Archive for the ‘benzodiazepines’ Tag

Baby wants a double vodka

Saturday, July 20th, 2013

Pregnant women who use methadone are likely to under-report their alcohol and drug use, a piece of research published this month has found. The admittedly small sample of fifty-six opioid-dependent women, prescribed methadone as a substitute for heroin, were found to continue taking illicit drugs and alcohol during their pregnancy, as discovered by testing mothers’ and babies’ urine, and meconium (first stools). The study showed that 91% of women taking part in the study had used illicit drugs – 73% had continued taking opiates, and 70% had used benzodiazepines (which are thought to be linked to birth defects). 47% of the babies had also been exposed to alcohol use at levels of at least 2 units a day or 5 units at once, despite only 5% of the women disclosing this level of alcohol use. The most common combination (drug workers won’t be surprised to hear) was heroin, cannabis and alcohol.

Now this is clearly a highly-contentious area to discuss. On one side of the debate, there are people who acknowledge that women become pregnant for a variety of reasons, not necessarily through choice, and that the lifestyle that comes with heroin addiction may not be the most happy or meaningful existence, or borne from the most stable of upbringings. Once pregnant, drug users typically face extreme feelings of guilt – feelings which they have historically used drugs and alcohol to manage. And then the judgements and processes they are subjected to during pregnancy – safeguarding procedures and meetings, constant monitoring, reports written weekly about them and their parenting capacity, every bad decision they have ever made dragged up and pored over – make pregnancy not a joyful but a very stressful experience.

And then, on the other side of the debate, there are the tabloid readers – and there is so much meat on this bone for them to chew. First of all, of course, all drug users should die. They sacrificed their right to be on this planet the first time they smoked a spliff. Then – it gets worse – they are mothers. Should a woman not cease to exist in her own right the instant she conceives? She is, after all, a vessel. She should be pure and demure and fit all the glowing, maternal images we associate with motherhood. So the lifetime of misery, abuse, ill-treatment and self-deprecation should end the second that sperm hits that egg.

Now, don’t get me wrong, I find it very hard not to judge drug-using mothers-to-be. The unborn child is helpless and dependent on her to meet its every need, and it is heart-wrenching to think that it is disadvantaged before it has even left her womb. I do read the riot-act to these women, making it very clear that they are putting their baby’s welfare at risk, and increasing the chance that, once born, their baby will suffer painful and distressing withdrawal symptoms. What a sad and sorry start to life.

However, one thing is for sure – guilt does not perpetuate healthy behaviour. The fact these women are under-reporting their substance use is a sure sign that they already know all of this. You can bet your bottom dollar that they are beating themselves up more than anyone else ever could. And it is the discrepancy between what is expected of them and what they believe themselves to be capable of that makes burying one’s head in the sand the most realistic option.

I would imagine that most women who have had children would find this research both sickening and saddening. Whilst the idea of doing anything that may put their babies at risk may repulse them, I bet most of them have also felt judged, squeezed by other people’s expectations, desperate not to stand outside the prescriptive maternal mould that is dictated to them. Surely there is no worse judgement than being a bad mother. And not breast-feeding…?!

In the late stages of her pregnancy, I took a good friend of mine out for a drink. She was a single mum with two other kids at home, and she was desperate, for one last time before her baby was born, to just be herself for a night. She hadn’t drunk at all throughout her pregnancy, but on this occasion, I bought her a bottle of Corona, and she savoured it as we sat talking for an hour. We were in Wetherspoon’s – not an establishment known for its distinguished clientele with high moral values – but you should have seen the looks she got that evening. People gathered to bitch and point; judgements were formed, comments were made. At the time, she was drinking within the acceptable limits in pregnancy (guidance has since changed to ‘no alcohol during pregnancy’, although I believe this was mainly due to the fact that people struggle to quantify a unit), and she certainly wasn’t putting her late-stage pregnancy at any risk by her action. But as she sat there, gorgeous and bulbous, trying to enjoy her one night of being a person before months of being a multi-tasking milk machine, she was deemed by the other drinkers gathered that evening as the scourge of the earth.

So I suppose, in conclusion, I just want to say – this piece of research is sad. It is sad for the babies, it is sad for the mothers, it is sad for society. But maybe, maybe, if we saw pregnant women as people first and mothers second, the gap between expectation and reality might not be so great, and the image of the happy, stable, glowing mum-to-be might change into something more achievable for all pregnant women.

Advertisements

Guns don’t kill people, tablets do

Friday, March 1st, 2013

My last post considered the over-prescribing of psychoactive medications. Your responses suggested that I was not alone in my belief that highly-addictive painkillers and sedatives are prescribed far too easily, for a specific symptom instead of for the benefit of the person as a whole, and sometimes causing side-effects worse than the original complaint.

There is currently a debate raging in the US which queries the links between psychiatric medication and violence. Various articles link recent shootings to prescription medication, and a substantial piece of research (carried out by doctors who have all made money by testifying this in court, ahem) has been published which looks at acts or threats of violence carried reported as serious adverse drug events to the American Government. This research found that drugs most likely to lead to violent behaviour were varenicline (a stopping smoking aid), antidepressants, some ADHD drugs, and good old sedatives. (Interestingly, for geeks like myself, it seemed to be drugs that affected dopamine or serotonin levels.)

Now, as you know, I have some issues with taking a drug to ‘take things away’. They don’t go away, they just get hidden, and along with them often come an array of unexpected and potentially damaging side-effects. I got stuck on the Pill aged 12 by my GP to ‘regularise’ my periods, and it was only when I decided to stop taking it, aged 24, that I realised – hormones make me MENTAL. Information I would probably have benefitted from in my teens.

However, even by my standards, the articles from the US make some hefty claims. One article quotes a neurosurgeon and a security expert, both of whom, in the wake of recent shootings, point towards antidepressants as potential causes for this impulsive and violent behaviour.

Now I think that the suggestion of a causal link may be somewhat presumptuous. Even if there is a link between some medication and violence, how can the medication and not the original complaint be implicated? One of the diagnostic criteria for depression is ‘recurrent thoughts of death’ (although admittedly normally one’s own death). I’m not saying depressives are prone to killing sprees (or at least not ones that can’t be controlled by thumbs and forefingers) – I’m just saying that one’s thoughts do tend to go a bit squiffy when clinically depressed.

Another queriable factor is the number of Americans who take mental health medication. Anyone who saw Louis Theroux’s crazy documentary ‘America’s Medicated Kids’ will know that psychiatric meds are not just for adults over there, oh no, over there they’re smashing them down little kids too. One family he interviewed had their 10-year old son on separate medications for ADHD, bipolar (which, I’m pleased to say, is still not really used as a label for children in the UK… yet), and ‘impulsiveness’ – which isn’t even a psychiatric diagnosis. His mother was on antidepressants and his father was on medication for bipolar, which he “may or may not have”. From what I can gather, they’re all bang at the happy pills over there.

Now, if mental health medication caused violence, this is the equation I think we should be seeing in America: everyone on medication + shit loads of guns everywhere = a serious amount of death. When I see the news, I definitely see some death, but not shit loads. Maybe I’m just not looking hard enough. Not a massive death fan.

However, some of the articles I have read claim that the lack of focus in the news on the link between psychiatric meds and violent behaviour is because it detracts from the current anti-gun agenda. I have to say this seems a somewhat naive standpoint – no matter how mad they are, no-one has ever, as far as I’m aware, committed mass murder with a pack of Prozac.

It seems far more likely to me that the lack of coverage on this issue is as a result of back-handers to the media by the ever-present and largely omnipotent drug companies. As we all know, whether it’s doctors getting sent on golf weekends for over-prescribing sedatives, or news editors cutting stories that implicate antidepressant use in murder cases – drugs reps drive very nice cars.

Breaking news – GPs to carry tasers

Thursday, February 14th, 2013

The official bodies representing GPs and psychiatrists have released a joint statement raising concerns about addiction to prescription drugs. I don’t really know who they are raising the issue with as it’s them who are prescribing the bloody things – it’s a bit like punching a child then telling it off for having a bruise.

Bodies representing pharmacists, social workers and drug workers have also jumped on board. The difference is – they mean it. While the GPs and psychiatrists spend 5 minutes every 3-6 months with these patients, it is the pharmacists who have to double-check dates and signatures on prescriptions every week to make sure they are dispensing legally and are not operating outside the law because they have been duped by some pitiful neurotic; it is the social worker who will be trying to monitor parenting skills through a legal, medical haze; it is the drug worker who faces abuse when the patient uses their medication illogically and unmathematically and comes begging for an early script. And the housing workers. And the Jobcentre staff. And Probation. And counselling services. And Women’s Aid. Basically any service that attempts to address the route cause of the ailment instead of smothering it with something sedative.

In exactly the same way that heroin dependence ruins people’s lives, addiction to prescribed medication can be, in many cases, as debilitating. And whilst it is more sociably acceptable, amongst the middle classes at least addiction is still embarrassing, and the lies resorted to in hiding it can be crippling and destructive.

In terms of the physical dependence, benzodiazepines (such as Valium, temazepam and nitrazepam, generally prescribed for anxiety, muscle spasms and insomnia) in particular are horrendous. Along with alcohol, they are one of the few groups of substances that can lead to death from withdrawal. They are so addictive that in heavy abusers, tolerance can eventually overtake capacity – meaning that the amount of the drug you need to stop your body going into withdrawal can be higher than the amount needed to induce overdose. That’s a pretty fine line to walk.

The withdrawals also create a desperation that supersedes even opiate addiction. Whereas a heroin user that has ‘dropped’ (read ‘sold’) his methadone dose will start to panic when he realises he is soon to start squitting out of both ends as the dreaded withdrawals set in, benzodiazepine users will go that extra mile in an attempt to procure what they need. We’re talking threats to kill, smashing stuff up, full-on tantrums and shameless sobbing. Now any but the most integrous GP will swat a script at that to get it out of their consulting room.

There are a fair few people now in drug treatment that have become opiate-dependent due to prescribed painkillers too. Generally prescribed in the first place for toothache or back pain, these clients are chilling reminders that this could happen to anyone. These people never thought they would end up in a drug clinic being treated in exactly the same way as a heroin user.

And the problem with both benzodiazepines and opiates is – they are amazing emotional blockers and make you feel great. Emotional pain – gone. Traumatic memories – vanished. Feelings of guilt – disappeared. And stopping taking them results in sky-high adrenaline production, so that these buried feelings are not only exposed, but anxieties around them go through the roof. So if you couple that with quickly-built tolerance, and the fact that these are being given to you, nay insisted on, by a revered specialist – and are free – it would take a strong person to resist. And the people going to their GP in pain or with depression or anxiety do not meet this criteria.

And while I’m levelling my criticisms at GPs, I want to uncategorically state that psychiatrists are a hundred times worse. In my experience, it is extremely rare to find a psychiatrist that doesn’t just dish out sedating meds. This is despite an ever-increasing evidence base for psychological therapies and social interventions to improve people’s quality of life. You only need to visit to psychiatric ward to see the scrap heap that people with enduring mental health problems get thrown on. There is no inkling that these people might get better, or any real effort made to increase their level of function – they are dosed up and kept quiet until they say little enough to be discharged. Then they are expected to be able to cope in the outside world, on reduced medication (as high levels are only safe to dispense in a controlled environment), and within a matter of time they are back in hospital and whacked up again. No wonder people become institutionalised. To anyone who likes to think that One Flew Over The Cuckoo’s nest is a thing of the past, I challenge you to visit a psychiatric ward and tell me how treatment has improved over the last fifty years.

And in my usual cynical manner, I can’t help but think – you’ve been dishing out tablets for years because it is the cheapest way to keep ‘problem patients’ quiet, so what’s changed? This has got to be laying the groundwork for some political announcement about austerity and impending cuts to prescription budgets, because many GPs and psychiatrists didn’t give a shit about the highly-strung benzo-dependent housewives and the antipsychotic-shuffling oddballs before, and I struggle to see why suddenly they would do now. I reckon it’s another one of those Tories’ ‘we’re doing it for your own good’ measures. Like benefit cuts. And paying bankers’ bonuses. And Care In The Community.

One thing’s for sure – it won’t be the whiskey-drinking doctors or the pill-popping politicians that have their doses reduced and their scripts stopped. And, to be honest, unless GPs start wearing stab vests as standard, I doubt anybody else’s will be either.

Postscript – catslondonmarathon you are a wonderful GP and human being and I do not refer to you or your practice here. There are many more like you – but we both know you are in a minority.

Also, here’s a link to (wait for it) The Daily Mail *gasp* – a scare-mongering set of photos relating to crystal meth, clearly an advert for private rehab programmes, but freakishly interesting all the same. Make you count your blessings it never really took off over here. We’ve got enough on our paste with Cocodamol and Mogadon.

%d bloggers like this: