Pushing for an Informed Consent Benzo Bill in Texas

Stephen LaCorte, JD
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Dr. Raymond Armstrong and I are currently working together to push Texas lawmakers to adopt restrictions on the prescription of benzodiazepines and sleep drugs. We feel fortunate to be able to draw from the experience of the benzo movement in Massachusetts, and we are grateful for the information that long time advocates like Geraldine Burns have provided us.

Dr. Armstrong and I connected on this issues in January of this year, after I came to him for assistance in tapering off the benzodiazepine, Klonopin. Currently, I am 18 weeks into a 40-week taper plan. Dr. Armstrong’s interest in this work stems from his own experience some years ago when he went through a protracted withdrawal after he abruptly cold turkeyed himself off of Valium.

For people struggling to discontinue psychiatric medications, Dr. Armstrong routinely uses a compounded, oil-based suspension of the drug. This can be gradually and precisely measured in a syringe with the dose reduced over time.  He prefers the suspension because it allows for precision in dose delivery that cannot be achieved through pill cutting.  He has successfully assisted hundreds of people to taper off psychotropic drugs.

A few months ago, Dr. Armstrong told me about a recent legislative initiative in Massachusetts to further regulate benzodiazepines and other hypnotic drugs (Bill 4062).  Knowing this bill might be persuasive to Texas lawmakers, I decided to contact every legislator in Texas by e-mail.  I also followed up with handwritten letters to all members of the Public Health Safety Committee in the Texas House of Representatives and all members of the Health and Human Services Committee in the Texas Senate.

Responses have trickled in from a few concerned lawmakers, and I continue to receive favorable responses from lawmakers from correspondence I sent them in May of this year.

The next legislative session in Texas will not begin until January of 2017.  From this time forward, we intend to connect with physicians, particularly young psychiatrists who are wary of benzos, primary care doctors, and OBGYN’s, who often serve as primary care physicians for women.

 

Why This Legislation Is Needed

I am a lawyer, and in law school, the most important thing you learn regarding medical interventions is the notion and legal concept of informed consent.  Informed consent is often defined as the permission a patient gives a doctor for a particular treatment with the patient’s knowledge of all the possible consequences of that intervention.

When I first saw a psychiatrist for trouble sleeping and resulting anxiety, I explicitly asked him whether Klonopin could cause dependency issues.  He shook his head no and emphatically said, “I have tons of patients that have been on benzos for years, and they don’t develop tolerance, it’s fine…My eyebrows don’t start to raise until a patient is taking at least 4 mg of Klonopin a day.”

I was completely denied informed consent for the risks of long term use of Klonopin even after I explicitly stated my concern to this doctor.  So we are focusing on a regulation that would require doctors to warn patients by having the patient sign a form stating all the possible risks of long-term use of these drugs, including new or worsening anxiety and depression, as well as, the potential for physical drug dependency.  We also want to make sure that physicians cannot abruptly discontinue prescribing these drugs to people already physically dependent on them.
What Patients Need to Know For Informed Consent 

Many doctors that frequently prescribe these drugs long-term focus only on addiction as the sole potential problem.  They know that taking benzodiazepines alone rarely results in addiction.  The doctor may conclude that the patient has no history of substance abuse and, therefore, feels completely comfortable prescribing a benzodiazepine for long term use.  In fact, my psychiatrist prescribed enough pills and refills for Klonopin to last half a year.  Alternatively, the patient may feel a false sense of security because he knows he doesn’t have an addictive personality.  Unfortunately, far more widespread than addiction to these drugs is physical dependency leading to the inability to discontinue these drugs due to severe withdrawal symptoms that can be agonizing and thoroughly disruptive to a person’s life and that of his or her loved ones.

Dr. Armstrong refers to the bell-shaped curve of biostatistical variation of responses to a drug in any sizable cohort of patients.  In the case of habit forming medications, such as benzodiazepines, this variation not only applies to direct side effects but also to sensitivity to the withdrawal process.  There are individuals on the left side of the curve that show a large tolerance for benzodiazepine reduction.  Sensitive people, however, who fall on the other end of the bell curve (right side) have poor tolerance for reduction of the drug.

It is important to note that there is not yet a reliable assessment tool for determining where an individual fits on the bell-shaped curve of tolerance.  For discontinuation of a benzodiazepine, no one and no physician can reliably predict how sensitive an individual will be to a benzodiazepine reduction.

Unfortunately, many doctors prescribing psychiatric drugs dismiss a person’s side effects or symptoms of emerging dependency because they want to believe that the tools of their trade only help and do not cause harm to people.  Moreover, it is tough for an individual to prove that the drug harmed him.  Often physicians, particularly those unwilling to believe there is a downside to the pills they prescribe, prefer to diagnose that the patient as having a new somatoform or psychosomatic disorder.

Early on, Dr. Armstrong himself did not understand the connection between all his symptoms and protracted withdrawal.  In those days, he simply thought he was developing “phobias.”  I can relate to Dr. Armstrong’s withdrawal.  It’s only natural for your anxiety to go up when you realize you’re trapped on a drug that’s making you feel awful but even worse when to try to discontinue it.  There is no end in sight without the right assistance.  Fortunately, taper plans for these drugs may be as long as 40 weeks in duration.  This can provide a way out of the trap and lead to a hope of freedom and recovery.

A chronic user of benzodiazepines may experience withdrawal symptoms even while regularly taking the medication.  This experience is due to tolerance to the drug or from failing to dose frequently enough in accordance to the half-life characteristics of the drug.

I asked Dr. Armstrong how I would be able to distinguish between anxiety unrelated to the medication from stress caused by tolerance withdrawal or inter-dose withdrawal symptoms.  He explained that it’s hard to make a distinction between the two.  However, one telling sign of inter-dose withdrawal is experiencing increasing symptoms in the immediate time before taking the next dose of the drug or in the mid-to-late dosing interval.

It appears that physicians generally lack a clear understanding of the pharmacokinetic half-lives of the various benzodiazepines.  This knowledge is fundamental in choosing the appropriate dosing intervals for the different benzodiazepines in order to minimize inter-dose withdrawal symptoms.  Klonopin, for example, has a 12-hour half-life, thus allowing every 12-hour dosing intervals. In contrast, Ativan has a clinical half-life of 5 hours, Xanax a 4 hour clinical half-life, and Valium a mixture of long half-lives.  The half-life factor is important in choosing a proper dosing interval in order to avoid inter-dose withdrawal symptoms.

If one were to prescribe Klonopin once a day, at bedtime only to treat insomnia, theoretically this could lead to a 75% decrease in function by the end of the 24-hour dosing interval.  However, dividing the 24-hour load by two and giving half the daily dose every 12 hours will optimize dosing with the avoidance of inter-dose withdrawal symptoms, save for the possible need for minor dosing changes applied equally to the two 12 hour dosing points.

Addiction Medicine, I am told, does not use a taper method but rather favors the rapid reduction or cold-turkey approach.  Historically, when drug rehab or detox centers were established as early as the 1940’s, the technique for alcohol discontinuance with its short half-life was abrupt cessation with seizure prophylaxis.  When alcoholics showed up at detox centers hooked on Valium when it was first marketed in 1963, the method of abrupt cessation was applied for both the alcohol and Valium.  The sudden termination approach to benzodiazepine “detox” is generally used 53 years later. However, it is associated with significant benzodiazepine withdrawal symptoms.  Unlike physical withdrawal from alcohol, that has a definite three-day acute period with residual symptoms lasting up to a few weeks, physical withdrawal from abrupt cessation of benzodiazepines can last months or years, during which the person endures much needless suffering.

Recently, most of the attention in the news regarding drugs has been focused on the opiate epidemic.  Little mass media attention has centered on the more subtle but equally devastating benzodiazepine epidemic.

To place this into context, some individuals find that detoxing from benzos is harder than detoxing from opiates, including singer-songwriter, Stevie Nicks.  Additionally, a close friend of mine had to detox from both an opiate, and a benzodiazepine, Xanax, both prescribed to treat frequent migraines.    My friend has said more than once to me, “Hands down detoxing from the benzo [Xanax] was harder than detoxing from the opiate [Vicodin]”  The combination of the drugs he was taking is particularly dangerous and prompted his physician, an addiction specialist, to tell him, “You know cocaine really isn’t that bad compared to the combination of drugs you were taking.”  The danger of such a drug combination is baffling when we consider that doctors are prescribing them.  What happened to the Hippocratic Oath and the rule of medicine, First do no harm?

I’ve heard the majority of people, including myself, felt that they had no choice but to take benzos or other hypnotic drugs, like Ambien because they were desperate to get more sleep.  Moreover, psychiatrists often tell us that we have a family history of anxiety so that we might be genetically dependent on their drugs.

But the efficacy of psychiatric drugs is being questioned more and more. For instance, mass media reports and publications, including Consumer Reports (February 2016 edition), state that all sleep medications leave much to be desired not only regarding potential side effects, like excessive daytime sedation but also in their lack of efficacy.  It appears that even the upside to these drugs as a long term solution is quite limited.

Research has indicated that benzos tend to increase overall sleep time, but significantly reduce the amount of deep phase sleep a person receives at night.  I remember thinking myself how much more refreshing, hour for hour, natural sleep was than medicated sleep.  I miss not having a hangover in the morning.  In my personal experience, I feel that the benzos are deceiving because when used on isolated and rare occasions, the drug tends to produce few unwanted side effects like the morning after hangover feeling.  So the user is lulled into a false sense of security that the drug will continue to be as kind in the long term.

There are, however, non-pharmacological options for sleep and anxiety.  I have read articles and heard reports from licensed therapists that cognitive behavioral therapy for insomnia, or CBT-I, is more effective than sleeping pills.  And there appear to be additional non-drug treatment options for sleep and anxiety on the horizon.  Sedatives may become a thing of the past as safer and more effective options emerge.

Call to Action

Readers, especially those in Texas, can contact me to try to coordinate our efforts to raise awareness of the dangers of these drugs, and push lawmakers to pass laws to safeguard the public.  We can likely get a bill introduced in the Texas House or Senate because members of the health committees are concerned about this. But to get a majority of the full body in the house or senate to vote for an informed consent law, we’ll likely need major medical organizations such as the Texas Medical Association on board with this.  I am encouraged to know that more and more physicians, particularly physicians in their 30’s and 40’s are wary of these drugs.

Additionally, we’ll need to share with Texas lawmakers video testimonials from as many Texas residents who have been harmed by benzos or other hypnotic drugs as possible.  The more testimonials we have captured on video, the better.

Persons seeking to help the cause in Texas in any way possible can contact me by e-mail: [email protected]

 

Authors Note: This blog was prepared with the editorial assistance of Dr. Raymond Armstrong.

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24 COMMENTS

  1. I too was prescribed Clonopin for sleep. I think the package said something about the stuff being habit forming or addictive but I always though people became addicted to drugs because the fell in love with the feeling produced and just decided to keep using the stuff cause they liked it so much and said screw everything else.

    I took the Clonopin as expected the feeling produced was no big deal, how could anyone fall in love with this and be unable to stop ?

    I found out the hard way how drug dependency really works, its NOT how the drug makes you feel when you take it, its what happeneds when you QUIT taking it. The package and no one else explained the hellish nightmare withdrawal reactions are and how THAT part is what leads to “impulsive” use of the drug. No one said take this stuff for a few weeks then if you don’t have it you get anxiety from hell, cant sleep and disassociation that only goes away if you take more. No one informed me about that part.

    In the end I had to go to rehab and I was told my problems with Clonopin were because “I am an addict”. No I am not an “addict” , if it was explained to me what benzodiapines do it never would have happened.

    Call me negative but I don’t see our government forcing the industry to provide informed consent and protect people, no they would rather put people in cages for smoking the wrong plants and protect the pharmaceutical industry from anything that would hurt their profits.

    “Push lawmakers to pass laws to safeguard the public.”

    I don’t think you could push those crooked people with a bulldozer if it means going up against the psychiatric pharmaceutical industry.

    Have you ever read this ?

    Let’s take a look at what informed consent might look like for psychiatric drug treatment. >>>> http://kellybroganmd.com/consent-form-for-psychiatric-drug-treatment/

    • Well, Cat, you must know by now that all benzos are addictive in that they produce tolerance, and withdrawal symptoms if you stop. This is true of all hypnotics, but the benzos are among the worst, being fat soluble, so traces of them can hang around in your system for months, as you’ve already discovered.

  2. I was on Klonopin, the generic form, for several months. Slowly but steadily the addiction developed and tolerance and I had to take pills every few hours just to temporarily stave off debilitating anxiety attacks where I could barely stand up and felt like a heart attack. This led to an inpatient hospitalization with more incompetent medical professionals (including one psychiatrist who wanted to increase the dosage as a way of “treating” the addiction). They switched me cold turkey to hydroxyzine. The switch was hell for some days, but the hydroxyzine (Atarax, Visterol) eventually helped with the anxiety. I finally got off of it and it was much easier to withdraw from.

  3. What I forgot to point out was part 2 of the benzo nightmare. Part 2 comes when you are going through the withdrawals and you get prescribed one of the “non addictive” chemical nightmares such as Paxil or Zyprexa to “help” with the anxiety.

    They call call the anti depressants , anti psychotics and epilepsy drug mood remover pills “non addictive” because they don’t produce any high feeling but when you quit taking them its the same thing can’t sleep bugging out anxiety and that evil shit Zyprexa the withdrawal is worse than the infamous Xanax and Benzo withdrawals. The criminals at Eli Lilly got in a little trouble pushing their Zyprexa off label but its still happening maybe not as much but people going from the frying pan of benzos to the fire of that crap because the definition of “non addictive” doesn’t mean you wont get so sick and bugged out cant sleep going crazy when you quit taking it and end up in the ER.

    The only thing “non addictive” means with psychiatry pills is it wont give you a little high, it doesn’t mean you can just quit the stuff without getting sicker then hell including the part where the only way to make sicker then hell go away is to take more and in a way part 2 with the “non addictive” chemical nightmares is worse cause instead of bouncing between feeling a little high nice and then bugged out sick you bounce between feeling like a damn zombie and feeling bugged out sick, no good part, zombie or bugged out at least in the case of the most wicked diabolical chemical ever created Zyprexa. Nasty withdrawal stories and lawsuits by people that suffered withdrawals from the “non addictive” stuff are all over the online. Type name of psychiatric drug + withdrawal then search.

    So why just push for informed consent for the benzodiazepine and sleep drugs instead of ALL psychiatric drugs ?

    • I’ve wondered for some time about using niacinamide for benzo withdrawal. They use the same receptor sires. Niacinamide has some anticonvulsive properties; seizure patients need less Dilantin if they use it simultaneously. Magnesium (with D) also helped Mr. Dubey; it raises your seizure threshold as well. I got trolled by someone using B-complex, who had a bad time, but he wasn’t using large amounts of niacinamide (B3) that way.

      • I wonder if drinking alot of beer before peeing on a forest fire would help ?

        On a purely scientific level it would help, the increased urine output from the beer drinking would slow the fire that much more so maybe when its all over instead of 20 square miles burned only 19.999999998 square miles of land would be burned.

        B vitamins for Benzo withdrawal , you must be kidding.

  4. I live in Austin, Texas. Clonazepam destroyed my life. I didn’t abuse it, but it destroyed my life nonetheless. I’m six years benzo-free and still in hell. I want to say that I wish to be a part of this effort, but the truth is that I’m too ill to make a commitment. What I will say is that we have an in-person benzodiazepine withdrawal syndrome support group here in Austin. I believe Dr. Armstrong’s aware of us. Perhaps, as a group, we can do something for this effort. I intend to bring it up at our next meeting.

    • I notice how you felt the need to say “I didn’t abuse it”. I completely understand that because as most of us know if you start having the usual problems they start with the victim blaming, this only happened because YOU must be abusing it. Your fault.

      Its like WTF, yes my 30 day prescription ran out in 28 and here I am at the ER with anxiety attacks but it did not run out because I was “abusing” it. Lets see YOU deal with the tolerance withdrawal, lets see YOU not go into that bottle and take an extra dose at 2am because the last one of the day wore off you can’t sleep and its better than staying up all night and going to work the next day with no sleep maybe get fired.

      So I took those extra ones in the middle of the night telling myself I would endure some anxiety hell withdrawal to make up for it the next day then the next day and failed cause I was weak but don’t tell me how strong YOU are till YOU have been to been to withdrawal hell cause I don’t think YOU would survive in that place very long.

      You are abusing it… No you victim blaming clueless A holes posing as medical “professionals”, that stuff was abusing me.

  5. Even when taken as directed for as little as one month Benzos can and do cause withdrawal syndrome. Temazepam can cause physical addiction in as little as one week. These are an evil class of drugs. In the prescribing info it states that these drugs should only be used for short periods of time but many doctors have people on them long term. Eventually benzos will cause more anxiety and insomnia that you had before taking them.

  6. I attended UT Austin in early 90s. I was on Xanax and Ativan at the time, for high anxiety, but I made it through school fine. It was a few years later, and with Klonopin added to the mix, that I ran into trouble, lots of trouble. Fortunately, I did very in depth healing with gifted healers, and that is all behind me now.

    What I was wondering about is if the public “mental health” system there is still called MHMR (mental health mental retardation)? That’s quite a stigma to project.

  7. Just like lifelieswaiting (who posted a comment in this blog), Clonazepam adversely affected me and my life. I, too, am very interested in supporting this bill in Texas (and other states) as best as I can; I reside in Austin, TX. Count me in for spreading awareness and supporting this bill!

    I have already begun speaking out about my benzodiazepine experiences and raising awareness about the dangers of psychotropics. You can hear some of my story at https://youtu.be/w8szh_KY0mo . It’s not the best interview, but it’s a start and it will give you an idea of what I experienced and my awareness/advocacy efforts.

    In 2015, I filed a complaint with the Texas Medical Board against my initial prescribing physician (who I mentioned in the video). After a sixteen-month investigation, he was found responsible for some unethical/inappropriate prescribing and entered an Agreed-Order with TMB. The Texas Medical Board did refer to the benzodiazepine in the Agreed Order as “a dangerous drug.” Therefore, there has been some acknowledgement and, in that sense, progress in my opinion for medical professionals in recognizing the dangers of controlled substances, Class IV drugs, etc.

    However, my experiences seeking help weening off Clonazepam (and without health insurance at that time) were a totally different experience. It was hell, and the vast majority of medical and mental health practitioners have no clue about this type of drug, the withdrawal symptoms, and what we experience. Absolutely no clue, and their ignorance and lack of appropriate support truly put people who are in withdrawal in danger.

    I hope more people realize that psychotropics don’t “cure.” They mask, rewire, and/or sedate and serve as a “bandaid” of what is truly going on, and most psychotropics aren’t intended for long-term use. If they were, then the trials and studies of them would be longer than just 4 or 9 weeks. There needs to be a paradigm shift in the way all perceive pharmaceuticals. For example, psychotropics are not “medicine;” they are drugs. Propaganda or not….I believe this awareness calls for a change in terminology.

    For those in Austin, TX, there is a supportive Meetup group: http://www.meetup.com/Austin-Benzodiazepine-Withdrawal-Support-Group/.

  8. How about just taking the drugs off the market?

    And then of the doctors who prescribe them to juveniles, how about pushing to have them tried for Crimes Against Humanity in International Court. This way they can’t invoke the Eichmann Defense.

    And then how about pushing to eliminate the possibility of disinheriting one’s children, as other industrialized countries do. Most of this stuff is simply family scapegoating, child abuse. Stop that, and then people start to have a chance at a life.

    Nomadic

  9. These drugs already have the requirement of a doctor’s prescription. This is supposed to be a stronger protection than a signed informed consent.

    So if we need the informed consent, then there is not only something wrong with the drugs, there is something wrong with the doctors.

    The drugs should be off the market, and doctors severely disciplined. Giving them to children should be prosecuted as Crimes Against Humanity, and in International Court.

    Nomadic

  10. Benzos have been prescribed for “panic attacks.” What seems counterintuitive is they can cause panic attacks, either by a direct side effect, or upon withdrawal. The drug can also cause a more extreme version of a panic attack that I call a terror attack. This can last for several days as the drug unlocks from receptors. Add in the sleep deprivation these drugs cause and the withdrawal reaction can mimic delerium tremens from alcohol withdrawal. It is not surprising That Iv Valium and Librium have been used to treat DT’s. It’s like alcohol in a pill. Sure it may calm you down at first, but there is a price to pay. For those who come accross an old Newsweek article “Halcion, nightmare or wonder drug?” it’s an interesting read.

  11. This request for informed consent always surprises me because it should apply to all medical practices and all drugs anyway and should not be specific to BZs – it should already be standard practice by law across the board anyway.

    Prof. Ashton made a similar comment in her review of the paper titled “Benzodiazepines: Risks and benefits. A reconsideration” where she said: “This statement is trite and unnecessary since it applies, as stated, to all drug prescriptions and all interventions. It is presumptuous and insulting to doctors to remind them of this ethic which forms the very basis of the medical profession. It is patronising if it is meant to apply especially to benzodiazepine prescriptions.”

    The review can be seen here:
    http://www.benzo-case-japan.com/docs/Ashton_Review.pdf

  12. Some people have suggested that doctors be prosecuted for prescribing these and other dangerous drugs. Although this may be hard to believe, the doctors may not be aware of the danger. This is because the doctor is fed the corporate/drug company promotional material before prescribing the drug. This always downplays the risk and up plays the benefits. There isn’t anyone feeding the doctor the negative info about the drug. Even though the PDR material may mention something like “suicidal thoughts” unless he sees a patient with such a reaction, it may not be readily apparent this is a real risk. The PDR is written by the drug maker, not the FDA. The FDA is also being presented with the drug company promo material. Unless there is a competing entity arguing the negative aspects of the drug, the well funded corporation will usually persuade the FDA it’s benefits outweigh the risk. It’s a problem inherent in the for profit drug industry. There is no profit incentive in un marketing a drug.

  13. I used prescription Xanax for over a decade along with an antidepressant. The psychiatrist who prescribed them was a well known panic disorder specialist in Virginia. He told me that Xanax was very safe and that people used them for years without a problem, and I believed him. After all, he’d written a book about phobias and panic disorders that can still be found on Amazon.

    I suffered from the combined effects of both drugs. Mania, interdose withdrawal, insomnia, akathisia, and periods of obsessive thinking and suicidal thoughts, which he told me were a part of my “disease.”

    After a series of embarrassing incidents involving extreme mania and suicidal ideation, the last of which landed my in the ER, I decided to taper off of both drugs and found myself facing a lot of resistance from the other doctors (non-psychiatrists) I sought help from. I was forced to taper with my last refills and it was really hell because I had taper within a couple of months. I was truly ill for a year.

    The doctor who hooked me on these things is a millionaire now and owns a custom built home in an exclusive neighborhood in a Virginia city. He should be cooling his heels in a prison cell, but unfortunately, his form of drug dealing is legal.