a state of benzodiazepine-induced neurological disability for more than a decade. 

Contrasting Physical Dependence with Addiction

The FDA, in their 2019 industry guidance, provided clear definitions of these terms: 

Physical dependence is a state that develops as a result of physiological adaptation in response to repeated drug use, manifested by withdrawal signs and symptoms after abrupt discontinuation or a significant dose reduction of a drug. In a person who is physically dependent on a drug, a withdrawal syndrome is normally anticipated when the drug is abruptly withdrawn, when the dose is reduced.

Drug addiction is a cluster of behavioral, cognitive, and physiological phenomena that may include a strong desire to take the drug, difficulties in controlling drug use (e.g., continuing drug use despite harmful consequences, giving a higher priority to drug use than other activities and obligations), and possible tolerance or physical dependence.

True Benzodiazepine Addiction is Quite Rare

Addiction to benzodiazepines is RARE. One recent analysis found that 12.5% of U.S. adults used benzodiazepines from 2015-2016, and only 0.2% met the criteria for a substance use disorder (SUD). Most benzodiazepine patients are suffering from prescribed physical dependence.

Effective help is not available to help patients stop their benzodiazepine

Dr. Labos accurately stated in the program that most prescribers are unable to manage benzodiazepine withdrawal, and specialized psychiatric services are required. Unfortunately, those specialized services rarely exist. Patients experiencing tolerance, physical dependence and/or severe withdrawal frequently find themselves harmed further by the medical field’s lack of knowledge and expertise, leaving them nowhere to turn for professional guidance. This gap in care leaves patients scrambling for help, often seeking the services of peer support forums like Benzo Buddies. As stated in the Psychiatric Times article Online Communities for Drug Withdrawal: What Can We Learn?:

The message is that physicians have been unprepared for these withdrawal disorders and are unable to treat or even guide patients through complicated withdrawal from these substances.

At Benzodiazepine Information Coalition, we regularly receive inquiries from all over the world, including Canada, from patients desperate for help. Some Canadian patients even seek Medical Assistance in Dying (MAiD) to escape their painful benzodiazepine-induced symptoms. 

Some Canadian patients even seek Medical Assistance in Dying (MAiD) to escape their painful benzodiazepine-induced symptoms. 

Patients are often left to figure out how to alter their doses alone, as the available benzodiazepine manufacturer dosages are insufficient to make reductions in increments that are tolerable and safe. Furthermore, there are rarely adjunctive medications or support measures that are effective for treating the multitude of symptoms that benzodiazepine exposure and withdrawal can create. There is not an existing inpatient medical protocol, or additional/alternative medications, that will eliminate benzodiazepine harm. Pretending there is, as this segment did, is misleading.

Protracted withdrawal and benzodiazepine-induced neurological dysfunction exist

Although Dr. Labos did acknowledge that benzodiazepine withdrawal is challenging, this description is grossly understated. The most concerning thing about benzodiazepines is not that they are “addictive.” It is that, with chronic prescribed use, they can physiologically alter a once-healthy nervous system, leading some unsuspecting patients to long-term benzodiazepine-induced neurological dysfunction (BIND). BIND symptoms be disabling, and can persist for months to years post-cessation, even after a slow taper. While patients will improve slowly over time, some symptoms may be long-lasting, or even permanent.

Other Details the Segment Missed

Dr. Labos’ claim that “better medications exist for anxiety and sleep” is debatable. He would have to define ‘better.’ While some have a lower risk for overdose, many of the medications prescribed as alternatives to benzodiazepines also cause a similar physical dependence and withdrawal. Without proper informed consent, patients could be led down an alternate path, just with different medications, ending up in a similar place.

Dr. Labos claimed that higher doses of benzodiazepines “are more complicated.” However, this assumption doesn’t necessarily hold true in real-world outcomes. Either physical dependence has developed, or it hasn’t. Either kindling has occurred, or it has not. Both can occur from exposure to what medicine deems “low doses.”

In BIC’s experience over the years, we’ve observed that some individuals, for unknown reasons, successfully discontinue a decade or more of high-dose benzodiazepines without encountering issues. Others, on much smaller doses and for shorter periods, end up with severely compromised nervous systems that may take many years to show any signs of repair. And, there is no way ahead of prescribing to these folks to determine who will be who. For this reason, every prescription and taper should be approached with an awareness of those facts, regardless of the benzodiazepine dose or duration of use.

Also, there’s an implication that cessation is always the best option, but sometimes it isn’t! A 2023 study found that benzodiazepine discontinuation was associated with small absolute increases in mortality and other potential harms, including nonfatal overdose, suicide attempt, suicidal ideation, and emergency department visits. With the medical field being so ill-prepared to assist patients effectively through withdrawal, some individuals who are not currently experiencing adverse effects on the drug may find that their safest option is to continue taking it. Especially vulnerable populations like the infirm and elderly may fall into this category as well. Some people may also not be in a place in their life where they can risk years of potential disability, income loss, etc. Policies that are insistent on deprescribing for everyone may ultimately result in more harm.

With the medical field being so ill-prepared to assist patients effectively through withdrawal, some individuals who are not currently experiencing severe neurological problems on the drug may find that their safest option is to continue taking it.

Dr. Labos suggested that we “have to try” to “transition” elderly patients off the medication in a “safe, structured manner.” However, I believe it should ultimately be left up to the individual, equipped with fully- informed consent regarding the risks of both remaining on the drug and stopping it. I encourage any elderly person, their family or doctor considering withdrawal to read the story of Arnold—an elderly gentleman with a protracted injury from lorazepam—to understand the dilemma that long-term benzodiazepine prescribing presents for older patients.

Cauchemar Sur Ordonnance addressed much of the misinformation in CTV’s segment. I would encourage Dr. Labos and Mutsumi Takahashi to watch it when it will be available in English, on Radio-Canada’s YouTube channel, in the next few weeks.