Are We Overlooking Benzo-Related Overdose Deaths?

Grief and sleeplessness brought Alison Painter to a hospital in Ottawa a few days after November 30, 2008—the day her husband killed himself.

Sleep had evaded Painter long enough for a doctor to prescribe her something to take the edge off.

Benzodiazepines are a class of psychoactive drugs like Xanax, Valium, and Ativan, used to treat a range of conditions like anxiety and insomnia. Painter was prescribed zopiclone, a z-drug that has effects similar to benzodiazepines. Notoriously habit-forming, these drugs are widely prescribed by doctors and easily available on the street.

Months later, at Surrey Memorial Hospital, Painter asked to see a specialist, but her psychiatrist was dismissive of her concerns. "He felt that I would probably have to be on medication for the rest of my life. He heavily pushed the medication," she said.

Two years after her first dose, Painter faced tinnitus, skin inflammation, muscle spasms, and shooting pains that took her to the emergency room, but she didn't connect the onslaught of symptoms to zopiclone.

The over-prescription of benzodiazepines and z-drugs in Canada is hardly new. It was first recognized in the 1970s, a decade after benzos hit the market as a treatment for insomnia and anxiety disorders among women. Doctors handed them out for PMS, chronic illness and stressful life events like childbirth and menopause, assuring unwitting patients that long-term use of the drugs was safe.

Despite research-backed links to dependence, abuse, injuries, cognitive impairment—even dementia—benzos such as diazepam (Valium) and alprazolam (Xanax) remain among the most commonly prescribed and misused class of psychoactive drugs in the world. Benzos are the second most common drug group implicated in medication-related deaths in the country—outranked only by opiates—according to the Institute for Safe Medication Practices Canada.

"We're talking about a situation that's developed over the past 30 to 40 years, and it's similar to what we're seeing with opiates," Dr. Annabel Mead, director of the St. Paul's Hospital addiction medicine fellowship and an addiction medicine consultant for Vancouver Coastal Health, told VICE.

"Opiates are just getting more attention these days, and benzos are kind of the quiet cousin in the background."

Benzos are heavily prescribed to women and seniors. A report by the British Columbia Centre of Excellence for Women's Health states women make up 60 to 65 percent of people taking benzodiazepines.

Researchers at the Stanford University School of Medicine found benzos are involved in at least 30 percent of all fatal opioid overdoses in the US. The number of pharmaceutical opioid related overdose deaths involving benzos in BC increased 600 percent between 2004 and 2013.

The Ashton Manual, regarded as the unofficial encyclopedia on benzodiazepines, suggests benzos are no longer effective after a few weeks or months of regular use.

While living with the side-effects is tough, getting off benzos is significantly worse.
Tolerance causes withdrawal symptoms to appear even if the user continues to take the drug. As a result, the dosage is increased to maintain its effectiveness.

In 2012, after suffering bouts of sickness, Alison Painter connected the dots and began to taper off zopiclone.

Like alcohol, quitting benzos cold turkey is dangerous. Benzodiazepine tapering should be gradual because withdrawal symptoms can be life-threatening.

"I had what they call the 'benzo flu.' It felt like I had the flu crossed with jet lag crossed with the worst hangover imaginable. Every single day I was like that," Painter told VICE.

Dennis Amott, 78, was prescribed clonazepam for mild anxiety by his GP in North Vancouver and was assured he could stay on the drug for life.

"This particular doctor had no idea of the harmful effects of the drugs, and on the contrary, he encouraged me to take it as often as I want, every day of my life, which I did," he said.

Amott battled his dependence on clonazepam, but didn't come out the other side unscathed. Many of the symptoms he faced during his withdrawal—stress headaches, tinnitus, heart palpitations, chest pain, short- and long-term memory loss—continue to this day.

"The more you take the drug, the more it hurts you, the more you want. It's a vicious cycle," he said.

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When it's comes to safe prescribing practices of benzos, Canada fairs poorly compared to countries like the UK and Australia where benzos are seldom prescribed for longer than the recommended time period (a maximum of two to four weeks), and only if alternative treatment options are exhausted.

Mead disagrees with the claim that there is no better alternative to benzos for treating anxiety and sleep disorders. SSRIs and non-drug treatments like cognitive behavioural therapy are safer and more effective, she said, yet they remain under-promoted and under-used.

But she did point out despite persistently high prescribing rates of benzos, things are looking up—at least in BC.

In June, 2016, the Royal College of Physicians and Surgeons of BC issued new prescribing standards for benzodiazepines, opioids, and other addictive drugs.

Under the standards, doctors must now carefully review patient histories, carry out a risk-benefit analysis to determine if treating a patient with benzos is safe, and refrain from prescribing the drugs for long-term use.

Failure to comply with the standards calls for strict disciplinary action, although no physician has been fined or disciplined so far.

"The College's experience is that all physicians want to practice safely and in accordance with current standards. They are very receptive to educational interventions," a representative from the College's communications department told VICE.

Mead agrees that educating doctors on the risks of benzodiazepines and enforcing strict guidelines for doctors are the best strategies to counter the prescription drug crisis we have on our hands.

"The big push for both benzos and opiates is prevention," she said. "Stop putting patients on it in the first place."