Say the words, “drug addiction,” and most of us think of heroin, alcohol, cocaine, or opiates. However, lurking in the shadows is a less talked about epidemic: addiction to benzodiazepines, commonly known as “benzos.” I should know because after taking a nighttime dose of lorazepam (Ativan) for about ten years; I finally weaned myself off this and all other prescription sleep medications.
About twelve years ago, my father died and then my dog. But that was nothing in comparison to the fight to save my marriage from alcohol addiction: not mine, but my wife’s. It occurred around the same time. She ultimately lost that battle and her life, but only after years of struggles, stints in rehab, and admissions for GI bleeding and liver failure. I was left divorced and a single dad. The stress of the constant combat with active alcoholism led me to leave the partnership of the cardiology practice that I had started, and go off of night call. I calmed the sleepless nights with medications.
Soon I could not sleep without taking a pill. I tried other medications like Lunesta, which I stopped because everything the next day tasted like tin. And then there was Ambien, which I tried after I re-married, but stopped because while “asleep” my wife said I threw my iPad at her. Lastly, there was Belasomra, which didn’t work.
Years went past, and doctors kept on prescribing the lorazepam for me. Finally last year, my sleep doctor (I have obstructive sleep apnea) said I should get off of the benzo’s because recent studies had shown it linked to Alzheimer’s disease in the elderly. After three months of slow weaning, I took my last dose two weeks ago.
Benzodiazepine addiction is real, and withdrawal has been described as more difficult than opiates. I was not on a large dose, one milligram every night, but I was on it for a very long time. I had the classic signs of “therapeutic dose dependence” — tolerance and need for higher doses to be effective, which I did not succumb to. Thus I was more dependent that addicted, which basically is two sides of the same coin. However, after reaching 65, I am not as sharp as I used to be, and when I heard about the benzo-dementia connection, I knew I had to act.
How common is this problem? The short answer is “very.” In 2008, approximately 5.2 percent of U.S. adults aged 18 to 80 years used benzodiazepines. The percentage who used benzodiazepines increased with age from 2.6 percent (18to 35 years) to 5.4 percent (36 to 50 years) to 7.4 percent (51 to 64 years) to 8.7 percent (65 to 80 years).
Benzodiazepine use was nearly twice as prevalent in women as men. In all age groups, roughly one-quarter of individuals receiving benzodiazepine involved long-acting benzodiazepine use. And a study in JAMA Psychiatry in early 2015 reports that among 65 to 80-year-old Americans; close to 9 percent use one of the following hypnotic drugs: Valium, Xanax, Ativan, and Klonopin.
During a work-up of memory loss, confusion, or possible dementia, every physician needs to take a careful drug history with attention to benzo abuse. It is far too easy to get these medications repeatedly refilled by multiple prescribers. It is easy to misdiagnose benzo dependence/addiction symptoms as organic forms of cognitive disorders. In fact in 2012, the American Geriatrics Society updated its list of inappropriate medications for older patients and advised doctors to “avoid benzodiazepines for treatment of insomnia, agitation, or delirium.” The strength of the recommendation was “strong.”
I developed withdrawal anxiety, insomnia, headaches, muscle aches, and had forewarned my wife that I would likely be more irritable than usual. I now take a naturopathic medication that contains melatonin; however, I am not sure that it is any better than placebo. Being completely retired from active practice, it is easier to adapt my lifestyle to my sleep disorder. One thing I know for sure is that I never want to go back on these medications ever again. In the words of Patrick J. Kennedy, “No one is immune from addiction; it affects people of all ages, races, classes, and professions.”
David Mokotoff is a cardiologist who blogs at his self-titled site, David Mokotoff. He is the author of The Moose’s Children: A Memoir of Betrayal, Death, and Survival and can be reached on Twitter @FreeMarketdoc.
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