Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Are benzodiazepines “the worst thing that’s ever happened to people”?

Nicole Lamberson, PA
Meds
July 17, 2019
Share
Tweet
Share

Although Arnold Knutsen and I “met” virtually five years ago, we only first spoke on the phone recently when he called to share his story. He’s the eldest member of the online benzodiazepine support group we cohabitate. His posts in the group always reeked of desperation, and there was a palpable sense of urgency to his pursuit of a cure for his situation. It was clear he was suffering terribly and was terrified he would die like this.

In his younger years, Arnold worked on guided missiles, submarines and space shuttles as a technician and quality analyst for NASA. Now, at age 81, he resides in Florida with his wife of 62 years.

In 2003, Arnold fractured his skull falling off a scooter. The hospitalist prescribed a two-week supply of lorazepam (Ativan), 1mg/day, with discharge instructions to follow up with a neurologist — instructions that would ultimately prove to significantly diminish his quality of life.

Unsuspecting, Arnold accepted nine-and-a-half years of “legacy prescriptions” for lorazepam from that neurology clinic — taking them as directed. Probably due to tolerance, his dose was escalated over those years to 4 mg/day, and then eventually to 8 — the equivalent to 80 mg of Valium. The dose increases were never explained: “It was always just a quick, routine visit — here’s your refill, bye,” said Arnold.

Most prescribing guidelines recommend limiting benzodiazepines to two to four weeks, including tapering off time. And, even though the 2019 Beers Criteria strongly recommends that benzodiazepines and Z-drugs are potentially inappropriate medications for use in older adults, a recent study reveals that seniors > 65 may be the most prevalently prescribed group.

By the end of 2012, Arnold had blacked out and fallen several times, amassing three concussions and an artificial elbow and shoulder from the resultant fractures. Connecting the dots, Arnold requested to stop lorazepam. His neurologist abruptly switched him to 80mg of Valium and instructed him to halve his dose weekly until down to 10mg, then stop. Arnold developed shakes and other withdrawal symptoms, so the neurologist reinstated 5mg for a week — a four-week taper in total.

For patients like Arnold on a benzodiazepine equivalent to 80mg of Valium (e.g., 8mg Ativan, 4mg Klonopin, 4mg Xanax) long term, the Ashton Manual recommends a stepwise crossover to Valium — subbing out a fraction of the total day’s dose every week or two for the equivalent in Valium — followed by a 36- to 67-week taper (with the disclaimer that more sensitive patients may require longer).

Post-taper, Arnold experienced chest pains as well as muscle tension and spasms that limited his ability to walk. As time progressed, he deteriorated even further. By 2015, he had stopped leaving his home: “It just kept getting worse. The tension is so bad now I can’t even barely get to the next room. And, probably one of my worst symptoms is: I stop when I’m trying to walk. It’s like if you have your car in neutral and you want to put it in gear, but it won’t go in gear.” In addition, Arnold also experiences head pressure, tinnitus, anxiety, panic attacks, crying spells, and difficulty falling asleep. “I also have no long-term memory at all; I don’t remember one day of my past life … so I have to ask people. And, people don’t understand,” he said. So for over six years now, Arnold has spent his days and nights confined to his living room chair. The silver lining? He can use his arms to pour cereal, brush his teeth and, with difficulty, comb his hair.

Arnold experienced none of these symptoms before lorazepam — describing himself in times past as “healthy as can be” — and he recalls no warnings about the potential for such outcomes at the time of initial prescription.

In the first two years after withdrawing, Arnold consulted four different neurologists and tried multiple muscle relaxers for his symptoms — they either didn’t help or exacerbated things. And, one 1mg tablet of Klonopin in a reinstatement attempt caused Arnold to stiffen up so tight he couldn’t move at all. He hasn’t taken anything since and feels doctors don’t know how to help him. “Withdrawal lasts no more than a year, so it must be something else, is how the original neurologist puts it,” said Arnold. I asked Arnold if he’s convinced his symptoms resulted from benzodiazepines. He assuredly replied, “Oh yes!”

Protracted symptoms following benzodiazepine cessation were recognized back in 1991 by Dr. Heather Ashton. Dr. Malcolm Lader, who has published more than 100 papers on benzodiazepines, can be quoted saying, “Some of the [UK] tranquilizer groups can document people who still have symptoms ten years after stopping.” And, a recent paper about benzodiazepines in PAINWeek Journal concludes, “Now other problems are coming to the fore, long known to patients but under-recognized by healthcare providers. Among them is the experience of mechanistically perplexing protracted withdrawal symptoms. Although the exact explanation of this phenomenon needs to be elucidated, it is mechanistically plausible, and should be acknowledged and taken seriously by clinicians.”

Arnold’s 79-year-old wife has to do everything for him. She walks with him everywhere, even to the restroom so that he can use her shoulder for support. “She just finished mowing the lawn, which I should be doing,” he whispered into the phone — the guilt audible. Arnold believes the stress of caring for him has caused her two heart attacks. “I can tell this is horrible for her. Sometimes I get into these crying spells because I hurt so bad and it never lets up, and I can’t stand it. Finally, I break down and start balling, like a kid almost, and she comes over and puts her arms around me, and she’s crying too,” he said — their deep love perceptible.

Arnold offered the following thought to close our call: “Knowing what I know now, I never would’ve taken benzodiazepines — no way. They’re the worst thing that’s ever happened to people.” Reclined atop some pillows in the bed I’ve grown to hate, my own health similarly blighted from eight-plus years of the same protracted syndrome, I imagined Arnold imprisoned in his chair. I wondered if I would’ve rather lost my prime to this, as I had, or my golden years, like Arnold. Each had its downsides—with youth, financial hardship and a loss of reproductive years; with age, frailty and a limited time clock. Ugh, what a futile exercise — there’s never a good time to endure this hell and, except in cases where benefits could greatly outweigh risks and patients are fully informed, it should be prevented at all costs.

ADVERTISEMENT

Nicole Lamberson is a physician assistant and serves on the medical advisory board, Benzodiazepine Information Coalition.

Image credit: Shutterstock.com

Prev

How technology ruined, and can save, the doctor-patient relationship

July 16, 2019 Kevin 1
…
Next

Be Bowser, not Mario in your medical practice

July 17, 2019 Kevin 1
…

Tagged as: Psychiatry

Post navigation

< Previous Post
How technology ruined, and can save, the doctor-patient relationship
Next Post >
Be Bowser, not Mario in your medical practice

ADVERTISEMENT

More by Nicole Lamberson, PA

  • The tip of the iatrogenic benzodiazepine iceberg

    Nicole Lamberson, PA
  • Words can hurt those on benzodiazepines

    Nicole Lamberson, PA

Related Posts

  • Advocating for people with disabilities: People First Language

    Leonard Wang
  • It’s important to keep tight controls on benzodiazepines

    Samuel Ridout, MD, PhD
  • Think beyond benzodiazepines for anxiety

    Wallace B. Mendelson, MD
  • People who take opioids are the AIDS patients of today

    Heather Finlay-Morreale, MD
  • Why your doctor may be concerned about prescribing benzodiazepines

    Arash Javanbakht, MD
  • The people vs. opioid pharma: Pharma wins again

    Rebecca Thaxton, MD

More in Meds

  • How India-Pakistan tensions could break America’s generic drug pipeline

    Adwait Chafale
  • The unfair war on buprenorphine

    Brian Lynch, MD
  • Drug giants face suit over hidden cancer risks

    Martha Rosenberg
  • The diseconomics of scale: How Indian pharma’s race to scale backfires on U.S. patients

    Adwait Chafale
  • A psychiatrist’s 20-year journey with ketamine

    Muhamad Aly Rifai, MD
  • How drug companies profit by inventing diseases

    Martha Rosenberg
  • Most Popular

  • Past Week

    • How one physician redesigned her practice to find joy in primary care again [PODCAST]

      The Podcast by KevinMD | Podcast
    • Rethinking the JUPITER trial and statin safety

      Larry Kaskel, MD | Conditions
    • The silent disease causing 400 amputations daily

      Xzabia Caliste, MD | Conditions
    • Crypto trading’s impact on mental and physical health

      Dr. Aristomenis Exadaktylos, Dr. Suhaib J. S. Ahmad, and Dr. Thomas Mueller | Conditions
    • Building the medical home before it had a name

      Ronald L. Lindsay, MD | Physician
    • A doctor’s duty on 9/11 in a small town

      Ronald L. Lindsay, MD | Physician
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • How one physician redesigned her practice to find joy in primary care again [PODCAST]

      The Podcast by KevinMD | Podcast
    • Rethinking the JUPITER trial and statin safety

      Larry Kaskel, MD | Conditions
    • The ignored clinical trials on statins and mortality

      Larry Kaskel, MD | Conditions
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why doctors must fight for a just health care system

      Alankrita Olson, MD, MPH & Ashley Duhon, MD & Toby Terwilliger, MD | Policy
  • Recent Posts

    • Building the medical home before it had a name

      Ronald L. Lindsay, MD | Physician
    • Why doctors are leaving insurance-based care

      Dana Y. Lujan, MBA | Policy
    • The surprising link between migraine and tinnitus

      Brian F. Worden, MD | Conditions
    • Rethinking the JUPITER trial and statin safety

      Larry Kaskel, MD | Conditions
    • Why culturally compassionate care matters for South Asian communities

      Nishat Uddin, MPH | Conditions
    • My rare disease was my greatest teacher

      Dr. Palmusima Tamang | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 14 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • How one physician redesigned her practice to find joy in primary care again [PODCAST]

      The Podcast by KevinMD | Podcast
    • Rethinking the JUPITER trial and statin safety

      Larry Kaskel, MD | Conditions
    • The silent disease causing 400 amputations daily

      Xzabia Caliste, MD | Conditions
    • Crypto trading’s impact on mental and physical health

      Dr. Aristomenis Exadaktylos, Dr. Suhaib J. S. Ahmad, and Dr. Thomas Mueller | Conditions
    • Building the medical home before it had a name

      Ronald L. Lindsay, MD | Physician
    • A doctor’s duty on 9/11 in a small town

      Ronald L. Lindsay, MD | Physician
  • Past 6 Months

    • Health equity in Inland Southern California requires urgent action

      Vishruth Nagam | Policy
    • How one physician redesigned her practice to find joy in primary care again [PODCAST]

      The Podcast by KevinMD | Podcast
    • Rethinking the JUPITER trial and statin safety

      Larry Kaskel, MD | Conditions
    • The ignored clinical trials on statins and mortality

      Larry Kaskel, MD | Conditions
    • How restrictive opioid policies worsen the crisis

      Kayvan Haddadan, MD | Physician
    • Why doctors must fight for a just health care system

      Alankrita Olson, MD, MPH & Ashley Duhon, MD & Toby Terwilliger, MD | Policy
  • Recent Posts

    • Building the medical home before it had a name

      Ronald L. Lindsay, MD | Physician
    • Why doctors are leaving insurance-based care

      Dana Y. Lujan, MBA | Policy
    • The surprising link between migraine and tinnitus

      Brian F. Worden, MD | Conditions
    • Rethinking the JUPITER trial and statin safety

      Larry Kaskel, MD | Conditions
    • Why culturally compassionate care matters for South Asian communities

      Nishat Uddin, MPH | Conditions
    • My rare disease was my greatest teacher

      Dr. Palmusima Tamang | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Are benzodiazepines “the worst thing that’s ever happened to people”?
14 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...