A Quiet Drug Problem Among the Elderly

Despite warnings from experts, older people are using more anti-anxiety and sleep medications, putting them at risk of serious side effects and even overdoses.

Comments: 279

  1. Delve deeper into this medical concern and one might see it as symptomatic of many other medical issues: limited research into the role of gaba and its neurotransmitter related system that underlies why benzodiazepines are effective, almost no research into cannabis as a possible substitute for benzodiazepines, primary care not trained on weaning patients off benzodiazepines, and an inadequate communication structure between patient and doctor. Chronic medical issues require frequent and accessible communication that can not be accomplished by either once every six weeks office visits or use of a tech assistant as a phone contact go between. Cognitive behavioral therapy is very expensive, highly communication dependent, and may not be silver bullet so often cited in mass media. Last, physicians have little accountability other than fear of a malpractice law suit. My elderly mother took a benzodiazepine for over 20 years as a sleep aid. When it stopped being effective her locally esteemed physician instructed her to stop cold turkey. Cardiac stress shortly occurred and she had a defibrillator implanted. By her own request she returned to nightly use of the same benzodiazepine and over the next year her cardiac issues subsided to the point that it was no longer evident that the defibrillator was necessary. Where was the equivalent of a trip wire to keep treatment from reliance on a cold turkey protocol? Peer review? Access to an ongoing clearing house of treatment results?

  2. William Phillips, cognitive behavioral therapy needs a properly trained psychologist and, as you say, isn't a silver bullet. But at the very least it does not have the harmful side-effects and dangers that these drugs have. As for being expensive, maybe, but not more expensive than the same amount of time spent at the physician or psychiatrist, while they just randomly try different drugs or doses on you.

  3. Great article. Thirty years ago I had trauma related emotional problems that really shut down my ability to sleep or work. I was told that, in effect, Big Pharma was my friend. That led to many years of nightmarish struggle to recover, not just from the trauma, but from the legal drug addictions. At the time there was no help available to wean myself off the drugs, in fact, was strongly discouraged from even trying. Now I read of massive problems with dementia and other long term side effects. We consumers of Big Pharma products need a vital and loud consumer agency protecting us from them and those doctors who more than anything, seem to work like the drug dealer down the street (metaphorically speaking) who only exists to sell drugs and create addicts. Hugh Massengill, Eugene Oregon

  4. As to that 30 years ago. At that time I was doing my pain management fellowship and many of the patients we admitted to our inpatient program were taking benzos and even then we knew we needed to get them off of them and we did so safely. It is not true that there was no one around who knew how to safely discontinue those drugs at that time. Perhaps your physicians didn't but it just meant you were going to docs who didn't understand the drugs they were prescribing.

  5. Thank you so much for this wonderful article. Nothing but respect and admiration for Ms Falstein. She truly is an inspiration.

  6. Maria Bierens in Holland, nothing but respect and admiration for you as well, my sweet love and partner for life. You've educated yourself way beyond the "call of duty" in all things benzo all to understand my plight. You've been with me for over two years in this struggle and always by my side. I only wish this article had included what an important role you've played in my life.

  7. Well written and don't forget alcohol. Although we are successful with things like campaigns against drunk driving and AA chapters but it is still a problem including with seniors, but with drugs we went in the opposite direction. We expanded our de facto criminal health care system and added another crime to it, legal drug pusher resulting in the current disaster.

  8. I wonder why doctors don't prescribe mindfulness based stress reduction (MBSR) first instead of immediately leaping to medication? It can be quite effective for anxiety and chronic pain.

  9. Although single professional guideline on the treatment of sleep problems recommends trying psychologically based therapies first before going on to medications (and not the benzodiazepines), I can give you two answers to your question: 1. Most physicians receive at best minimal training in the psychologically based therapies and so don't even know about them and because they don't do them aren't going to paid to do them. 2. Sadly, many patients think that if they aren't prescribed medications for a problem, they aren't getting the best treatment and will be dissatisfied with the doctor. This is true about sleep medications, pain medications, and antibiotics which is why doctors prescribe them for viruses for which they have no benefits. Doctors find it far easier to give patients what they want and not what is in the patients' best interest.

  10. they do.

  11. The problem with these studies is that they promote one size fits all thinking. It is happening with people with pain and prescription of opioids. Patients are being weaned of pain medication who never abused it and need it for unrelenting pain. It is the same with Benzos. There are people who don't abuse them, have never upped the dosage, and know not to mix them with Alcohol or Opioids. I'm one of them. Let's finally deeply look at each individual patient, and prescribe accordingly.

  12. Thank you; very well written. Some patients need benzos to function, let's not stigmatize their medical condition nor scare them.

  13. The problem is that there are no studies demonstrating the benefits of extended use of either opioids or benzos with the exception of using the latter for true anxiety disorders (this does not mean the person is just feeling anxious, it means they have diagnosable disorder that is preventing them from functioning and I can assure only very small minority of people prescribed benzos have one of these). Doctors can either practice medicine based on true science and research or based on anecdotes. You decide which you would prefer.

  14. The majority of people who wind up in trouble with benzodiazepines take them exactly as directed for longer than 2-4 weeks. Not abusing them is not insulation against their damage. In fact, people who do abuse them might fare better in regards to becoming physically dependent than people who take them as directed, because abuse is sometimes sporadic and not daily, whereas they are often prescribed for chronic, daily use. Daily use long-term is what results in tolerance, tolerance withdrawal, interdose withdrawal, physical dependence, and subsequent withdrawal syndromes. Abuse, of course, is more dangerous because of risk of overdose, especially in combination with other drugs/polypharmacy. Also, most of the escalating dosages are done by the prescriber in patients who are on long-term benzodiazepines as prescribed. They increase the dose because they're "treating" tolerance withdrawal. The problem with that is, you can only chase that dragon so long until you're tolerant to the higher dose -- then what?

  15. I think that one general problem is that dosing of most meds - is done as if every adult were the same: age, sex, size, health and despite other meds being taken (including OTC and prescribed meds). Some times even before I got "older," I reacted more strongly than average for some drugs, to the extent of taking a child's dose of say, an allergy medicine, and finding it sufficient. I suspect that the older you get, the slower the metabolism, and the greater the risk that something will also remain in your system longer. Or perhaps the enzymes or liver function are not as effective in clearing toxins. When there is a lack of specific information about differences in effects on older folk, it makes sense to act as if this is probably the case. AND - we so do need more geriatrically trained physicians.

  16. I'm glad to see this article. Several years ago a doctor prescribed 25mg of amytriptylene to help me sleep. "Any side effects?" I asked. "No, maybe dry mouth." No warnings at all. It was soon clear that 25 mg was way too much. So I eventually got it down to 5 mg a night, taken 4-5 nights a week. A year or so later, sleep felt heavy, so I stopped taking it, assuming ending such a low dose wouldn't register much difference. A week later, I came down with nausea, chills, such fatigue I absolutely couldn't even get out of bed. Only a few days later did I connect what I thought was an oncoming flu to discontinuing even such a small dose. A Google search into "side-effects of amytriptylene" showed in a box every one of my symptoms, and testimonials of people who suffered for months from withdrawal. My doctor should have warned me about the dangers of stopping even a small dose. I will never forget what those weeks of withdrawal felt like. Wise up, doctors! Take a few minutes to explain what you're giving people who trust you.

  17. The doctor should have been prescribing amitriptyline for sleep problems in the first place.

  18. I left out the "not". It should have read the physicians should not have been prescribing amitriptyline for sleep problems.

  19. Benzos are fantastic for hospice and dying patients, therefore we do not want to ban the use in the elderly. It is important to tell the rest of the population that benzos can increase the death rate and dementia risk. Sometimes folks would rather not be in withdrawal for however many years of life they have left and elect to continue them. I think the critical first step is not prescribing them for daily use in the first place for anyone with a life expectancy > 1 year.

  20. It's doctors who put elderly patients on these drugs, and it needs to stop. When my mother went into a nursing home, she was understandably depressed and sad initially. It was a big adjustment, of course. The doctor started her right away on an antidepressant. I was furious. Then, I found out that most of the patients were taking them. They make it easier for staff to deal with the patients. I moved my mother soon after to another nursing facility, where I refused to allow her to be put on the drugs. After a few months, my mother made a few friends and adjusted to her new life. She continued to have some periods of depression, but that was normal, in my view. She knew she was nearing the end of her life and naturally, she was sad and sometimes anxious about it. Who wouldn't be? But, the care she got was gentle and understanding. The doctors who hand out those drugs to the elderly should be disciplined, and their licenses revoked.

  21. Excuse me but as the article was about benzodiazepines, I don't see how your discussion of antidepressants was a relevant issue. And if you want to compare benzos to antidepressants, it's an easy one as the former are addicting and withdrawal from them can be life threatening and the antidepressants are neither.

  22. Actually, the good folks at Cochrane have proved otherwise, Steve: https://www.ncbi.nlm.nih.gov/pubmed/21992148

  23. Excuse me, Steve. I guess I'm not as smart as you are. Sorry I confused "benzos" with antidepressants. My point was that these kinds of drugs (and hold on to your hat, Steve, while I refer to anti-anxiety and antidepressants in the same sentence) are handed out in nursing homes to make patients easier for staff to deal with. Who wants a bunch of old people being sad and depressed and anxious because they have outlived friends and family, and many are alone and know that the next step is death? Easier to have them all complacent and calm and in their happy places. We need more understanding and compassion for the elderly. Trying to address their needs with drugs doesn't help. OK, Steve, go ahead and patronize me again.

  24. Wow!-a scare article in the NYT about benzos. Please look at the recent medical literature on benzodiazepines; it appears that antidepressants have been over-sold as a substitute and benzos are now being considered as first-line. Right, be really, really careful with benzodiazepines and opioids are taken together. If you take an older patient off benzos, what do you propose to give them instead for their anxiety? CBT? There have been so many studies that show that while people do become tolerant of some of the effects of benzos, the benzos maintain their ability to quiet anxiety. As to dizziness, nothing causes dizziness like anxiety. The main problem with benzos is that they are very inexpensive (ca. 10 cents a tablet) and the pharmaceutical industry would much rather you were dosed a second-generation antipsychotic, which cost $30 a tablet and poses the risk of stroke, diabetes, etc. http://hughes12.com/The-Bias-Against-Benzos.php

  25. Yes, you are right that pharma would rather you be on a more expensive drug, but that does not mean that benzodiazepines are safe to take for more than 2-4 weeks. You wrongly assume that tolerance to the other effects is painless just because the anxiolytic effects might continue a bit longer -- they are not. Dizziness is not the only issue either -- you fail to consider falls, delirium, dementia, psychiatric manifestations of tolerance, memory loss, aggression, muscle spasticity, and withdrawal syndromes which can often be severe and/or life-threatening, etc. In response to your posted article, there are others you might want to check out: https://www.youtube.com/watch?v=WUK64RcSDj8&t=138s https://www.psychologytoday.com/blog/saving-normal/201607/yes-benzos-are...

  26. I wonder whether it is different in other countries. Perhaps there are some cultures/nations that provide a better support for elders and there is less dependence on drugs. (It might also be true for younger people.) I suspect our nation is disease focused with little effort to encourage or facilitate the “good life” for our citizens.

  27. The medical system is not equipped for the necessary individualization in the roulette game of legal drug dealing/addiction, nor are individuals equipped to deal with the drug marketing and naive trust in the profession. A temporary relief of any symptom is often followed by chemical adjustments in the body that make the drug no longer effective - and the PCP then recommending going off the drug with little knowledge of how to titrate off slowly. Then more side effects kick in. Cannabis is a great alternative to synthetic drugs for sleep aid; edibles being the easiest for those who don't want to smoke. The use of psilocybin mushrooms is also being researched relative to anxiety and depression, since most current anti-depressants have little effect. Not a bad idea for the elderly to start some exercise, increase endorphins, meditation, and look back to some of the early (abruptly stopped at the time) research on drugs from the 60's, which the MAPS Foundation out of San Francisco is busy doing. NYU and John Hopkins are doing research, as well as the Realm of Caring in Colorado Springs which focuses on cannabis. The DEA needs to be revisiting their relationship to Purdue Pharma and the others that make daily news and effect lives negatively daily as well.

  28. I keep hoping to hear research results on the use of psylocybin as a sort of first line offense/defense for chronic and acute depression ( and for PTSD). A Dr. I see for depression thinks it offers a lot of hope for long lasting freedom from depression w/o having to use medications long term ( life-term) which does relieve depression for many, but with side effects.

  29. Cannabis. It totally helps anxiety, increases appetite and used regularly for insomnia. Also, when using cannabis there's never a feeling of being lonely. It's perfect for the elderly. And you can't overdose or become an addict. Get with it people!

  30. @Mr. Slater: Ah, but you left out the part where underlying paranoid schizophrenia can be activated by cannabis use, as I saw happen to a close family member who ended up committing suicide.

  31. Mr. Slater you hit the nail on the head. Thank goodness prohibition has ended in parts of the country. This one simple plant! I am no longer an addict of alcohol or opiods. I stopped taking anxiety and sleep medication I had been on for 30 years. I don't get addictive cravings and I feel great every morning!!! 50 yrs old. Been taking HUGE amounts of aspirin and ibuprofen for years, and.... No need anymore! I have effectively broken my chains with big Pharma and rely less on insurance!

  32. Proud smoker for 50 years. It worked for me.

  33. The term,psychopharmacologist,is false and misleading. There is no such entity. There is no licensure, standards of practice or occupation as psychopharmacologist. It refers to prescribers who refer to themselves as that in order to obscure the fact that they restrict their practices to lucrative money making and time limited drug prescribing without the concomitant responsibility of monitoring for drug effects, adverse ones along with the desired ones, performing adequate physical assessments and practicing medicine with the patient's overarching benefit in mind. Please, New York Times, expose the ruse of "psychopharmacology" and physicians posing as "psychopharmacologists" and stop using them as legitimate terms.

  34. The Times might also stop referring to psychiatrists as "shrinks" a perjorative term. I don't recall it referring to anesthesiologists as "gas passers" or cardiac surgeons as "chest crackers." Why then the anti-psychiatry term?

  35. Dear Ms. Span, You didn't use the term and I didn't say you did, but if you're interested I can cite you many instances when your Times' colleagues have used it. And if you're unaware of this, apparently you don't read The Times very much.

  36. "Gas passers." "Chest crackers." A bit longwinded compared with "shrink", but otherwise not a bad first attempt, Steve. Maybe we should try using these terms.

  37. I believe Ms. Span has written a similar article that implied that people over 65 do not have the intellectual ability to handle ambien (which I take). Insurance companies have used these articles to exclude coverage for these drugs to men and women over age 65. This saves the insurance companies a lot of money. In the past before AARP, automobile insurance companies used to charge people over 65 a higher premium for coverage, because all people over 65 are poor drivers, just as all people over 65 can't properly manage their prescriptions. On the contrary I recommend that ambien be banned for anyone not retired under age 65. They might be driving to work over medicated, unlike the retired senior having tea, watching the Today show.

  38. I take a low dose of Klonopin (after weaning off another medication) for restless leg syndrome, which started about five years ago. Without it, I average only 2 or 3 hours of sleep a night. In my mid-fifties, the onset of menopause isn't helping my sleep either. My doctor requires me to check in every three months to discuss the effects of the medication, because it is a controlled substance, and has warned me that if it stops working I will have to taper off it as well before restarting treatment with it or a different medication. Do you think I'll be a safer driver dozing off at the wheel from lack of sleep, just because some people over medicate and some doctors prescribe medication without checking what their patients may already be taking?

  39. Informative articles like this are one of the reasons I subscribe to NYT.

  40. Informative comments too!

  41. Sounds like more elder bashing to me. I guess we are just too stupid and old to know not to take benzos with opioids, unlike the younger crowd who are dying in huge numbers. Maybe when you get older you should have the right to do whatever gets you through your life. Hey we have lived longer than most of the drug salesman and doctors.

  42. Tell me about it! I just turned 65 a mere month ago & have already experienced the attitude that I'm a mush-brained senior who can't read an RX label or be able to discriminate about appropriate use of drugs.

  43. I disagree. The problems described are endemic to the medical industry as a whole. A prescription is the quick and easy way out. Don't attempt to get at the deep roots of anxiety. Don't attempt CB or other non-drug therapies. Just write a prescription and send them on their way. Indeed, the only evidence of ageism I see here is the ignorance many doctors seem to have of the special needs of their older patients.

  44. If you want the right to do whatever gets you through life, stop asking for special perks due to your age.

  45. In my province, Ontario, folks over 65 get their benzos et al for free - score one for big pharma.

  46. First of all there is nothing new about concerns about the overuse of benzodiazepines. I and other physicians have written about this for years. In fact, this column could have been written 20 years ago as we have known everything in it for at least that long. As to the use of benzos with opioids, something else we have known for 20 years. It is that use of benzodiazepines actually reduces the analgesic effects of opioids. That physicians not only continue to prescribe both but have done so at increasing rates just demonstrates how many docs don't know enough about these meds to prescribe them properly due to inadequate education. Finally, it isn't true that benzos and the "z-drugs" are the same. The former are addicting in every sense of the word and, unlike with the opioids, withdrawal from them can be life threatening if the person goes cold turkey (I'd be willing to bet that if you polled your readers, most would think withdrawal from opioids is more dangerous). The Z-drugs can cause oversedation and are only meant for brief use but don't carry the same addiction risk as the benzos.

  47. Actually, the Z-drugs cause physical dependence and withdrawal syndromes as well and must be slowly tapered (see schedule 12), often by using a benzodiazepine: https://benzo.org.uk/manual/bzsched.htm Addiction and physical dependence are not synonymous.

  48. You are mostly on the mark, except for the statement "that physicians not only continue to prescribe both....). In many cases, different doctors are prescribing the benzos and the opiods. Polypharmacy is particularly prevalent in the elderly because they are usually seeing several doctors for different issues, and there is no coordination between them. I saw this with my own father, where I had to try to keep an eye on what he was getting and make the different doctors aware of his other prescriptions. Physicians tend to be pretty resistant to non-physicians (I am a PhD) trying to get them to stop a med or coordinate with a doctor in another specialty.

  49. Scientist, If it were only a case of poor communication between physicians that would be bad enough but studies have shown that in many cases the same physicians are prescribing both classes of drugs which indicates they don't know what they are doing

  50. One other point. Although both benzos and opioids are sedating, they both can interfere with normal sleep architecture so that use of them can actually worsen sleep, not improve in it.

  51. I think we are to swayed by anecdotal stories of a small % of people who have issues with the drugs they are taking. Opiod addiction and overdose (on prescription drugs) is very low. Some people who become addicted have had past issues with addictive substances (and hopefully we are starting to see addictive substances don't exist without an addictive personality (and another note is that the addictive personality is a continuum that we are all on, and subject to in different circumstances (stress, anxiety, etc)). Anyway, is complex. I have a family member who had a depressive/anxiety episode and is on Zanax and anti-depressives. Hopefully, when it is appropriate, he will be able to function without them. For now, thank god they exist and are available. He would not be here now without them.....(don't ask me how I know that, it is too painful).

  52. Experts state that anywhere between 30-80% of people who take benzodiazepines for longer than six months will experience withdrawal -- the severity of withdrawal varies from person to person (it may be due to a concept called 'kindling': https://en.wikipedia.org/wiki/Kindling_(sedative%E2%80%93hypnotic_withdr... You lack a basic understanding of the difference between physical dependence and addiction. Physical dependence is the body's adaptation to the presence of the drug. Addiction is a behavior of abuse. You can be physically dependent to a benzodiazepine without any abuse behavior at all, just by taking as your doctor prescribed. This has nothing to do with an "addictive personality". https://www.drugabuse.gov/publications/principles-drug-addiction-treatme...

  53. Studies have shown that as many as 25% of people without any history of addiction or substance abuse who are prescribed opioids for chronic pain become addicted to them. Perhaps you consider that low.

  54. Since most people are not prescribed opioids, the fact that 25% of those that are may become addicted to them does not make his statement incorrect.

  55. The fact is that most doctors don’t understand the sleep mechanism in the brain and that each person may respond differently. Many people can not tolerate melatonin, otc sleep medications, etc. and benzodiazepines work best at small doses. Please stop generalizing patients - it does them a disservice. Lack of sleep can kill people, increase anxiety and suicide rates. This is not a small problem problem for those of us who have it.

  56. But benzos actually disrupt sleep architecture so they end up making sleep problems worse. Why would you take medications that exacerbate a problem? If you had hypertension would you want to take a medication for it that actually raises your blood pressure?

  57. A person desperate for sleep will take something that helps him or her sleep. I know whereof I speak. There's a reason sleep deprivation is used as torture. People who are not in the position of needing relief are not able to understand those who are. Making theoretical arguments and warnings about a drug to someone in terrible pain is cruel.

  58. I have taken a small dose of ativan at night for years to help get a good night's sleep. My sleep problems are better, not worse, with this. Last year, after I heard about problems with benzos and old folks like me, I went to the manufacturer's website to see what the recommended dosage was, esp. for someone like me who takes it at night. It was 2-3 times as much as my doctor prescribed.

  59. Ah, geez, another scare article about another class of drugs. How about some real analysis of why people are in so much pain and anxiety? Could it have to do with the constant state of war, violence, and frequent threats to daily living?

  60. Tom, you're n the mark. The Grannies for Peace Brigade is full of old people with arthritis, tachycardia, asthma, and all the other problems of old age. But they understand the direct and indirect consequences of violence and injustice. So these old folks get out and take action. We hobble to the local high schools and hand out leaflets about planning for life after high school to avoid going into the military. We have anti-military actions on military holidays like Memorial Day. Getting out and taking action really helps control lots of the symptoms. And some of these elderly take action in spite of much physical pain!

  61. You really think that taking medications are going to do anything for those problems?

  62. YesYesYes! And from living so long in a society that is felt as more complex and threatening than most can manage. Getting through each day for a Crown*, is a long slow slog of being inadequate to its demands or opportunities. It is for me, at 91, in excellent health, living in a pleasant retirement community, with adequate income and a present family. I think that covers all the basic needs. But! and ! I live in a rural town with very limited transportation and no longer drive; it is necessary to ask my family for or order special transportation for the elderly and disabled to market or keep health appointments and, more important, meet a friend, go to the library, buy a newspaper and have a cup of coffee. I live in a community but it's rural and that is because it is less expensive to house us there rather than in the town. When I look out my window at any time of day I see the same thing; it's a nice view but static: small buildings that hold our apartments, the road that connects them, trees. Not much changes: birds fly intermittently, more rarely a deer or flock of turkeys or a squirrel, or the trees sway if there is a breeze, an auto or delivery truck now and then. And I like looking out my window and observing the minute changes that do occur. What I'm saying is that it is easy to become bored, to become wrapped up in loneliness and fear, better known these days as anxiety, to feel useless and fatigued and like doing nothing. *Crone of either gender. L&B&L

  63. I am soon to be 68 and never had a problem with sleeping or leg cramps, dry eyes and mouth, nor dizziness until I was prescribed statins and blood pressure meds along with an anti platelet forming drug after having two stents placed. I take a 5mg ambien now and then for sleep. But my go to drug of choice is cannabis for the cramps and it also helps with sleep. After 50 years of using cannabis I can say that I don't appear to have any side effects. It's also very relaxing and fun to share with my girlfriend.

  64. Thank you so much for writing this. This is a REAL problem. My mother started taking Klonopin right around the same time as Ms. Falstein, still takes it, and it has been a very bad thing for our family. She is not the person she once was. She passes out at strange times (babysitting....), is prone to alternate vagueness and fits of rage, and forgets lots of stuff. She has violently attacked me for suggesting that she reconsider her prescription drug use - like, frightening, addict behavior, ready to throw me under the bus if that will keep her on her Kpins. This has been the cause of significant family conflict, and is now a significant worry for all of us as she gets older. It was absolutely unnecessary. She never had anxiety disorder - just docs in the early 1990s seem to have been in love with the Klonopin for middle-aged women. Her one attempt to wean herself down was hideously miserable. I fear that she may end up in a medical situation where she gets cold-turkeyed - which would be disastrous.

  65. Another jumping on the bandwagon story about the evils of drugs. Stop judging. This type of anti-drug hysteria is so damaging to the majority who use drugs responsibly.

  66. Many of us commenting have taken the medication exactly as prescribed and are now having debilitating symptoms.

  67. As Tim said, many commenting have taken the drugs exactly as prescribed and have had their lives destroyed. No on is judging the victims. They are judging Big Pharma and the medical establishment that aids them.

  68. "Judge not lest ye..." And yes these articles foster hysteria largely because they are read carelessly: see NYT Replies. They are, however, informative and give us valuable information to use when we are often isolated from the informal discussions we used to have when we were younger. Rx ads on the TV are not a substitute and, your doctor like some cited in these comments may not have the knowledge of geriatric medicine that you need. Among the friends of my earlier life were many physicians. Some were thoughtful men and women who respected t-he body of knowledge available in their time and understood how much they didn't know - and proceeded with caution. Some of them experienced the horror of making a mistake even so. Some of them were not so thoughtful. Each of us needs to know, has the responsibility to know as much about our own health needs as possible, as well as about the state of current medical thinking and practice. The NYT publishes news about current medical thinking and practice, and makes me aware of what I need to know. I always take another person to my medical appointments - including dental, eye, and hearing appointments - to help remember what is said and done and, especially, to ask questions that don't occur to me. I always try to have some idea of what I am and am not willing to do or take and refuse to proceed unless I have satisfied myself that it's a good plan for me. I've got more good advice but only 43 words left... L&B&L

  69. Some years ago, my family doc stupidly prescribed a benzodiazepine "off label" to help me quit drinking, and I became almost hopelessly addicted to the "cure." It took me years to get off the addiction treadmill - finally quitting the benzos was far harder than giving up the booze. Any addiction doc would say that was a huge mistake, but primary care physicians have taken to prescribing this class of drugs almost mindlessly for any number of ailments because, as the article illustrates, they make for initially very happy patients. Like opioids, this stuff is literal dynamite, and the medical profession needs to understand that.

  70. There are folks who abuse these drugs and those who really need them. These reports always leave the latter out of the picture and that is very unfair. My mother suffered from the terrible pain of rheumatoid arthritis for the last 31 years of her life. All they would give her was aspirin then finally ibuprofen became available and they gave her that in mass quantities. The pain would lessen for a while and then come back and she'd have to suffer until the next dose. Eventually the relief was minimal.She did not drive or drink alcohol. I wish they would have given her opioids to ease her pain. She had a terribly painful condition. Would it have been so bad if she had become addicted to something that would have allowed her to at least have less pain? There are folks who need these drugs and take them responsibly. Living with intense pain is horrible. Let's think about those people too.

  71. Except that opioids don't work well for rheumatoid arthritis pain. And something you and most of the other comments overlook regarding both opioids and benzos is that extended use of either can actually lower the pain threshold making the pain worse. This doesn't occur suddenly but is a gradual thing and what happens is that they get prescribed higher and higher doses of medications that make things worse.

  72. Believe me I understand that it is a vicious circle in many cases but can you imagine what it may be like to live in pain and progressive deformity for 30 years. I would much prefer to at least occasionally be able to take something that would alleviate such horrible pain. I know she would have become addicted. I know she would have needed more of the substance if she took it too regularly. The point I'm trying to make is that there are people for whom society needs to have some compassion and understand that addiction or at least dependence is more than justified. There should be no stigma in those cases and certainly not form the medical profession.

  73. Many of us out here are sick and tired of being denied the medications we need because a small proportion of the population have problems with them, including abuse of the drugs and overdoses, usually due to their own stupidity. In terms of weaning people off these drugs, I have talked to many people about it and I haven't met anyone who was weaned off their pain killers or benzos. Most doctors summarily cut people off and let the chips fall where they may. I have constant pain from various sources and choose to smoke marijuana instead of taking opioids. Last year I was drug tested, and because of the marijuana, I was immediately cut off of my anti-depressants, Xanax and Ambien. Since then I get about 4 hours sleep a night, constantly have a feeling of impending doom and can barely function. The only thing that keeps me from completely flying apart is my marijuana smoking. I have found that too many doctors are uncaring and incompetent, and the law is most definitely an ass.

  74. Ambient and Xanax are NOT anti-depressants.

  75. Sarita, I know that. I guess my writing wasn't very clear. My antidepressant was Zoloft.

  76. Which entity did that "drug enforcement" on you?

  77. Elderly patients who are prescribed "benzos" should be required to engage in non-drug anxiolytic activities such as mindfulness meditation, yoga, tai-chi and age-appropriate exercises in general. The best time to make positive changes in one's life is when the positive effects of drugs like benodiazepines are having their maximum effect. That way, when the pill's effects are wearing off, the benefits of positive life style changes are kicking in, making weaning from benzos easier.

  78. Truly a consideration, particularly when used with opiates and/or with dementia and dementia-like cognitive deterioration. The big BUT here is how do you ensure adequate quality sleep and, where indicated, how do you manage pain? “Alternative treatments like cognitive behavioral therapy and improved sleep hygiene can be as effective for insomnia[...]” - this may not work for the majority of those who are habituated or whose insomnia has been well-managed by this category of drug. An uphill battle on many fronts.

  79. As usual, many commenting here want to distance themselves from the clueless folks who are abusing benzos and becoming addicted. They see themselves as separate, as people who legitimately NEED and deserve these drugs. The question people should be asking themselves, however, is not "Am I an addict?" It's "Are these drugs I'm taking helping or hurting me?" The answer is, they're probably hurting you, even if you don't know it. I had to go through a wicked withdrawal from Oxycodone after knee replacement surgery at the age of 61. When I still wasn't getting well 8 months later, I realized I needed to ditch the small dose of Xanax I had occasionally been taking for sleep for five years. It turned out the Xanax--a benzo--had been doing a number on my brain and body I hadn't even realized, and the difficulty of getting off much greater than with opioid pain meds. It's been five-and-a-half years since my last crumb of Xanax, and I'm finally fully recovered. Since I was already a published author (Children of the River, Random House 1989 and still in print) I decided to write a memoir to give other nice ladies such as myself a heads up. Your doctors won't worry about you becoming an addict, so you better worry about yourself! Accidental Addict: a True Story of Pain and Healing....also Marriage, Real Estate, and Cowboy Dancing. Linda Crew www.lindacrew.com

  80. I wonder if we should also not start looking at the efficacy of knee replacement surgery in almost everyone, as all I read about is the awful pain that requires heavy duty opioids for long periods of time (and sometimes, forever). Is a surgery intended to give people more functionality WORKING if it gives them lifelong intense pain requiring opioids for the rest of their lives?

  81. While the science is far from settled, many patients use marijuana for both sleep issues and anxiety (among others). Marijuana is far safer than the benzo drugs. There needs to be further study to support the vast amount of anecdotal evidence for the use marijuana for such conditions. And in the meantime, broad legalization will allow the wider use of this safer and perhaps more effective alternative.

  82. The solution to drug addiction is never going to be "switching to another type of drug". Some people posting here, rhapsodizing over their pot usage, admit to being users for FIFTY YEARS. That's not pain control -- that's an addictive personality who has found their drug of choice.

  83. Some Jimi Hendrix music might help.

  84. Compounding and causing a lot of this problem is the lack of continuity of care ethic that is the foundation of good medical practice. Patients keeping their own health providers are rare these day, as the managed care model of medicine has overtaken the traditional model and people are shuffled from provider to provider almost at random. The provider no longer talks face to face with you, instead reading from a computer screen, and gives you 15 minutes. Basically the provider has only a flashing picture of your medical needs. Yes, overdosing is a problem and so is underprescribing. Hard to tell when this is a very common time frame.

  85. I have taken these very sporadically for years, less than 60 low dose pills a year. I use them fpr anxiety when I fly and for sleep when I am on vacation with my loudly snoring husband. Very occasionally I have used them for other episodes of anxiety, never more than one a day and never for more than 3 days or so. I have experienced no bad side effects yet, I'm 69. I would be very leery of taking these more often, so limit myself to the amount I take now. I find them very helpful and would resent being told I can no longer get a prescription. There is a lot of truth to what some other commentators have said, somehow people think all of us seniors need their protection.

  86. You are taking them as they are intended -- as needed, sporadically. Although, if you are older, you could still be at higher risk for adverse effects from those sporadic doses because the body does not metabolize the drugs the same as age progresses. The greater danger, however, is chronic daily use, for which these drugs are not intended but are prescribed for regardless of the multitude of professional guidelines which advice against doing so.

  87. I agree. I also take a low dose benzo once or twice a week at bedtime for chronic insomnia. It helps. These articles by Paula Span never include a discussion of dosage.

  88. Me too - exactly that, except that my doc prescribes 30 low dose pills a year. (They have a long, long shelf life so I keep a stash.) I use them to help sleep on planes, to get through the worst night of a cold, and for other rare times when I really want a good night's sleep but can't get it. We all need to educate our young docs on evaluating individual cases. In the meantime on a related matter contrariwise, I'm looking for other OTC meds such as decongestants that aren't automatically "Maximum Dose" since as we age we need less: looking into pediatric doses. (Also buy smaller apples, oranges and bananas.)

  89. I am so glad melatonin works for me. My sleep has been poor all my adult life and I tried ambien, lunesta, and sonata they all worked for a bit, but not very long and lunesta left me with a nasty taste in my mouth too. Valerian worked longer, but still failed eventually. Melatonin has worked for years and my only side effect is vivid dreams. One of my kids gets nightmares from melatonin, though, so that is something to be aware of if you try it. I also cut my five milligram tablets in half, five is more than needed, though it doesn't affect me badly.

  90. Klonopin was prescribed for me, with no warnings, for 19 years. It took me 6 months to taper off the 1 mg a day dose. I completed the taper in 2012. I have been free of any benzodiazepine for almost 6 years. I am still having disabling withdrawal at age of 72. It is believed that I have permanent damage to the brain and CNS.

  91. This exact same thing happened to me. I followed my prescription exactly as prescribed and ended up sick for years tapering off the drugs. Was not warned this was even possible beforehand.

  92. It is simply incompetent psychopharmacology to prescribe benzodiazepines as maintenance drugs for anxiety, panic or insomnia. It could be recognized as malpractice. These medications are not cures, they manage acute symptoms- ideally for a brief time. Other treatments are necessary for the long run. Patients are impatient but ultimately follow careless prescribing by MDs. Benzos lose effiucacy as a patient develops a tolerance. Dosage creeps up. The down-regulation of GABA systems is plausibly depresso-genic. It can impair cognitive functions. Medicated sleep is not quality sleep. Being unconscious through sedation is not restorative. The brain needs real sleep cycles, useful 'architecture' to keep neurochemisttry humming. Fragmented sleep may be an intractable feature of aging, but alcohol & Xanax are toxic 'solutions,' Short term solace from suffering is compassionate. Long term bad medicating is shameful, shallow and causes iatrogenic (needless) woe.

  93. The hysteria concerning opioids has given the author a step onto the trendy bandwagon. She pretends to advocate for the elderly, yet time and time again she writes of the dangers of sleep and anxiety medications, with the underlying assumption that seniors are fuzzy minded and unable to weigh risks and benefits. First it was Ambien and the “z-drugs”, now it’s benzodiazepines. Note the large number of comments. This article will be read by everyone and will provoke strong feelings. Physicians have become punching bags in the comments, another unfortunate trend. Common sense dictates that these medications be used with caution. Ms Span apparently believes that elders lack common sense; that they will drive while using them, escalate their use and not check in with their physician. I agree that maybe 1 out of 10 will misuse pain and anxiety medications, but I advocate for the 9 who will not. I’d also like to reiterate that not all people over 65 are demented and in need of younger people’s advice.

  94. This is not about elderly people being too fuzzy headed to take the drugs "properly". Many people were instructed by their physician to take these drugs every day, for years, thus increasing the risk of dependence. This is about the physicians, and the pharmaceutical companies who encouraged this type of prescribing. Younger people are just as vulnerable to this horror.

  95. Are you a physician? You seem more concerned about physicians being criticized than about the health of vulnerable people. Surely the wellbeing of the elderly is all that matters. Elderly people are not all demented, but even more than younger people they are vulnerable to being bullied by their carers and physicians.

  96. Well said.

  97. I think this article is very timely and does a great job of explaining the dangers of these drugs in the elderly population. These drugs are dangerous at all ages but present specific risks for seniors. I am tapering off a benzo myself and it has been an awful experience. I now co-direct a nonprofit Benzodiazepine Information Coalition www.benzoinfo.com which raises awareness about the dangers of benzos because I believe patients have the right to adequate informed consent about the drugs they are taking. This article does also point out that cold turkey is dangerous and enforces the need for a slow taper. Our organization has seen way too many horror stories of seniors who were forcibly cold turkeyed off their long term benzo simply because they were 65. This is cruel and inhumane given that withdrawal symptoms can be severe, not to mention dangerous as abrupt cessation can also result in seizures and death.

  98. I was prescribed benzos after daily panic attacks left me unable to function. I would wake at two a.m. unable to get my breath, my heart raced while adrenaline pumped through my body. It was terrifying, but without any reason for why. This would go on for hours, affecting me throughout the day. I was unable to drive, go into public places, partake in life. First I was given extended release 12 hour Xanax, but within two weeks I developed 'rebound' anxiety - my body reacting to the withdrawal of Xanax by creating the same symptoms which caused me to take the medication. In between each dose I was so drugged I slept all day. Finally another doctor helped me get off the medication, putting me on antidepressants to help with this anxiety symptoms. Years later I still consider this one of the worst periods of my life.

  99. I haven't taken Xanax in years, but I keep a few pills (less than 6) on hand in case of a panic attack. I had them in my 30s, and they were awful beyond imagining, so you have my sympathy. They worked in an amazing way for me, literally turning the symptoms off like a light switch in about 30-40 minutes. They relieved incredible suffering, plus the FEAR of having more panic attacks -- a fear almost as bad as the panic attacks themselves. However, I never took them daily or got dependent on them. I think most doctors here are way overprescribing a drug that should be used only when needed, and not daily.

  100. The article is unbalance.These drugs exist for a reason. old people suffer more depression and insomnia. Cognitive therapies do not work well with this group, simply because they are more mentality fixed. Physicians prescribe them for the quality of life. Are there any statics concerning how life was more enjoyable after taking them. Many States even pass legislation to restricted physician. it is not surprising,Considered that the legislators are not suffering these diseases . But they are going to be old just like everyone will die. it is political correct to condemn them. It makes people think it is bad to take them. For many cases, " detoxification" in old people is very debilitation. the struggling deviate most patient form other meaningful things. These drugs can induce dependence. So are anti-hypertensives and anti- diabetes. Patient take them for life. There is always complications. Auto accidents killed a lot of people.

  101. jcyang, how is this "politically correct"? Have you read the victims' stories in these comments? What do you think auto accidents have to do with this topic? Do you think that if someone dies in an auto accident, it's okay for someone to die from taking benzos?

  102. jcyang: neither blood pressure meds nor diabetes meds (metformin, insulin, etc.) cause dependence. In fact, most people DO NOT LIKE taking them, and the real problem is getting patients to comply with doctors orders. Nobody gets high from BP meds or metformin, and most people would be overjoyed to STOP taking those drugs!

  103. Why the hell do they prescribe these drugs for long-term (anything over a week) use?

  104. Because some people have debilitating anxiety that prevents them from functioning and these drugs alleviate it. Why do they prescribe insulin for diabetics?

  105. Antidepressants work better long term for anxiety in most people. Generally there is no reason to be prescribing benzos long term.

  106. Because the things that might help people long term are costly interventions -- years of psychotherapy, talk therapy, cognitive behavioral therapy -- they don't work predictably or on every person. But they are more likely to result in a permanent cure, without drugs. BTW: this also goes for true pain management programs. They take a long time, involve cognitive and physical therapy and participation by the patient and are expensive! so it is far easier for most doctors to say "here, take a opioid drug and shut the pain off instantly with no effort".

  107. For anxiety, which often is linked to depression, we may try one x 1000 micrograms (1 mg) of Vitamin B12 daily, plus three x 5mg (three x 5000 micrograms) daily of oral high dose folate aka folic acid. Both are cheap and safe. Both can be bought usually without a prescription, therefore. Search for: Megafol 5 mg Folic Acid Tablets 100 ($4.99 to $5.49); Nature's Own B12 1000 mcg 120 Tablets; (or Nature's Own Activated Methyl B12 60 Tablets) Daily dose and duration of treatment seem to be crucial. Low dose folate supplementation is reported to have little or no effect. Dose must be high strength folate (5 mg) taken three times a day. And one needs to follow the daily folate and B12 regimen for at least thirty days. (NB, Megafol 0.5mg Folic Acid 100 Tablets are also available. Don't bother with these. They're just one tenth the strength of the 5 mg folate tablets. The former don't seem to have any effect on anxiety, agitation and irritability. It seems one MUST take three high dose 5 mg folate tablets a day for thirty days to notice any improvement) 1. Treatment of depression: time to consider folic acid and vitamin B12 http://journals.sagepub.com/doi/abs/10.1177/0269881105048899 2. 'L-Methylfolate as Adjunctive Therapy for SSRI-Resistant Major Depression: Results of Two Randomized, Double-Blind, Parallel-Sequential Trials' https://ajp.psychiatryonline.org/doi/abs/10.1176/appi.ajp.2012.11071114

  108. Of course, doesn’t have to be any particular brand of B12 or folate.

  109. While I would not negate the effects of good nutrition -- good sleep hygiene -- stress reduction -- relaxation techniques (like meditation, yoga, etc.) and exercise -- there is no one vitamin or supplement that is a cure, just like there is no one drug that is a cure. Some of what is bothering people here -- especially the elderly -- is just LIFE. The fear of growing old, poor health, lack of income, isolation from family or friends -- the ongoing deterioration of one's body as you age -- impending death. There is no cure for the human condition that exists in a bottle.

  110. 3 week taper in Jan/ Feb-2013 by my neurologist ,and first year I was able to go visit people ,just mild walking difficulties,second year somewhat more difficult and shoulder and back muscles were contracting quite a bit, along with severe head pressure ,third year it was all I could do to get thru a supermarket holding on to a shopping cart once a week ,and I passed out momentarily in the check out line ,forth year could barely get to my bathroom and needed assistance to get to my doctor ! Also felt like I was going crazy and going to pass out and convulsions picked up to 3-10 times a week ! Year 5 still getting worse as standing is so hard,I limit it to once or twice a day !( I have been living 24/7 in my recliner since I stopped the 8mg daily of lorazapam! ) Also I was 75 when I stopped my Benzo and now I am 79,but most say that doesn't impede the healing.

  111. 3 weeks seems much too fast to taper from an 8 mg dose. Check benzobuddies.org.

  112. I've never taken anxiety medications but have recently developed intense anxiety over having involved dental procedures, probably because I've had to have so many of them. My primary physician has declined to prescribe for me any short-acting anxiety medication such as Ativan because I'm in my 70s and he says it isn't safe for the elderly. And so at my last 2 1/2 hour dental procedure, I had a full blown anxiety attack the whole time with racing pounding heart and high blood pressure. My heart continued to race for hours afterward and my chest ached for two days. How can this be better for my health than taking a short acting anxiety medication and have my husband drive me to the appointments? Oh yes, my dentist tried nitrous oxide but I'm one of the rare ones for whom it had no perceivable effect. Maybe prescribing an anti-anxiety medication would actually be helpful for certain elderly people in certain situations. I don't think it's fair to give blanket warnings that it's always a bad medication for us.

  113. There's a difference between using these meds for "performance angst" (including dental work, public speaking, air travel, etc.) And treating long term anxiety with them. I'd ask my dentist for an rx if my primary was reluctant just on the basis of age. For me, a half-mil.of lorazepam is every bit as essential at Novacain to surviving a dental procedure. The problem with your primary may also be the HMO protocol which may be tying his hands. Plus, of course, a bit of ageism. Which this article also suffers from.

  114. I would agree to the use of a benzo in your specific case, for a limited time.

  115. On a recent prostate biopsy ONE Valium, an hour before, was very helpful; that's it, though...ONE.

  116. I took a "low" dose of Klonopin as prescribed for around 4-5 yrs. I tapered off in a month. My CNS was so damaged henceforth that the next 3.5 years of my life were truly a waking nightmare: a never ending feeling of terror, sleeping 2-3 hrs a night, muscle spasms, nonstop nausea, hallucinations, cognitive impairment, rage, severe depression.. Amazingly, I was met with complete rejection by the medical community. Thank God benzo victims are beginning to unite online. There are SO many of us, many are still unaware the drugs are their problem. This is a true scandal far surpassing the Thalidimide scandal of the 1960's. Please, NYTs continue to run with this!

  117. Want to see more frightening stories? Check benzobuddies.org

  118. Overprescribing and misuse of benzos may indeed be a problem, but to suggest that this problem surpasses the thalidomide catastrophe of the 1960's is both hyperbolic and completely insensitive to the thousands of people who have faced lifelong disabilities due to thalidomide. Comparing apples to oranges does not strengthen your argument.

  119. A "low dose" of Xanax for me for 16 years; still dealing with what I feel are the aftereffects, dizziness mostly, although that could also be a function of age.

  120. This is a very real problem for all the reasons in the story. As a geriatrician, I am often asked to evaluate older patients for complaints of memory loss. If they are on a benzodiazepine, my first recommendation is that they taper the medicine off. But patients - and often their families too - are frequently very resistant, even after I've explained how potentially damaging these drugs can be to their cognitive function. Many times patients can't even explain why or how they were started on the medicine. These are useful drugs for limited indications (e.g., anxiety in dying patients), but are too often overprescribed.

  121. This article is my story at age 71. 16 years on Xanax with extreme difficulty tapering off. My advice? Only for temporary, emergency use.

  122. Curious to know the dosage you took and how many times a day.

  123. Don't remember dose, but it was relatively small; maybe 1 mg 3 times per day. It was the length of time that hurt me. Really do believe I have damage to my central nervous system, but symptoms (dizziness) could be result of ageing too. A few months without any now and I am managing.

  124. Benzodiazepine medications are extremely dangerous. Here in the U.K. Public Health England are conducting a review into the dangers of prescribed drug dependency. Professor Heather Ashton wrote the Ashton manuals that are an invaluable resource. Physical dependency on benzodiazepines can happen even on a lose dose and more often than not has nothing to do with misuse at all. In the U.K. there are specialist centre for benzodiazepine related disability. But not enough. We are campaigning for a 24/7 helpline. Some people need 24/7 care for many months and sometimes years. In severe cases people need Zimmer frames and wheelchairs. Benzo related disability is absolutely horrific. Well done to the NYT for this coverage.

  125. Patients in the US expect a pill for everything. They expect to feel happy and pain-free all the time. Doctors succumb to the pressure from patients to prescribe dangerous drugs. Another doctor may already have done so under a different name. A recent study showed that OTC painkillers worked as well as opioids without the addiction. Doctors should take the lead and not endanger patients which drugs which can cause confusion, loss of balance, addiction and more problems down the road.

  126. I actually do think people have a right to freedom from debilitating pain (not to be confused with general "aches & pains" of old age). But nobody can expect to feel 100% happy all of the time. It's not the normal human condition. I think part of our problem is media -- which our ancestors did not have to contend with -- everything from TV to movies to social media, that present the lives of very affluent people or celebrities, all of whom seem to be giddy with happiness 24/7 and engaged in endless "fun" activities -- with no hard work, downtime, mild depression or general sadness ever. We compare our drab ordinary lives to this, and feel awful -- jealous, anxious, deprived, lonely, sad. But the images and ideals are not realistic and they make most people feel WORSE about EVERYTHING.

  127. I guess I'm fortunate. I have been prescribed every type of benzodiazepine, and every time, I cannot follow the prescription, because within 2 days, I become suicidal. It's a not-especially-common side effect. I'm not suicidal any other time - only when I have tried to take any anxiety medications in the benzo family. I'd rather be frantically anxious and utterly unable to sleep than suicidal. So now, when I see a new doctor - which happens with some regularity, as my career takes me to live in new places every few years - I just write that I cannot take benzos, ever.

  128. How much of this is due to real anxiety the elderly face? And the fact that it's easier to get a drug than it is to deal with the real source of the problems? Yes, there are plenty of people with anxiety disorders but it's hard to get health insurance to cover the therapy that could help them deal with it. Insurance will cover drugs but not meeting with a therapist on a regular basis. There's a lot to be anxious about in America, no matter how old you are. And nothing is being done to alleviate the very real anxieties people are facing: how to pay for health care, keep a job, keep a place to live, pay off loans for education, pay for kids college educations, save for retirement, care for elderly parents, etc. The real wonder in America is that more of us aren't addicted to pain killers and other drugs.

  129. The issues I’ve seen with these drugs in my family have involved alcohol. What they tell the Doctor rarely includes the truth about their drinking.

  130. In 1996 I was prescribed klonipin first for anxiety but it wasn't very helpful for that, but since I thought I found it helpful for sleep the doctor said at least it's helpful for that and that it was often prescribed for sleep, (always taken as directed).  By 2006 I was so cognitively and memory impaired, plus serious anxiety and depression, I had to go on disability.  Lost my job, house everything!  Even then doctors didn't know benzodiazepine tolerance and major side effects were the culprit. By in 2011 the nasty physical effects hit. I went from easily being able to walk 6 miles to struggling to walk 1 mile with serious muscle weakness, pain, very fast heart rate, heart palps. I searched online and found the answer at: benzo.org.uk  .  It turns out millions around the world have become physically dependent, injured. Many have been lost to suicide because of the horrendous symptoms benzos can cause. Others have died from seizures and other health complications caused by cold turkey removal of the drug. I used the Ashton manual to taper for 15 months.  Now 57 months post taper I am still very much disabled with severe cognitive and memory problems, severe fatigue.  I'm better with better physical abilities now and the total hell tapering was is mostly passed.

  131. One thing that isn't clear to me from this article or other articles on this subject in the Times is how much of these drugs people are/were taking. Jessica Falstein says she was taking multiple drugs. How many multiple drugs? With opiods we hear of people who were prescribed them for pain, then started taking them all the time, then started taking even more than that all the time and stealing to get enough of them. So was Ms Falstein taking them just days,just nights, or days and nights and what kind of dosages was she taking Was she taking what was prescribed or more than what was prescribed? And was the prescription from a GP or from a psychiatrist who knew something about drugs? Are the anti-anxiety meds bad for everyone in even tiny doses or is the point that people start taking ever larger doses and mix them with other drugs, as opiod addicts do?

  132. ellienyc, patients, especially the elderly, are often prescribed an increasing cocktail of drugs because drug 2 is needed to combat the side-effects of drug 1, drug 3 to combat the side-effects of drug 2, and so on.

  133. Low doses are a red flag that the drug is potent. These drugs impair people and are linked to dementia. They're unsafe at any dose for more than a day or two. The point of the article is that many people don't realize this.

  134. John: when I took over the care of a 91 year old aunt, I found she was on 14 different medications. It was not just costly and confusing for her -- she had early stage dementia -- but I suspected strongly the drugs were interacting in a negative way. Among other things, she took laxatives because some of the drugs were constipating -- then she got diarrhea from the laxatives, so they put her on anti-diarrheal drugs. Not short term -- forever. Once she got prescribed a drug, even in the hospital, it was continued indefinitely. She took allergy drugs for allergies I could not determine who had diagnosed or when -- inhalers and pills and shots -- after getting her out of her filthy, dust-covered apartment, we determined she had a DUST allergy that nobody even considered. In a clean environment she needed no allergy meds at all. Once off all drugs....the stomach problems and sleep problems ended -- there were no more allergies or runny noses -- she slept normally without the Klonopin she'd been taking FOR YEARS. Her only ongoing problem was mild hypertension of 130/85, which her doctor and I agreed was debatable as needing drug treatment in a 91 year old with dementia. I would have given her the BP meds anyhow, but the Assisted Living facility charged $700 a month EXTRA for "medication administration" even if there was one pill or even VITAMINS -- so I stopped all drugs entirely for her. She lived another 3 years, with no problems and died a natural death.

  135. Physician Assistant here. Took benzodiazepines as prescribed for work stress. Began to develop what I know now was tolerance withdrawal. Psychiatrist prescriber denied it was possible, but I had done my research and knew it was the benzos. My family noticed drastic changes in my moods and personality. I had developed severe suicidal depression, chronic diarrhea, rashes, persistent anxiety and agoraphobia (all supported in the expert literature as being due to benzo tolerance). The withdrawal syndrome is horrific and has become protracted, lasting 5 years and 3 months to date. I have been so ill I am on disability and cannot work, requiring much assistance from family. My symptoms include, but are not limited to persistent and chronic muscle rigidity, nerve pain, numbness, dizziness, a sensation of being "on a boat," anxiety, paranoia, depression, apathy, anhedonia, memory loss, cognition problems, inability to focus or multitask, depersonalization/derealization, etc. I have been met with pure ignorance from the majority of medical professionals I did see while desperate for help and validation. I have, however, since consulted a forensic psychiatrist for many years who knows this withdrawal syndrome is very real and very debilitating. It's important to note that I had none of these issues prior to taking these prescribed benzodiazepines. Buyer beware. Taking benzodiazepines exactly as prescribed has catapulted me into a hell I couldn't have dreamed existed.

  136. How sad that it takes a FORENSIC psychiatrist to understand what his/her medical peers don't.

  137. Last year exactly at this time, I was nearly overdosing on a daily basis on my prescriptions of klonopin, Valium, oxycontin, and oxycodone (in addition to other psychiatric and pain medications, like gabapentin and cymbalta and Prozac). I was suicidal, so I’d “not remember” how many I took of each prescription or how often during the day. I never took more than my allotted monthly number of pills. Doctor with 20 experience in my field here. I know pharmacology. I know the particular dangers of benzos and opioids. I took them as prescribed anyway. I was given these drugs for the reasons most people are: anxiety, depression, pain. Scripts were always refilled, no questions asked. I truly believed I was in so much psychic and physical pain that they were necessary. I didn’t make the connection (and neither did my doctors) that the more drugs I took, the worse I got. In the end the choice was simple: get off the drugs or die. So I went to rehab. If you want to experience a particular type of hell, be a patient with the as-yet poorly characterized and medically misunderstood phenomenon of severe benzodiazepine withdrawal reaction and be cold turkeyed at an expensive, reputable rehab. If you didn’t want to die before, you sure will after that. I now spend my time researching. Trying to find patterns in data and anecdotes and information to explain why the disconnect is so profound that even doctors who prescribe the medications themselves become entrapped.

  138. Thank you for sharing. I hope your expertise and research can help us fuel change.

  139. Please also research gabapentin/neurontin for adverse effects and severe withdrawal agony. The medical community has seen fit to ignore or wash their hands of the problem. Withdrawal threatens profits, and therefore is ignored.

  140. You are a DOCTOR and you did not realize there was something horribly wrong with taking DAILY klonopoin, valium, oxycontin and oxycodone, PLUS gabaprentin, cmblata and prozac???? There is no medical condition that would justify using all of these DAILY and nearly overdosing. Is it possible you were given whatever you wanted by colleagues because they thought a DOCTOR would be more responsible and knowledgable about mixing such heavy drugs?

  141. These drugs, like many others, have potential to cause harm. The conditions they treat, particularly insomnia, have the potential to cause harm and also to degrade quality of life. An elderly person who hasn't slept well for several days is not going to be fully functional and risks falling, accidents, etc. That person may very well be safer using zolpidem or lorazepam. A person in constant pain from arthritis may very well decide that a considerable risk from a drug that controls that pain is well worth it. It's a balancing test.

  142. From failing to do my yoga exercises for months, my 74-yer-old body painfully locked up with muscle pain. Luckily here in Guatemala where I live, I encountered a wonderful Brazilian physical therapist who makes home visits, and with his treatment, massage and specific exercises, the pain is going away and I feel good again. Why don't more US doctors refer patients to physical therapists instead of passing out pills?

  143. Perhaps because insurers in the United States cover pills but limit coverage for physical therapy and medical massage.

  144. Ann Cameron: the treatments in Guatemala are likely crazy cheap because you have a high level of AMERICAN income in a very poor third world country. What would someone pay IN THE USA to have a wonderful physical therapist come to your home twice a week and give you not just therapy but massages and TLC? Several hundred dollars PER SESSION!!! No insurance is going to pay for that, and such treatment is only available to the very rich.

  145. Taking Klonopin daily as prescribed has ruined my life, stolen my career, health, on and on. After a 16 month brutal taper, I am still disabled and suffering two years since my last dose. There are no words to describe the horrors of withdrawal from these pills.

  146. This is a really well done article. Thank you. I followed my doctor's instructions, exactly, while taking prescribed benzos (prescribed in combination with opiods) for 12+ years, until I was paralyzed and almost died. The description of "acid in the veins" is, sadly, apt. Ultimately, the suffering caused by the myriad damages from my #MedicalObedience was beyond cruel and inhumane. At 4+ years on the free side of all meds, I am SO grateful to be SO much better!!

  147. Yes, Lisa. Blind #MedicalObedience is a killer. I'm sorry to hear of your paralysis and near death, but glad you survived and got much better.

  148. After experiencing anxiety attacks in my 20's I began a regimen of talk therapy and 1970's tranquilizers. None of this worked and I became increasingly housebound. In the early 1980's I was given Xanax. It was like a miracle. I still became anxious, but I now had an effective tool to reduce the anxiety. Thanks to this single drug, I had a productive career and am a happily retired grandparent. I still get anxious and I still take Alprazolam (the generic for Xanax). Although I am in my 60's, I can still work the NYT's Sunday Crossword puzzle in 30 minutes. Yes, it would be great to be anxiety free and not need any medicines, but, after 40+ years of anxiety, I really don't see that happening. Certainly people who drink or use contraindicated drugs should not take this medication, but to deny it to people it has helped is not acceptable. Frankly, I'd probably turn to other drugs or alcohol, which would be much worse.

  149. About 12 years ago, we had to have my mother-in-law involuntarily committed because of her use of Ambien, Xanax, Oxycodone, valium and Percocet. She had a chronically failed back, anxiety, depression and difficulty sleeping. She didn't speak to us for two years after the 72 hour hold which led to 28 day detox. I could have sent my girls, then 3 and 5, to college on the street value of what was in her apartment. At 75, she was doc shopping for pills. Thank you for this. So many families don't know how this can happen and how devastating it can be.

  150. Most of all: SHAME ON HER DOCTORS! anyone 75 is on Medicare, which is excellent SINGLE PAYER insurance as all liberals fondly desire for the rest of us. So why was this permitted? why did her doctors not keep records and share information? Of course, though it is hard to believe -- even a 75 year old can be "doc shopping for pills" and have a very addictive personality.

  151. I was on a low dose of Xanax for years, prescribed by a psychiatrist who said I needed them "for life" (his words). They turned on me eventually, and I had to wean myself off. This took me about a year. There was no help offered and no real guidelines out there so I white knuckled it. These are short-term (think two to three weeks) drugs, tops. Not meant for long term use. Use at your own risk.

  152. Thank you NYT for bringing attention to this matter. It’s just not the elderly. It happened to me too. I still have neurological damage from benzos after taking them as prescribed. I was cold turkey’d by a doctor in the VA because the drugs literally turned on me and I became suicidal overnight during my tapering off process. Please do more articles like this one. I came off opiates 11 years ago and it was a walk in the park compared to benzos. I wouldn’t wish my suffering of withdrawal effects on my worst enemy.

  153. Thank you for exposing the dangers of benzos. I took Klonopin for 17 years and it took me 19 agonizing months to get off of it using a liquid titration taper. The official prescribing guidelines for benzos is for 2-4 weeks, not months or years! I would still be on Klonopin today if I hadn't initiated getting off of it. And when I mentioned to my doctor I wanted to get off of it he said "okay, we'll taper a third, a third, a third". I knew that that was ridiculous and would have put me into horrible withdrawal (because I had tried cutting a third and it was hellish!) The tone of the article seems to put most of the blame on the patient for "overuse and abuse". Statements like "despite warnings...." and "persuading older people that there are other methods [for dealing with anxiety] has proved an uphill fight". I can assure you that patients are not being adequately warned. Not once in the 17 years I took Klonopin was I warned by a healthcare provider, including both my psychiatrist and my PCP. in my opinion, the law for benzos should be changed in at least two ways: 1) Adequate written informed consent should be required prior to prescription, and 2) they should not be permitted to be prescribed for longer than 2-4 weeks. Doctors are woefully under educated in this area as relates to the prescribing guidelines, the damage they cause, and the extreme difficulty in getting off of them. THANK YOU VERY MUCH for this article exposing the dangers of benzodiazepines!!

  154. I heartily agree, Ken. Informed consent is essential. Had I taken "street drugs" I'd have been off in 2 weeks.

  155. HELLO! Medicinal Marijuana. Oral tablets. Two versions: - one for daytime - one for nighttime/sleep 5mg or 10mg. 12 hour Extended Release form available. Ready for market distribution in standardized doses from heavily regulated producers, and at affordable price points. Minimal side effects, but could include reduced blood pressure and smiling. Marijuana has been vilified in the Unites States for decades, yet its track record for misuse/overuse is minuscule compared to the many risks from the rampant use of 'benzos', other prescribed drugs and alcohol. Offering this alternative -- legally -- gives the consumer more choice at a lower cost. Where and Why is this not an obvious option across the United States? ....and until now I had not even mentioned the job and tax opportunities!

  156. We used to think oxycontin was a reasonable drug to give people for long term pain. Substituting ONE DRUG for ANOTHER DRUG is never going to be the solution. Getting high is not a substitute for getting well.

  157. Thank you so much for this important article and JF for telling your story. I was first prescribed Ativan 1mg by a GP. When I cold-turkeyed, symptoms were misunderstood and I was sent to a psychiatrist where I was misdiagnosed and given more drugs, including clonazepam (Klonopin) 0.5mg, “one or two at bedtime”. I took them as prescribed, often less, not every night, for nearly 20 years. I was led to believe these drugs were safe, that they could be taken long-term and they could just be stopped. I had no idea how powerful they were or the harm they’d caused. In retrospect, I see that, but for a short period of time, I became increasingly unwell. Benzodiazepines and z-drugs are insidious. They hijack the normal function of the brain, so every system in the body is affected. I learned the truth online and it was a stunning revelation. I tapered for 15 months, with no medical guidance or support. In fact I was told benzo withdrawal did not exist and I live in a “world class city”. I am 66 months post-taper and I am still recovering from CNS/brain damage. The mental and physical suffering has been inhumane and unimaginable. And the lack of knowledge in the medical community and public has only added insult to injury. Physical dependence can happen even with low dose, short-term and/or sporadic use. I wish I’d been warned.

  158. The Ativan was initially prescribed for IBS. When I discovered I had Celiac disease and felt much improved on a gluten-free diet, I decided to come off the benzos. That's when I entered Hell on Earth.

  159. Can you give a bit more detail on the nature of brain damage you have suffered. Would help in recognizing these problems in others?

  160. It is challenging even writing this because I now have trouble with organization and planning. Fear, anxiety and looping thinking doesn’t help. I have paranoia, anger beyond justifiable, depression, agoraphobia. I was a practicing artist, but unable to be creative now. Insomnia comes and goes. These were not pre-existing problems for me. I gained 35lbs on benzos and lost 50 while tapering, most I have not gained back. Being in “fight or flight” much of the time burns calories. I have olfactory hallucinations. I had light sensitivity. I still have some sound sensitivity. My right eyelid droops some days. I have pain, weakness and rigidity in most of my body, including my gut. I never had pain before benzos. I have severe GI problems now that are far beyond the IBS I once had. Many of my muscles feel short and tight, despite stretching and walking. Everything that was relaxed by the benzo is now the opposite. Some of these symptoms were present to an extent while on benzos but came on with a vengeance during my taper. They are less acute now, but come in waves, that are often crippling and I am unable to have a life yet. I believe I will heal once all GABA receptors (calming) have up-regulated. There are trillions of them, all over the body. Most are in the gut. It just takes time, more for some than others, due to I believe genetics and because going off and on benzos, like I did, is known to make each subsequent withdrawal more difficult.

  161. I am an elderly alcoholic with decades of sobriety and avoid drugs like those described in this article. I use Cognitive Behavior Therapy and have found it exceedingly helpful in the long run for better sleep and reduced anxiety.

  162. Absolutely the most devastating scourge to blanket the over 55 crowd over the last decade, the best anxiety killer was, is, and will always be exercise----it sedates, inspires, motivates, repairs, and restores! Couple this magical concoction to a reasonable diet and a wee bit of restraint, the results are astounding! Nothing too dramatic here or new news, the very nature of every pharmo- based cure stated in this article begins and ends with decreased effectiveness---therefore, you need more stuff because the old dosage fails to deliver, within three months, you are hooked. These revelations are dated, yet very applicable. I would encourage any reader here to resist following anybody's medical direction here on titration, dosage, or decreasing effectiveness---plenty of published material from the Cleveland Clinic, Hopkins, the Mayo Clinic, and the NIH. Following these anonymous spigots of medical advice is as foolhardy as the drugs themselves.....do your own research.

  163. While I agree exercise, diet, and a healthy lifestyle absolutely play a role in reducing anxiety, for those of us who have true anxiety disorders, this is a physical condition that sometimes does require the use of medication. Just like exercise, diet, and a healthy lifestyle can be enough for some people to be able to control their diabetes, others have to take insulin as well. I will say though I don't think benzos are the way to go for most people with an anxiety disorder (there may be a few exceptions.) Generally, antidepressants are the way to go.

  164. And what precisely are you supposed to do if you're already doing a brisk walk walk of 3-5 miles a day, go to the gym 3 or 4 times a week, don't drink, do stretching exercises/yoga, and still have difficulty getting sound, restorative sleep?

  165. In April 2004, the coroner failed to request an autopsy in spite of the fact I showed him two empty pill bottles. Within a period of about two weeks, my friend had taken a two month's supply of diazepam and lorazepam. Her doctor knew she was suicidal, too, since she had tried to take her life with an overdose of insulin just before Christmas, yet prescribed the second med after she claimed the first med was not working. How many more deaths result from overdose when a man can claim the death was from other causes and get the doctor-on-call to sign off?

  166. I also found that the pharmacist filled the second prescription without question. My friend was daily ingesting a cocktail of around 15 medications, including haloperidol and risperdol. The Haldol was initially prescribed at too high a dose and she was exhibiting signs of tardive dyskenesia, which I noticed and reported to the doctor. More recently, another friend in a nursing home needed me to be a 'watchdog' over all the meds she was taking. We need to be wary.

  167. If the medicos are not held accountable even when their actions lead to death, what hope is there?

  168. I still believe my friend died from an overdose of 'benzos'. Accordingly, the data on related deaths is not given its full importance. The statistics should also include cases like that of my friend and, therefore, represents a much greater problem.

  169. Hysterical flavor of the day. Painting with a broad brush. You don't speak for me. Alprazolam is a miracle drug as far as I'm concerned. Been on it 20 years. Never have increased my dosage. I am able to function - to work - be productive. Do not preach to me. I would find this article silly but for the fact that its fervent misguided message may keep some from using a drug that has been of tremendous help to me and may in fact help them too.

  170. Mark, have you considered the possibility you are the one being hysterical? Paula Span did not claim to "speak for [you]". She did not quote you in her article. You're lucky if everything worked fine for you. But read all the other comments here. These drugs have destroyed people's lives.

  171. Agreed. It's been a lifesaver for me.

  172. I am sincerely glad you haven’t had any trouble as a result of these drugs, but I assure you that for the percentage of those of us who do, the central nervous system damage is completely devastating and total hell on earth. I was on benzodiazepines, as prescribed, for only a few months (for sleep and as an anticonvulsant), and have now been completely off of them for over three years, and I still suffer debilitating symptoms. There is new research that demonstrates that some people are genetically predisposed to be poor metabolizers of pharmaceuticals, and that such people tend to be in the high-risk category when it comes to complications. This is likely the problem that causes benzodiazepines to be so problematic for some people (like me), and yet seemingly not problematic at all for others (like you). Here’s hoping that there will someday be a test that will help prescribers determine which people are more likely to be helped and which are more likely to be harmed by various medications. That way, people like you can reap the benefits of such medications, while minimizing the suffering of others who are more likely to be harmed by them.

  173. I just recently kicked a 9 year opioid addiction.. I was injured in the military in 2010 and was immediately prescribed 30 mgs of oxycodone, 3x per day, and Xanax 1mg 3x per day/as needed... This is over prescribing at its finest, after a 15 minute appointment, out of which I’m not even sure the Dr. understood what happened to me, I walked out with a prescription for some serious drugs.. Following orders and assuming that a Dr. would be looking out for my well being, I fell into the trap.. Long story short, it took 9 years to kick both drugs and move on... My major concern is the fallacy that there is help out there for those with no insurance, or the poor.. (The people really affected by addictions) There isn’t help for anyone who wants it, or even needs it.. I called the VA for over a week pleading with them to get me somewhere to detox... I finally had to break and go to the Emergency Room and tell them that if they didn’t help, I was going to shoot myself... This isn’t acceptable... I desperately reached for help, to no avail... Will I be labeled a crazy? Maybe, but I have my life back after almost 10 years of life on a timer, it’s like an invisible prison, you wall yourself in... Thank you for bringing light to these issues, but we’ve got a long way to go to get this right..

  174. Good for you, RG. Health is weath.. Iyengar yoga has helped me stay healthy inside and out. Good Luck!

  175. The sad fact is that there's no help for this issue even for people who CAN afford it. Ultimately, everybody here is pretty much on their own. Psychologically it would be nice to have some docs who knew what was what holding our hands, but they are too busy being in denial about the damage caused by the very drugs they've prescribed. I would have happily paid out of pocket for somebody to help me, but nobody could or would.

  176. Please bear in mind that 1 mg of klonopin is equal to 20 mgs of Valium. If faced with taking 20 mgs of a benzo wouldn't you be more daunted then ingesting "1" mg of Klonopin even though they are the same strength. This is one of the reasons that these "newer" benzos so freely accepted by patients.

  177. Thank you Jaf. People should be warned about this.

  178. Jessica's experience is very relatable to mine. I originally took Klonopin for a bout of insomnia and anxiety a few years ago. It worked quite well for the first 2 or 3 weeks, but then began to work less and less and ultimately my anxiety got worse being on the drug. After trying to get off the drug a few months later on my own, I was unable to function due to severe fatigue that I had not experienced prior. I realized I was stuck on a drug that no longer helped but getting off the drug was hell. Ultimately an older doctor helped me and many other patients gradually taper off these drugs over the course of many months using a compounded liquid prep of the drug. Sadly, this doctor died a couple of months ago with no one to take his place. I owe my life to him. Hopefully, medicine will begin to recognize that severe and protracted withdrawal from benzodiazepines can happen in a number of folks.

  179. ironic isn't it Stephen? we have to take the poison to get off the poison. and ever so carefully. i wish you luck and courage.

  180. I was prescribed Ativan by my doctor for 10 years. I started at .5 mg and by the end was up to 4 mg a day. Not only did my anxiety get progressively worse during this time, I also started experiencing brain fog, depression, loss of emotions, muscle aches and other odd symptoms. 26 months now after taking my last dose, I’ve gone through absolute hell, and I’m still suffering. Doctors say this is all in my head and it’s not possible I could still be affected by he drug. They say “it’s out of my system”, so then why are there more than 4,000 others in my Facebook Benzo support group still suffering too after many months and years? I always took as prescribed, and it enrages me that doctors put it back on me and others and claim that we’re dependent, addicts, or just mentally unstable. Without a doubt, I would be a much healthier, happier person today without them. I hope and pray someday I will feel normal again, whatever that is. Thank you for covering this important topic. It’s a lonely place to be and I feel somewhere vindicated.

  181. Describes my situation perfectly. Four and a half years of my life in effect wasted by taking a drug, Valium, as prescribed, originally following back surgery as a “muscle relaxant,” then, incredibly, continued to help with my original reaction to it. My doctor, to this day and notwithstanding all the documentation I’ve presented, insists protracted withdrawal difficulties are impossible. It’s scandalous, infuriating, and means you’re on your own when you try to deal with it. The medical community is completely unhelpful and occasionally downright hostile.

  182. I was prescribed Xanax, then Klonapin, almost 30 years ago for panic attacks. I’ve always taken them as directed. Doctor after doctor prescribed them without hesitation. I became dependent. I’ve tried tapering slowly - twice - under doctor supervision, but the withdrawal was too painful and difficult. I have to take these drugs for the rest of my life, because there is no alternative. I still suffer withdrawal symptoms and rebound anxiety. I have an increased risk for dementia and other problems mentioned in the article as I age. Benzos are a problem. Doctors need to learn to prescribe them properly - for no longer than four weeks at the lowest effective dose. Patients beware!

  183. Your situation mirrors mine almost to a "t". At 64 years of age, this article sort of scares me.

  184. Venlafaxine 300 mg/day for 15 years. The only thing I know is that if I missed a dosage it was like I was half dead. In fifteen years I never knew if those pills made me feel better. I weened my self off for in year. I’m done. Atavan 1-2 mg/day for 10 years. Miss a dose, no sleep. I weened myself off for in year. I’m done. I wanted to turn 65 and get my Medicare and be off prescription drugs. I’m enjoying my retirement smoking pot.

  185. I was given a benzodiazepine to "calm me" when diagnosed with thyroid problems. There was so little patient education that I didn't even know what a benzo was, or that I was taking one, until eight months later. When I began having adverse effects after 7 or 8 weeks and told my doctor, the dose was raised. Multiple doctors, several emergency dept. visits, and hearing "it can't be the med, you're taking it exactly as prescribed", led me to stop the benzo on my own. This constant denial nearly cost me my life. The only medical assistance offered was more psych meds, which I declined. I could have never imagined the hell that is benzodiazepine withdrawal. Two years later I'm around 75% healed, still hoping the severe cognitive impairment will improve. Dealing with the fall-out, the impact this 'benzo sickness' has had on every aspect of my life, will never be over. I was/am a mid-fifties woman with a common thyroid issue, hardly considered elderly, and previously very healthy. I applaud you for writing what I hope to be the first of many articles on the dangers surrounding benzos. Please consider reaching out to the patients commenting here, the amount of dedicated research we have all done on the subject could be very helpful. Thank you for your excellent article.

  186. Many patients refuse to take safer medications for sleep or anxiety and want a quick fix to their problems. They ask for (or demand) benzodiazepines. Others have been on them for years and refuse to taper and stop despite warnings about side effects. Put those obstacles into a brief office visit with 5-10 other chronic medical problems to fix and add in patient satisfaction scores...is it any wonder there are so many people taking these meds?...

  187. Yes, we are conditioned to want a quick fix, but doctors can say no to prescribing benzos. For those who are on already on them, doctors need to offer incredible patience and reassurance that it is possible to taper and heal. Our medical system is horribly broken. But a little compassion, understanding, and knowledge go a long way. I had to fly halfway across the country to find a doctor who was sympathetic and who supported my slow taper plan. I could not find a benzo-aware doctor in the DC area; they all wanted to taper me too fast. Just some food for thought. If you are a physician, please read the Ashton Manual if you haven't already.

  188. In addition to the side effects, these drugs impair anyone who takes them. Of course the person taking them refuses to believe they are impaired, but everyone around them can tell. If you're taking one of these drugs, you ought to get a life sentence if you're ever caught driving a car.

  189. oh yes, ....a life sentence will definitely fix this problem.

  190. I'm not interested in fixing a grown adult's voluntary decision to impair themselves; I'm interested in preventing them from killing innocent people. If it takes a life sentence to keep them off the roads, so be it. Nobody makes them take the drugs.

  191. Sigh... so-called "modern" medicine has fallen into a DEEP hole in many countries. The emphasis has shifted from prevention and common-sense lifestyle changes such as excellent nutrition, more exercise and fresh air, spending more time in "green spaces" outdoors, getting out of the house, making more friends and doing things like volunteer work that foster closer ties to community and give folks a sense of "belonging" and being wanted, needed and doing something for others, building nourishing relationships, etc... most doctors don't even mention these to many of their clients who could most benefit from them!! Its drugs, drugs and more drugs, with surgery sometimes thrown in for good measure. SOOOOO many lives have been wasted, shortened or made miserable by drugs which are simply not necessary. Many medical schools don't even have adequate courses on nutrition, lifestyle choices and their effect on health, and on the intricate relationships between mental, social, emotional and physical well being. I;m only 62 myself so know little to nothing about being "elderly", but i DO know that i'll never take any drugs except as a last resort, excluding a few things like antibiotics, which are difficult to avoid when the need arises. We should be educating our children, AND our populace at large, in sensible and practical ways to attain then MAINTAIN robust health as long as possible, with a focus on prevention rather than predominantly treating symptoms.

  192. Thank you for this article; this information needs to spread far and wide. It is extremely important to reach out to those who have no idea what's wrong with them while taking their meds exactly as prescribed. I wasted thousands of dollars over several years on doctors and treatments; attempts to fix me when no one knew what was wrong and no one could figure it out. People are not expecting their medicine to turn on them. People are not expecting to be treated like addicts and people are not expecting their lives to be turned completely upside down from a half milligram of medicine prescribed by their trusted doctor. I certainly did not expect to become completely broken and debilitated for years. It was the benzodiazepine.

  193. I am ready to be cut down by your readers. I have been a physician for many years and I can tell you that benzodiazepines are a disaster and I can rarely think of ANY of my patients where they are indicated. Your writer mentioned side effects from rapid cessation but seizures are also a serious risk if there is not a gradual withdrawal. Unfortunately, alcohol, benzodiazepines and opioids are commonly used with often little regard for the serious risk of respiratory depression. Thank you for your article which may increase awareness of benzodiazepines. Personally, I believe it is time for more discussions on alcohol and give it the respect that it deserves.

  194. jp, the vast majority of reader stories in these comments support your point that benzos are a disaster.

  195. I'm 73 years old, healthy a a horse. My sleep problems began with menopause, which is when I discovered the world of the insomniac- an hour of restlessness until falling asleep and then wide awake at 4:30, for a total of maybe 4.5 hours of sleep. I was constantly fatigued and cotton headed all day. Every doctor I asked for any kind of sleep med gave me the sleep hygiene lecture. No caffeine, plenty of fresh air and exercise, same bedtime every night, no electronics, etc etc. So I used OTC stuff like Benedryl and melatonin, not great but better than nothing. Finally I described my sleep problems to a nurse practitioner who gave me a script for Ambien. My world changed. I took it almost every night for months, then was able to take it every other night. I still, 10 years later, take it once in a while, when traveling, or if I am upset or worried about something and know I won't be able to fall asleep. I no longer get my Ambien from MY doctor, I get it from younger friends and family who share their supply. No medical doctor will ever prescribe Ambien or Xanax to someone as "elderly" as I am, I suspect because they fear liability if I fall and break a hip. I know lots and lots of older people who get their supply just as I do, and sometimes money changes hands, or friends who visit foreign countries with fewer restrictions will being back a supply.

  196. Susan, I am in your age group and now in SE Asia in a country very harsh of drug use for any purpose. In the US, I used Ambien irregularly to adjust my insomnia, over here, I use a med called Esilogan but I do not like it but it works to get me back to sleep. I was taking a .5mg that was a 1mg split in half, worked fine for sleep but left a mild headache. Then they stopped making/selling the 1 mg and now sell only the 2mg so I weaned myself, going cold turkey. Lately though, I have irregularly taken the drug but wonder what I will face when I return to the US soon. VA hospitals will not give me Ambien anymore, I did not know about the ban on Ambien for seniors. I am really a robust person, exercise like mad so slipping is not even in the picture. The garbage that VA does give is useless. I will NOT use marijuana, have always frowned on all but the most ubiquitous OTC drugs and never a recreational item. NEVER!

  197. Susan: if they give you the "sleep hygiene lecture"....why don't you follow it, instead preferring to take OTC drugs or meds you obtain illegally? Sleep hygiene is real and it DOES HELP. Also: there is cognitive behavioral therapy you can use in conjunction with good sleep hygiene! and I wonder if this started with menopause, if you went "cold turkey" or used hormones? In either case...by age 65 or retirement and surely by 73, you don't have to drag into a job each day. So being sleepy is not the end of the world. You can exercise, meditate, do yoga, etc. and take NAPS. I have personally noted a lot of folks with sleep problems drink way too much coffee, and are IMHO addicted to caffeine but absolutely refuse to give it up.

  198. There would be no quiet drug problem among seniors if more of them inhaled "medicinal" marijuana. And if they grew their own that would provide the extra benefit of exercise. I am 82 and still growing.

  199. I will be 84 next October and hope that marijuana is legal in my state when my arthritis gets "unbearable" (I think I still have a few good years).

  200. Inhaled? Edibles so much easier.

  201. This article reflects the sorry state of medicine today when these harmful drugs appear to be prescribed routinely by many doctors on a long-term basis without appropriate monitoring. What also appears to be missing in these practices is patient informed consent by the provider as to the known dangerous side-effects of these drugs, especially when mixed with other drugs or alcohol. Patients should not have to research this on their own on the internet. Unfortunately, we live in a pharmaceutical culture that promotes drugs as the only remedy for every ailment or condition.

  202. I’m wondering about the patient info sheet that is enclosed with every prescription med. I’m not blaming these people who have suffered, as the medical personnel could certainly do better. However, I’ve found that reading the enclosed info about each medication is very helpful. For example, I recently had a prescription which the dr said to use for “2-4 weeks”, but the enclosure clearly and emphatically stated the med should be used no longer than 2 weeks. Also, there is a lot of info online at reputable sites such as the Mayo Clinic site. Knowledge is power.

  203. Thank you for highlighting this almost silent problem which carries significant risk to frail, elderly individuals. The public, and the medical profession, certainly need to be educated about the serious consequences of inappropriate and overprescribing of benzodiazepines. For more information about potentially inappropriate medications for the elderly, consult the Beers Criteria published by the American Geriatrics Society.

  204. And what if you're elderly but not frail. Or is everyone over 65 automatically now considered frail?

  205. Stop searching for grievance.

  206. A serious problem for elderly patients is that reliance on these drugs often causes reductions in physical activity. Long-term reliance produces irreversible muscle loss and bone deterioration. It would be better for an older person experiencing anxiety to engage in repeated bouts of physical exercise and meditation than to start a regime of regular use of deadly drugs.

  207. I know many people who have similar adverse effects from Neurontin/Gabapentin. Long term use, on prescription dosages, results in severe problems for many people, one in my family. There is also a Facebook group for people relating their experience with usage, and with the long, long taper. The medical community has virtually no help to offer for withdrawal. The manufacturers did not carry out any long term studies, and have no detox protocol to offer. The local drug addiction treatment centers refuse to help, since usage is not classified as addiction. So people are left to their own with zero help from the medical community. Left to pursue alternative solutions on their own. And often the prescription for Xanax or Ativan is given as a way to calm down the anxiety and panic attacks and to help with sleep. So an additional addiction is layered on top of the gabapentin problem.

  208. I was given gabapentin to ease withdrawal from klonopin. Gabapentin is an anti seizure drug prescribed off label for anxiety. As soon as I read about it, I wanted to wean off it. I believe it's delayed my recovery from klonopin withdrawal. Another over prescribed drug.

  209. I used to take all the prescriptions suggested by my doctor, and take the ones prescribed for the side effects. It was a constant struggle to maintain a balance between functionality and physical and mental pain. After addiction treatment, and cognitive therapy, I only take a low dose blood pressure medication.

  210. As someone who has suffered from a severe anxiety disorder my whole life, I can say that for long term relief, benzos are not the way to go. lf you need to take a medication daily (and not sporadically or for a specific situation), you need to be on a control medication such as an antidepressant that does not have the addictive qualities of benzos. The body also doesn't tend to acclimate to antidepressants, so once you find your dosage rarely is there a change needed. I was basically unable to function my anxiety was so extreme, yet with cognitive behavioral therapy and a daily antidepressant, I an basically anxiety free. The only time I ever took a benzo was when on a long flight to Australia. My psychiatrist won't even prescribe them to me (not that I have asked), excepting the Australia flight because I voiced concerns about having a panic attack halfway across the Pacific. Even then, I was only prescribed a few pills.

  211. Panic attacks are NOT anxiety attacks. This kind of ignorant comment is very infuriating and insulting to those who do have panic disorder, a condition that is truly terrifying and that antidepressants and therapy cannot help at all.

  212. Misinformation here. Some anti depressants are quite hard to stop. Paxil is notorious.

  213. In case it helps, my sleep cocktail, which is working quite well (but not perfectly,) is 3mg Melatonin, 500mg Valerian, 25mg Trazadone. I'm a pretty healthy man, 74. After looking over the BEERs, none seem to be listed, though I'm wary of the Trazadone. I've only been on this for a few months, here's hoping it lasts!

  214. I just spent the last two weeks doing my own Clonazapan study- watching my 87 year old mother go through serious withdrawal from going off this drug 'cold turkey'. By the grace of God I was able to figure out what was happening to her. After 20 years of taking the drug for "night terrors" and thinking of it as her sleeping pill, Mom stopped taking her Clonazapan after being prescribed Percoset for severe sciatic and back pain. She was rightfully concerned about combining the two meds. After 10 days of increasingly severe withdrawal symptoms that we initially attributed to the Percoset, including delusions, hallucinations, itching, sweating, etc. I stumbled onto the fact that she had stopped taking the Clonazapan and a call to a Nurse Practitioner family friend confirmed her symptoms were withdrawal from the Benzo drug. Mom went back on it immediately and was feeling better within two days. I am amazed at her ability to weather this harrowing experience. Now the task of weaning her awaits.

  215. My heart goes out to you and your mother. She is so fortunate to have you looking out for her. Slow and steady is the way to go with a taper plan...and your mom should dictate the pace of the taper so she is as comfortable as possible. It is not easy, but it is possible. Your faith is God will help! God bless you.

  216. I meant to say "your faith IN God will help."

  217. Clonazapan aka Klonopin is in a class by itself as far as being extremely physically difficult to withdraw from. This is a known fact. It should not be prescribed.

  218. What seems very strange is that -- when I was in my 20's I knew that benzodiazapines were addictive, and that a certain type of omnivorous drug user would hunt doctors who would prescribe them freely ( and everyone in town knew which doctor was the oca Dr. Feel Good) We're talking 45 years ago! So what gives? There are good reasonable uses of the drugs; none involve long term prescriptions.

  219. Some forms of chronic pain can only be treated successfully with opioids. The current hysteria over long-term use of narcotic pain relievers is due to poorly compiled and skewed statistics that directly contribute to costly drug "recovery" programs, health insurance companies and private prison investors. Unless suicide by chronic pain patients is considered beneficial, I'd argue that opiate prescriptions need to be carefully considered on a case-by-case basis rather than condemned in a sweeping statement.

  220. Dependence on benzos is probably more rampant than what patients and physicians think. It is hard to convince a close relative or friend who had been using it for many years since their own physicians haven’t addressed the problem.

  221. I’m shocked how easy it is to get Benzos from Drs in AZ.

  222. Bet you are not over 65 years of age. If over 65, you almost have to head for Mexico.

  223. "Benzos ARE alcohol." That's what a nurse practitioner friend of mine always says. They operate in the same part of the brain and in much the same way. So, all the issues related to alcohol use are mimicked by Benzos...including dependence, impairment, tolerance, overuse...and death. Stay away. Learn instead: mindfulness, meditation, melatonin, exercise, less food at dinnertime and patience.

  224. I have a lifelong sleep problem which had been treated with trazodone and Sonata for the last 20 years. After surgery for lumbar stenosis, I was started on low dose Vicodin which improved my sleep enormously, apparently because it alleviates the severe restless leg syndrome which is part of my insomnia. With news about the possible contribution to dementia of the z-drugs, and because I started to experience late night dizziness, I tapered off the Sonata last year. It now takes longer to get to sleep, and I smoke a bit more 'medicinal' marijuana as a nightcap than before. Cognitive Behavioral Therapy has helped, too. Now I am tapering off the weed, but given the long history of insomnia, my sleep is deteriorating further. In spite of the current opioid hysteria, I am unwilling to give up my 5 mg of Vicodin, as it helps so much with the restless legs which wake me every few minutes in its absence. Some degree of drug dependence is preferable to being in a permanent zombie state from chronic lack of seep.

  225. Many elderly people, myself included, find kratom to be a good substitute for these prescription drugs. It's made from the leaves of a tree in Southeast Asia, and provides similar relief to a mild opioid, although it is not an opioid. I use it to control the symptoms of severe restless leg syndrome, but others are using it for PTSD, anxiety disorders, and chronic pain. It does not make one high, does not suppress breathing, and has no effect on one's ability to function. Sadly, the FDA is trying hard to ban it, perhaps because it is cutting into the profits of the drug companies.

  226. It is such a welcome sight to finally see an article in a major newspaper about the dangers of benzodiazepines. So much media attention is devoted to the opioid epidemic, but there is another underreported epidemic--the millions injured because of benzodiazepines--that is also destroying lives. I took a benzodiazepine (clonazepam) as prescribed, never abused it, and went through a hellish 27-month period of tapering and recovering from the damage the drug wreaked on my brain and body. Unfortunately, my story is very common; there are thousands of us all over the world who are going through this disabling experience. Since the medical community is largely ignorant about just how insidious benzodiazepine withdrawal syndrome is, the benzo-injured look to one another for help tapering these medications and coping with the unbelievably tortuous symptoms. I believe there is a story here for someone brave enough to write it--a story about the incredible community of benzo survivors who do everything to help one another. We find the language of addiction (which patient-blames) to be insulting because we took our medications as prescribed and never abused them. Most of us were prescribed these medications when we were at our most vulnerable because of traumatic events in our lives, and we trusted our doctors. I ended up writing a book about this; let me know if I can be of any help for further articles on this topic.

  227. We (me and my doctor peers in our practice) recommend a long titration off Klonopin/clonazepam, decreasing by 0.25mg daily per month. When the patient has used 0.25mg daily for at least 4 weeks, we recommend decreasing to 0.25mg every other day for at least 4 weeks before trying to stop, but some patients then decrease to 0.25mg every 3 days before trying to stop. There is so much in the medical literature on how to start and continue medications, and precious little on how to get patients off meds. I might be a doctor, but inevitably I'm a patient, too, and I want to know why Big Pharma isn't made to be equally responsible for understanding how patients can stop medications. Would you happily take a drug if you knew in advance you'd be need to take it forever to avoid devastating withdrawal phenomena or need a year to wean off? If intolerable, protracted discontinuation syndromes were more fully evaluated, fewer drugs might win FDA approval.

  228. hey ninteen- thats an insanely fast taper rate. .25 mg of K = 5 mgs of V equivalent. go on Klonopin yourself for several months and then try tapering off at that speed.

  229. Has anyone told the pharmaceutical companies about these problems? Maybe they would stop incentivizing the prescription writing. And maybe doctors will doctor, amirite? Amirite?

  230. The pharmaceutical companies are making millions off of these benzos. They KNOW the dangers of these drugs, but are motivated by greed. Upjohn funded a Xanax study in the 1980s, but unfortunately downplayed or dismissed the long-term side effects that affected more than half of the patients who took the drug. The Xanax study was criticized by an international team of eleven psychiatrists and two psychologists in a two-page letter in the July 1989 Archives of General Psychiatry. The letter argues that “this trial poses problems for the long-term efficacy of alprazolam [Xanax] because 1) its superiority vs. placebo seems to decrease by week 8, and 2) it has severe discontinuation problems.” The authors also stated that it was “biased” to conclude that the drug was effective “based solely on short-term partial gains” (Marks et al). So, let me spell it out: Upjohn KNEW that their magic pills can create neurological impairment and worsen quality of life in every way, and even though concerned psychiatrists called them out that it was unprofessional to only report Xanax’s short-term benefits, Upjohn duped the public (including the Federal Drug Administration and the National Institutes of Mental Health) into believing the medication is an effective and safe treatment for panic disorder. Read Robert Whitaker's book Anatomy of an Epidemic--it is an eye-opener.

  231. Andrew, your point is correct. As long as it makes huge amounts of money for Big Pharma and doctors, they will never want to hear about these problems and change, however many lives are destroyed.

  232. The above comment is an excerpt from my book--

  233. The problem is that for some (many?) people improved sleep hygiene and congnitive behaviour therapy dont work. Between a rock and a hard place.

  234. Very likely marijuana would solve 80% of these problems. Too bad the laws make it almost impossible to even research this.


  236. I could not ignore your post, as the urgency of it speaks perhaps to personal experience. I have spent more than 35 years dealing with addicts personally and professionally after surviving my own journey through alcohol and drug addiction. I spent several of those years working at a treatment facility that included a non-medical detox unit, i.e. closely monitored cold turkey. Withdrawal from many drugs can be a protracted struggle that continues well beyond the nightmarish early days. Although it is a miserable slog through physical and psychic pain, and can reveal or intensify existing health problems, the withdrawal process itself is not life-threatening, with two exceptions. Those two exceptions are alcohol and benzodiazepines. There is not enough room here to describe the misery I have experienced and witnessed, or to expound on the many reasons I believe have led so many in our society to a state of life-threatening drug dependence in the search for a life that seems worth living. However, there is room to say this: If you believe you or someone you care about may be dependent on any drug, GET PROFESSIONAL HELP form a certified addiction specialist or facility. It may be a matter of life and death.

  237. Those chirpy perky baby docs can pry my benzos from my cold dead fingers.

  238. Wwe are a sick nation. We overmedicate our children, and our elederly. Let's see how this will pan out in 20 years.

  239. My mom (an alcoholic) was unbelievably prescribed Klonopin in her 70s for anxiety/tremors. Shortly after she started it, she fell and broke her neck. Luckily her neck has healed, but it's amazing to me that a Dr. would do something so stupid.

  240. " it's amazing to me that a Dr. would do something so stupid." Mike, unfortunately doctors will continue to do that because they are never held responsible for their actions.

  241. If doctors are never responsible for they're actions, why do they have to invest in millions of dollars of malpractice insurance? When patients beg for quick fix pills, now with the threat of poor "customer ratings" on the internet, doctors are naturally going to attempt to provide their patients relief from suffering using inmperfect but sometimes helpful methods.

  242. Carrie, are you a doctor? If you are, I really hope you are more grown-up than to give patients "quick fix pills" just because they "beg" for them. Do you grudge doctors having to take out insurance? All sorts of people take out insurance for all sorts of things that may or may not happen. It's just part of the cost of life, or in this case the cost of doing business. It's just a small fraction of what they earn, and it has the effect of making them not responsible for their actions, which is the opposite of what you're claiming. I know people who have died as a result of medical malpractice and nothing happened to those doctors who killed them. There are other stories like this by other readers in these comments. Please read them. Being responsible for their actions would mean being deregistered at the very least, and possibly put in jail if their actions warrant it.

  243. Taking pills when you cannot sleep or wake up in the middle of the night? How stupid, when one bottle of Guinness Extra Stout will do the trick, whether you take it at bedtime or at 2 am (with a slice of heavily-buttered bread).

  244. Must be allergic to any and all beers. I throw it up as soon as it hits my stomach. Damn, will have to stick with Xanax. BTW, w/o I sleep 3-4 hours at best. Exhausted.

  245. What is missing is that many older people have trouble sleeping, whether caused by pain, restless legs and twitching, worry, and so on. Getting only 5 to 6 hours of sleep may be as bad long-term as some drugs. Perhaps oral marijuana should be made more easily available.

  246. Older people do not necessarily need 8 hours of sleep. But since many are irrationally convinced they do, they end up hooked on these drugs.

  247. It's not up to you to decide what amount of sleep older people 'necessarily need'. Everyone has individual needs. If I feel tired and irritable after 4 or 5 hours, then I obviously need more sleep. Getting 'hooked' on a good night's sleep isn't a bad thing, and it's 'irrational' to suggest that it is.

  248. and i am sure you have not found a way to tell how much sleep any given person needs

  249. These comments are such a comfort to me and I hope they move me to action. My psychiatrist suggested Vyvanse for Binge Eating Disorder. I am on that plus antidepressants plus a small dosage of Ativan when needed. I want OUT and I don't even know where to start!

  250. Hi Julianne, A few resources for you, if you're interested: www.benzoinfo.com https://withdrawal.theinnercompass.org/ www.survivingantidepressants.org

  251. This is not just a problem for the elderly. These drugs will become a problem for most anyone who uses them. Saying they "turn" on you is true --it is just a matter of when. If you read the package insert it clearly states they're NOT to be used for periods beyond 2 to 3 weeks. I became dependent on ativan while sick with Crohn's disease. At first ativan seemed like a dream come true. It worked so well to control my anxiety. But just a few months later my anxiety was threw the roof. 1000 times worse then the original problem. The drug turned paradoxical and I was trapped on it. I went from doctor to doctor trying to figure out what was wrong with me. I suspected it was the drug but no one believed it. Also no one knew how to safely taper me off. I almost died and I will spare you the details of that. I became delusional and psychotic and ended up in the hospital. Once a benzo goes off all bets are off. Miraculously, I recovered but it took almost 2 years as the withdrawal syndrome can be very long and made non-functional for a while. I share this to spare anyone else the pain I endured. Maybe benzos are ok to take before surgery or for flying but never continuously. And please don't go cold turkey off these drugs if you're on them. They need to be very slowly weaned.

  252. Curious to know how many mgs. a day you took at your "peak."

  253. 2 mg max. I was only on it for 4 months first time and came off with few problems. Second time about 7 months and was a totally different story.

  254. Opioid use by older Americans is blamed for “fatal overdoses — which are a comparatively tiny number given the size of the older population.” Sleeping medications (benzodiazepine) can lead to “falls and fractures... drowsiness and fatigue” and may “have a negative effect on memory and other cognitive function.” Most physicians are relatively young and have yet to experience the unique joys of aging: chronic pain, difficulty sleeping and resulting mental fatigue and depression. We know what the doctors and scientists think – how about asking what an aging population would prefer. Our options are a relatively pain-free life and a decent night's sleep with the small amount of risk that brings versus living with chronic pain and trying to function on four to five hours of sleep per night. Perhaps the classic “cranky old geezer” – denied pain relief and sleep -- is cranky for a good reason. We aren't getting any younger and prettier, and we understand the majority of our lives are behind us. Perhaps we are less concerned about when we will die and more focused on spending what time we have in less pain and discomfort.

  255. Thank you. You have pointed out the reality that most authors - but thankfully not yet all doctors - are missing when considering the risks. Options are few, our lives are challenging in ways incomprehensible to the young, and the pressure is on physicians to withdraw what little relief can be had. Cognitive therapy at hundreds of dollars a month and a five year withdrawal plan (in some cases longer than our actuarial lives) so the DEA or Board of Medicine doesn't get on the doc's case?? I too would like to see the focus turned to what we would prefer and what we are willing to accept as risk for diminished pain during our days, and a night of reasonable rest.

  256. That a story based on a tiny sliver of the “aging population” amidst the National handwringing over the opioid crisis is published as dire warning is so misleading as to border on the comical. Kris hits the nail on the head. Heading into my sixties having had my share of bumps and bruises, I have watched a boatload of thirty something physicians cut off dozens of patients who had been just fine wth long term proper use of sleep medication, not because of their concerns for their patients, but for their fear of being enmeshed in the next witch hunt. So it goes with the opioid crisis. With all evidence pointing to the conclusion that cutting off prescriptions for opioid users overwhelmingly leads to heroin, we choose to treat the symptom rather than the disease. One great thing about being 60 is that I’ve been around long enough to know how this story ends.

  257. here we go again ..it is always "old women" who need to discipline themselves with some new age quackism about "sleep hygiene." My Ambien is low dosage at night and allows me to enjoy my days. I am 75 and know how to go to sleep.... Yes, Dr. I know not to watch tv and not to have bright lights on and OH YES ...I remembered to brush my teeth. The condescension is stupefying. lectured

  258. It should be noted that a one month (1mg twice a day or 60 pills) supply of alprazalom cost between fifty cents and $2.00 making it one of the few drugs that many seniors can afford.

  259. I'll turn sixty-nine this month and have had my share of aches, pains and certainly trouble sleeping at night. The day they legalized recreational cannabis in Colorado, I got a vape pen, edibles and THC oil cartridges. I vape a small amount before bed, and sleep well on a regular basis. Its odorless, neat, and simple to use. Theres no fear of overdose. With knee replacement and other typical afflictions, I'm offered opiods from doctors and dentists, dermatologists and more. Except for a few days after major surgery, I avoid them. I'm not proselytizing for Cannabis, but for some of the ailments that produce the handwringing in this article, I simply want to offer that there's a cheap, simple alternative available for adults, that works with tested results. When Jeff Sessions and some state legislatures come out of the wilderness, I hope you can get a better night's sleep.

  260. Substituting one drug for another cannot be a solution.

  261. substituting a less harmful drug is a good idea.

  262. Sanctimonious twaddle.

  263. This article is dead on. I've spent thousands of hours researching this as I'm the main caregiver for my mother with Parkinson's. For years her sleep doctor had her on klonopin (she has REM Behavioral Disorder from the Parkinson's). In 2015 her neurologist increased her Lyrica for pain from 50mg to 300mg. She almost immediately started having problems, so a sub for her primary took her off Lyrica cold turkey...which caused major withdrawal symptoms...which caused confusion and dizziness...which caused her to stop her clonazepam because she said it made her dizzy at night...which caused even more withdrawals, hospitalization, and putting her on ativan. Soon after that, she was referred to a pain clinic for her back problems, put on various pain medicines that caused hallucinations, finally settling on oxycodone with the least side effects. By the time we got a new neurologist to tell us she shouldn't be on ativan, it was months later and she was dependent on them. We've been weaning her off ever since, now using water titration. She was on 3.5mg a day 3 years ago. Now we're at 1.6mg a day. What's worse is she fell and hurt her back again in January. So they give you meds to help your back pain, which make you confused and dizzy, which makes you fall and hurt yourself again, which makes them want to give you more pain medicine. What kind of sense does that make?

  264. Drugs may be the only relief for some people, but as mentioned earlier there are other methods that occasionally can yield results. I am 64 and was having panic and anxiety attacks over the previous 12 months. After a trip to urgent care related to a panic attack, I was prescribed a tranquilizer that allowed me to sleep. However this approach was not addressing the problem, and had side effects. My physician strongly encouraged anxiety management coaching as a first alternative. As mentioned in other posts, this type therapy is typically not covered by insurance, and takes effort and time to work. The process also initially interrupted daily routines. I am fortunate that I have an understanding associates, and only work part-time with a flexible schedule. The approach uses methods to become sensitive to the onset and techniques to reduce the anxiety level before it spirals out of control. While it has been a very effective methodology, I still have a tranquilizer as a back-up.

  265. This is the key. Insurance covers drugs. Coaching and counseling are very expensive and not covered. Finding a competent clinician can be challenging. And doctors feel they’ve failed if you leave without a prescription for something.

  266. If you ever go on Medicare you confront an entirely different situation: either the treatment isn't covered, or it is covered but nobody who provides it is willing to be a Medicare provider. A low-cost alternative is looking into whether any senior centers in your area offer classes in stress management, meditation, etc. Some near me do (though I haven't been to any).

  267. Anxiety management coaching does not work for panic disorder which is totally different from anxiety. Panic disorder is much worse and one can get panic attacks even when having a good time. Stop already using panic attacks for what is just anxiety. They are two different conditions.

  268. I was prescribed Ativan over 20 years ago for muscle spasms. It worked well for that, however over the years while taking it I developed new symptoms like panic attacks, tachycardia, digestive problems and a number of other conditions which were actually indicating that when the dosage wore off I was in withdrawal. The physicians that I went to for help wanted to either up my dosage, or add other medications to control my new symptoms. I do not want to be tied to this drug anymore, so I am slowly tapering off of it. The hell that I have been going through the past six months is indescribable, and something I would never have anticipated I would be doing at the age of 62. Like Ms. Falstein, I have had to taper at incrementally small rates, and it is going to take me at least another year to finish.Oten, even reducing 1/4 of a pill at a time is too much, producing horrendous symptoms. This is why people like Ms. Falstein and myself are resorting to DIY methods like liquid titration and cutting and weighing pills on a jewelry scale. The pharmaceutical companies need to to provide smaller incremental dosages for people to assist in getting off them safely. I believe there are going to be a lot of lawsuits regarding benzodiazepines in the coming years.

  269. Would also be helpful if pharmaceutical companies didn't provide dosage guidelines that are actually 2 or 3 times what many people need. Many GPs, lacking experience with these drugs, go by these guidelines and grossly overprescribe.

  270. Victoria-keep going (slowly) and you'll make it. 1 mg of Ativan = 10 mgs of Valium. just keep cutting that 1 mg.

  271. Concern about people having negative temporary, or more permanent, experiences with meds prescribed for a range of feelings ( anxiety, panic, depression) and behaviors (sleeplessness) associated with their types, levels, and qualities of their well being is legitimate.To note that they have a "drug problem" is both misleading and inaccurate.We have been seeding and harvesting a culture which has rooted the belief that there is a solution for every human problem for a very long time.One needs to just try hard enough! And modern science has permitted us to live the myth that there is a chemical solution for whatever ails us.Even when we may not be able to adequately express and describe whatever IT is. Or when IT happens less. More, or most, frequently.There is no "magic bullet;" pharmacological, or not.Notwithstanding Big Pharm's promises.There can be, and are, daily challenges to experienced states of well being, wellness, and quality of life on so many levels."Pills," whatever their structure, action(s) and associated "experiences," are not an effective antidote for the outcomes of discriminated against age, identity; gender, ethnicity, etc.Nor functioning in a survival mode.While living longer.Feeling existentially alone.With insufficient personal resources.And inequitably shared available, and accessible, external resources so necessary for good enough daily living. "Pills," designed to affect targeted systems, cannot and do not replace a PERSON's coming to terms with...

  272. I had sleep difficulty for several years. After reading Mathew Walker,s book "Why We Sleep" the TV was removed from the bedroom and I went on a schedule for my sleep. I meditated and used an Alexa Dot to play soothing music. Now five months have passed and I feel better than I have in years. The only cost was the price of the book. There is a reason that they use sleep deprivation as torture. You don!t have to torture yourself.

  273. Works for mild problems, not more severe problems.

  274. Thanks for the recommendation.

  275. The real source of prescription drug problems is Physicians! They Do Not know their patients and do not spend the time it requires to monitor their care. Visits are short and hurried. The doctor spends most of the time typing, not listening. The only thing they can offer is a pill or a test or more pills. Medicine doesn't treat the source of a health issue but looks for a work-around or a drug that for unknown reason masks the symptoms. Annual exams, with the hope of maintaining health, have become especially worthless. With dwindling funds for research True cures will not be found. The $$ is in pills and the volume of doctor visits & tests.

  276. There is some truth to this. This is what is happening in the doctor's office: 1) Physicians, especially those of a bygone era, fought but lost the battle to NOT have to enter electronic medical records. Medicare required it. So hospital systems and other insurances require it. (Notice that the clinic puts a computer in the room, so this data entry required of the physicians is being done during YOUR appointment. Doctors actually hate it. Also, Typing 101 is not taught in med school.) Now you have metrics and the high-paid-data-entry-physicians are judged by their metrics, not by their ability to listen to patients and take care of them. It's insane. 2) The other issue is whether doctors understand the pharmacology of these drugs. Many do. Many do not. So yes, physicians really can add to this problem, and a pill is easier when the patient wants immediate relief. Therapeutic counseling is the way to go with these types of conditions but patients usually decline counseling. 3) The third problem is the patient. It's very difficult to wean patients off of drugs that can make them feel better. They want relief, and the overwhelming information from friends and internet implies that their doctor is negligent if they don't treat with a readily available pill, regardless of the adverse effects. What is the solution? Retrain doctors, educate patients, and for heaven's sake, stop making doctors type into some fancy data system and let them talk to their patients again!

  277. 1) Physicians didn’t take typing 101 in med school? How did they get through college without typing? Never wrote any papers in college? Please. 2) Physicians don’t understand the pharmacology of the meds they’re prescribing? Not okay- if true they need to give up their license until they educate theirselves on what they are doing.

  278. I think this is especially a problem with GPs, internists, etc. which is all many elderly see. Many people do not live where there are psychiatrists or where they can get to a psychiatrist, and even if they do have access to a psychiatrist, he or she probably doesn't participate in Medicare, so seeing him or her could involve paying $300 or more out of pocket.

  279. Another problem here is that we can be "elderly" for forty years (or even more, who knows?) I always wonder what "65 and over" really means, but it probably means that any research did not discriminate between 60s, 70s, 80s, 90s, 100s.