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: 257

  1. There is a shortage of psychiatrists, psychologists, couselors and social workers in our communities, and the ones we do have are underpaid for the years and money it takes to achieve their skills. As long as drugs are more readily available than clinicians, these drugs will continue to be a terrible burden on our communities. You can thank your employers, governments and insurance companies for the lack of funding.

  2. Not to mention the fact that many of them -- especially psychiatrists -- do not participate in Medicare so you have to pay out of pocket if you want to see them.

  3. Gotta love it. The experts are warning older people from using the anti-anxiety and sleep meds but how on earth do you think the older people get the meds? From experts of course. They can't be purchased over the counter. As a side note, this is another reason marijuana should be legalized. It really helps with sleep & anxiety and is far safer than many of the legal meds currently sold.

  4. I visited a marijuana store in my city where it is legal, and inquired about use for insomnia. The clerk selling it said he used it himself for that purpose, but that he kept having to increase the dose. So I have not gone that route, myself. My sense (also that of my physician) is that marijuana has a certain appeal as a natural plant product, but it's not clear if it's really a good alternative for long-term use as a sleep aid.

  5. Why do you presume that marijuana is "far safer" than "legal meds"? It is addictive and alters the mood. I don't see how you think it is any different than other drugs.

  6. Wow,my thoughts about benzodiazepines are that for certain major mental illnesses and end of life care,they are immensely useful,but for anxiety disorders or insomnia,they are excruciatingly dangerous drugs. As a retired RN who worked primarily in psychiatric settings and chemical dependency, I have cared for far too many who were iatrogenically over prescribed and ultimately addicted to these very nasty drugs.I have seen first hand how sensitive seniors are to the downside of benzos. More than once we had elderly patients involuntarily committed to our locked psychiatric wards who were floridly psychotic only to discover them to be prescribed both benzos and opiates and often multiples of different forms of these drugs. Xanax perhaps because the dosages seem tiny compared to Valium is especially prone to overprescribing and abuse.It is also one of the most difficult from which to detox.As it is metabolized, it steps down into its component parts of less complex but still psychoactive drugs as the liver works to remove it.For example it passes into its less chemically complex forms of Ativan, librium(often given in ERs for alcohol detox to prevent DTs),klonopin and Valium.These drugs especially Valium and Ativan are also used to treat the seizures of alcohol withdrawal and also severe epileptic seizures.They can be lifesaving in these emergency situations.BUT in those who have taken them long term, stopping suddenly can result in seizures.I list them as my allergies.

  7. Unfortunately, elderly in nursing homes become guinea pigs for the theory is that there is a medicine for every ailment. A friend had recently gone blind and her sister's neurologist told her she was having hallucinations resulting from what he called Charles Bonnet Syndrome, yet the nursing home began a strong series of anti-psychotic medications. Several of those meds had serious drug interactions with all the other pills she was taking. It took our subsequent research on Charles Bonnet Syndrome to get the nursing home to stop the medications.

  8. in many nursing homes these drugs are given in order to make people easier to manage

  9. And something you should always research when looking at nursing or rehab faciities for you or a friend or family member is its reputation on medications. I'll never forget when I was looking at rehab places for my late mother 12 years ago and called a local nonprofit that advocates and collects comments on such facilities in my area -- when I mentioned one place I'd looked at they said "well the medical director there DOES have a reputation for over medication." They also had quite a few patients crammed in some rooms (lots of triples). Guess the medications helped them manage their "population."

  10. I had the opposite experience when a family member was in a nursing home, and I considered the facility itself to be about average in quality. They were constantly looking at titrating, reducing, dropping medications that the doctor thought were unnecessary or no longer needed. They were very careful with pain meds.

  11. now that marijuana is legal in my state (california), both my wife and my 95 year old mother and father use marijuana tinctures for sleep and neuropathy. as do tens of thousands of others all up and down the pacific coast. risk of overdose? risk of addiction? drugs that turn on you? not their drugs. this must be an article about big pharma.

  12. Can you please tell me what tincture, dose, etc. can be used to enhance sleep? Thanks.

  13. The upcoming Canadian marijuana legalization...if the cons.in our Senate will stop their self righteous obstructionism....has no provision for edibles for the foreseeable future. Very shortsighted in my opinion. It is illegal to smoke in so many settings...edibles make way more sense.

  14. Gee, drugs that improve quality of life for seniors -- alcohol, Xanax, Valium -- what are the risks thirty years down the road? A happy 97 year old with an addiction problem? Now where's my bottle of gin?

  15. Dear fellow readers, I apologize if I offend anyone, but whenever I read articles like this one, I always think, this author needs to talk to me about my mother, My mother is 90, and has been, for years and years and years, simultaneously taking on a daily basis, two different antidepressants, large doses of Ativan, and Ambien before bed. She does not get - and has never gotten - any exercise, has always had terrible eating habits, and despite all the medication, she has always been an unhappy and miserable person. To top it all off, despite all I just wrote, my mother does not have any chronic or life-threatening medical problems. So, go figure.

  16. Ever care for an elderly parent? Amazed that they don’t know what they are taking. Amazed that the doctors don’t know all the drugs they are being prescribed. Enter in Hospice, which is another form of medicated euthanasia. We don’t have healthcare, we have managed death care.

  17. Hospice is a blessing for terminally ill patients and their families. Ask anyone who has used hospice care and you'll understand how ill-advised your comment is.

  18. Amazing... Adequate sleep probably the single most therapeutic self-care - up there with weight control... But, in your usual self-righteous way, you sound subtle alarm... Yet - you advocate for... > Marijuana legalization... *ttps://www.nytimes.com/interactive/2014/07/27/opinion/sunday/high-time-marijuana-legalization.html > Facilitation of continued heroin addiction... *ttps://www.nytimes.com/2017/08/18/opinion/overdose-naloxone-opioids-trump.html Perhaps you should spend more time getting mid-life adults "weaned" off of these two "pharmas", along with alcohol and opioids... Or getting diabetics weaned off insulin (by losing weight) vs proceeding to (highly lucrative for the providers, while bankrupting Medicare) dialysis-for-life... Recurring theme across US health care seems to be higher-priced more labor-intensive intervention vs real prevention - which'd be greatly facilitated by widespread genomic sequencing and whole-body imaging... For clarity, glad to take on anybody who wants to argue against these, citing "false positives", "privacy" and other such faux-barriers to progress... Analogous contrast - today, an airliner can disappear out of the sky, and be lost for months...Yet - people can track anyone anywhere within cellphone range or carry an auto-on distress beacon, for when out of range... PS - looking at technology trends, a whole genome sequencing AND a whole body (3 Tesla) scan will soon cost less than the typical price for a colonoscopy...

  19. At 69 years old waking up in the middle of the night and not being able to get back to sleep without reading for an hour or two is torture. You see when I wake up at 2 or 3 am and start thinking about anything it leads to thinking about everything. I've been taking Temazapam for about 6 months and now I'm good for 6 1/2 to 7 hours of uninterrupted sleep. I feel much better when I wake up and am more productive during the day. Seniors are inundated with articles about how bad sleep deprivation is for us so what's an old guy like me to do? Take sleep rehabilitation classes? Wean myself off the pills and go back to waking up in the middle of the night and reliving how I may have screwed up when I was younger or worse yet worry about not having enough money to get me to the finish line? I'm sticking with the pills because at my age I don't really care about the addiction part of the equation. I want to feel good for my remaining years and if a good nights sleep does it for me I'll live with the addiction.

  20. I recognize and agree with much of what you say, but let me tell you that my addiction to klonapin for sleep very nearly killed me. Look up the story of Lindsey Buckingham, famous singer, for another similar history. Recommend virtually ANY other sleep med rather than benzos--low dose Seroquel, trazodone, doxepin, melatonin, hydroxyzine. Best bet is a combo of really low doses of more than one of these, that is how I survive now. ANYTHING but benzos. That said, of course some people can take benzos for extended periods of time without problems. You might be lucky. But it is Russian Roulette.

  21. Most of us with chronic insomnia have tried everything you say. It's much easier to NOT depend on a controlled substance for sleep. It'd be much easier to take an OTC sleep aid. But if they don't work, you're still left with the problem of not sleeping. Trazodone actually made me MORE awake. Those of us with chronic insomnia depend on those sleep drugs, mine is Ambien. I've taken it for years, with no ill effects...but I do fall asleep upon taking it, and get 6 hours of sleep that I would have to fight for, and only do in two hour shifts...so, no thank you. I'm fine with my Ambien...and my sleep.

  22. Smoke a joint. You'll feel better and not put those at risk of so many debilitating side effects.

  23. Oh goody, another article bashing the use of benzodiazepines and their terrible side effects. All drugs have side effects. Let's talk about blood pressure drugs that are commonly prescribed to the over 65 set. HCTZ can cause dizziness. Amlodipine (a calcium channel blocker) can cause chronic constipation and will keep you awake if you take it at night. Ace inhibitors can give you a nasty hacking cough. Oh, then there are statins. They can cause severe liver damage. If you don't have that side effect then you may just have debilitating muscle pain and weakness.

  24. "Improved sleep hygiene" - tell that to elderly people that have chronic pain as well as daily anxiety about not being able to afford to live to whatever age "their time" is up and the ugly direction of this country. Education about medication dosage and use may help but these are likely not the people dying from heroin and fentanyl. Elderly people have many years of experience dealing with life challenges. Recommending "improved sleep hygiene" ? I'm sure elderly people are well aware of recommended sleep habits. It's just hard to do when you are in pain and your mind just won't shut down.

  25. I wish I could get the millenials upstairs to improve their "sleep hygiene" -- i.e., not stay up till the wee hours, then stalk around their uncarpeted bedrooms in high heels before throwing shoes on floor with bang -- then I wouldn't need to do anything to improve my "sleep hygiene." I am fed up with what AARP doesn't do with us and would love to find out whatever happened to the "Grey Panthers" of olden days. Does anybody know?

  26. they died

  27. What annoys me is the generalizations in an article like this that ALL people over the age of 65 should never receive anti-anxiety or sleep meds like Ambien because of the risks they pose to SOME older people. Physicians prescribe boatloads of meds with terrible side effects for problems like, AF, hypertension, , high cholesterol, prostate problems, ED, GI issues, etc. I never see an article about how elderly people shouldn't receive heart medications because some elderly patients faint or fall as a result of the meds. I think physicians would say "Well heart problems are SERIOUS and can be life threatening, so the risks are worth it." I can tell you, chronic insomnia and/or anxiety is a terrible problem for many elderly, it decreases the quality of life and causes depression and weight gain among other things. I'd happily sign a waiver accepting the risks associated with Ambien and Xanax so that doctors would give me a reasonable amount to make my life better. Shouldn't it be MY decision?

  28. But in many cases doctors don’t specify, or even understand, the risks. I think that’s the complaint. Hard to disagree.

  29. The article never said that no one over a certain age should not receive these drugs. How you read that is being me. It simply points out the real risks associated with their use and (correctly) suggests that they are over-prescribed. As are almost all medications meant to treat emotional and psychological issues.

  30. It should always be your decision; it's your funeral too.

  31. Benzodiazepine addiction, morbidity and mortality are not limited to the elderly, as illustrated by Tom Petty’s recent death. The stated cause of death was opiate overdose, but he was also taking alprazolam and temazepam. It is possible his use of the benzos, combined with the opiates, contributed to his death. We talk about the scourge of opiates in this country and overlook the similar problem of benzodiazepine addiction. Opiates and benzodiazepines beautifully treat symptoms, but once accustomed to them it’s hard to find anything that works nearly as well. Opiates and benzos are both addicting, physically and emotionally. Accompanying addiction is withdrawal for those who abruptly stop the medication or cut down the dose. While overdosing on opiates is deadlier, withdrawal from benzodiazepines is the more urgent medical emergency and can also kill you. Combined use compounds the dangers exponentially. Doctors eager to treat anxiety and insomnia do so with benzodiazepines too often, and risk creating new problems for their patients.

  32. I just turned 70. I’ve been taking 0.5 mg of alprazolam on an as-needed basis for over 20 years. In an average week, I take four pills. I have had decades of cognitive behavioral therapy, have taken almost every anti-depressant out there, and I exercise, but none of these approaches has provided relief from the overwhelming anxiety that I sometimes feel. Over all these years, I have not had to increase the dose of alprazolam. Sometimes a week will go by when I don’t take it at all. However, on those occasions when my anxiety feels like I’m on the verge of going mad, that 0.5 mg alprazolam pill is a life saver. This article paints benzo use with a broad brush. I know there are many cases where benzos should not be prescribed, but for me, when anxiety starts snowballing and taking over my life, alprazolam provides relief. Alprazolam doesn’t turn me into some kind of zombie. I read complex literature, solve problems, and am able to stay focus and concentrated when I need to. When I feel overtaken by anxiety, alprazolam restores the equilibrium that makes me able to function. Sometimes the mere knowledge that the alprazolam is available if I need it is enough to calm me down.

  33. The fact that the knowledge that you can take it can calm you down points to the poorer of our minds. You're reaping a placebo type of benefit. I'm not trying to convince you to do anything differently. I've battled boys of depression and anxiety so I have a great deal of sympathy and empathy for what you go through.

  34. I don't view this as a placebo effect. If my anxiety is not severe, than it is a comfort to me that if it does get worse, I have the option to take a pill so that I don't have to go through the terror of a full-blown panic attack.

  35. God, I hate auto-correct. AI has a long way to go before it poses a threat to humanity. In the meantime, I have to stick to posting comments with a real keyboard.

  36. I've been on many benzos. Was on three when I-was working for extreme anxiety no amount of CBT or bedtime hygiene could help. Now, retired, I am on one to which I am habituated. In a similar way I-am habituated to 5 mg paroxetine. Both are nearly impossible to wean off. I get brain fog, extreme runny nose, insomnia, wild mood swings, among other symptoms, only after three weeks off of the paroxetime (which is at half of the smallest tab). I have extremely vivid nightmares, in addition, and night sweats three weeks after I stop the lorazepam. My psychopharmacologist advises me to continue with both. No Dr. I have found in N. VA can wean me off of them.

  37. Oh, a couple more here: https://withdrawal.theinnercompass.org/ www.survivingantidepressants.org

  38. J, as long as you can get enough pills from your doctor, you can taper on your own. Many of us have been in the same situation. I did a slow, self-guided taper with no medical support. Here are some good resources: Heather Ashton Manual (for tapering): https://www.benzo.org.uk/manual/ Support forum: www.benzobuddies.org Benzodiazepine Information Coalition: www.benzoinfo.com More comprehensive info: www.benzo.org.uk

  39. J: paroxetine (aka paxil) rivals benzos in their difficulty of withdrawal. it took me 3 tries to get off that drug: finally successful after using liquid and an eyedropper and decreased by a tiny bit every night.

  40. Back in the '70's, I took my mother to task for taking a sleeping pill every night. Suggested she asked her doctor about it. She did and he said "So you take a sleeping pill every night, so what?!" She lived until the ago of 89 and suffered no ill affects from the pills. Mind clear as a bill until she died. How p.c. we've all become.

  41. This is called an anecdote - one person's story. Although interesting, it has nothing whatsoever to contribute to a scientific approach to medication management. Benzos are highly addictive, do nothing to address root causes, and create a great deal of suffering for patients when they are improperly prescribed. Using science to make decisions isn't PC.

  42. The issue has precisely nothing to do with pc.

  43. Anecdotal evidence is the worst kind.

  44. Being on benzos has been a nightmare. The "calm" I was receiving from them has certainly been futile compared to the extreme symptoms. In fact, they are still going on to this day, four years after ending my taper. I would caution anyone to go slowly in weaning themselves off. I cold turkeyed .5 mg. Ativan. Though doctors ignorantly call that a "low dose," it is not in terms of the damage it can cause the nervous system. I then was put on Klonopin, which I would not suggest to anyone. Unfortunately, no one knows who will suffer greatly and who will escape unscathed. These drugs should only be taken short-term, meaning days. I don't believe in the four-week rule. I knew someone who only took Ativan for 21 days, and she was suffering for at least a year. Those who have suffered a great deal lose their homes, livelihoods, friends, finances, their very souls. They become crippled in every way. This is a very seductive class of drugs. It draws you in. You feel as if you're completely calm. But it can turn on you in no time. No doctor told me anything about its dangers. My sister said she hoped I wouldn't be addicted, but I knew I was nothing like an addict, so I didn't heed the warning. I didn't know anything about GABA or glutamate either. I certainly do now! Nerves take a long time to heal. I wish there were a test that definitively showed who should NOT take these pills. The suffering has been unbearable.

  45. Can you clarify what the damage to the nervous system is of a .5 mg dose of ativan. A lot of people here are mentioning that, permanent brain damage, etc., but isn't clear to me what that is. Are you experiencing that? How does it affect you in your daily life?

  46. I have had cognitive problems resulting from the benzos. I couldn't read, be on the Internet for long because it would be overwhelming. The brain becomes very confused. Reading, which I love, became a chore. I developed agoraphobia, light and smell sensitivity, heard things that weren't there, saw things that weren't there. I looked in the mirror and could not recognize myself. Walking around, it felt as if I were in a movie. Nothing seemed real. All that is gone. It just takes time for the brain to heal. It is as if there's been a brain injury. I don't feel that this is permanent, though. It just takes time to right itself. Some heal much quicker than others. However, I'm feeling MUCH better cognitively than a few years ago.

  47. I'm nearly 67. For the past four or five years, I've used valium to combat occasional insomnia. At most, I use it two to three times a week and usually take it at half the prescribed dose. There are many weeks when I don't need to take it at all. But when I do need a valium to get to sleep, it's a life saver. Waking up stone cold at 3:00 in the morning and unable to get back to sleep is a debilitating experience, especially if you have appointments or other things that need to be addressed later in the day. Similarly, laying in bed for hours on end trying to get to sleep is torturous. It not only lessens your productivity the following day, but it can also throw off your circadian rhythm for days or weeks on end, and leave you vulnerable to various infections due to your suppressed immune system. Like many commenters here, I resent the medical community's and government's growing hysteria and overgeneralizations concerning opioid and now benzodiazepine use. This year, I could not find a single doctor willing to prescribe a codeine-based cough medicine for me despite my bronchitis and the hacking cough that kept me up most of the night. I also know several older people who were either not prescribed or were under-prescribed effective opioid-based painkillers after surgical procedures. Enough is enough. Most government officials and younger Americans view older Americans as useless drains on the economy. Why not just write us the prescriptions and get rid of us humanely?

  48. My friend was only able to use Excedrin extra strength after her root canal. Too painful for words.

  49. I have found ibuprofen very useful after all sorts of dental surgery. In past, doctors often prescribed opiate pain kilers, but I didn't like how I felt when I took them, so doc said decent alternative would be 2 or 3 200 mg. ibuprofen instead (so a 400 or 600 mg. dose). Haven't had any pain problems with that -- I find most severe dental pain is just in 12-24 hours following surgery and after that can reduce dosage. I had emergency surgery & insertion of pins for open fracture of a thumb last fall. I checked out of hospital w/prescription for percocet, which I was to alternate with prescribed 600 mg ibuprofen tablets. DIdn't need such high dose of ibprofen after a couple of days, so stopped it and substituted 2-200 mg. of my own tablets, and tapering down to 200 mg. doses. Still have a big bottle of those 600 mg. doses they prescribed, as well as some unused percocet. I have to be careful with the ibuprofen as it seems to induce acid reflux if taken over a period of months and then I have to go on a course of prilosec, which happened this winter after all the ibuprofen I took last fall.

  50. You can’t generalize like that. I’ve had dental surgery twice in my life, first time I was in severe pain and most definitely needed opioids, second time around I didn’t even need ibuprofen.

  51. My spouse was able to withdraw from the fairly high dose of Ativan he was taking with the guidance of our HMO’s chemical dependency program doctors. They substituted Clorazepate, a longer acting drug, which he then withdrew from. They also added Gabapentin to his treatment to suppress the withdrawal.The withdrawal took 2-3 months and we now can’t remember too many ill effects. At the end, he concluded that the anxiety he had been feeling daily was from frequent withdrawals from Ativan in between pills. He is in his 70s and on quite a few other drugs for pain and heart problems, so it was a relief to be off the Ativan. I’m surprised not to read more about this method.

  52. I became a doctor because I truly wanted to help others life happier, healthier, safer lives. I certainly didn't expect to serve as a glorified, if licensed, drug dealer. Following the exhortations of TV advertisements, patients seem to believe they can direct me to prescribe whatever they want; and while no one has ever requested Lipitor or Prilosec by name, I'm inundated with demands for Xanax, Selexin, Ambien, Adderall, OxyContin. Anxiety and insomnia are two disorders that respond well, if not immediately, to therapeutic and lifestyle interventions. Unfortunately, drugs are a lot cheaper and thus beloved by "healthcare administrators" and the suits at insurance companies. I spend far too much time working to mitigate the ravages of addiction in my patients to cavalierly expose anyone else to such misery. There's been an explosion (spurned by the contraction in opioid prescribing) in new patients asking for benzos or benzo-combos. In our practice, we NEVER prescribe Xanax (a highly problematic drug with impressive street value,) prescribe only small quantities of benzos only for infrequent, as needed use, and never prescribe combos or co-administer with relaxants or stimulants. Our safe prescribing policies have met with vociferous blowback, but for patients who are willing, we'll taper them off these addictive drugs, even if it takes a year and referrals to multiple ancillary services. It's the right way to practice and promotes healthier long-term outcomes.

  53. As others have pointed out, most, if not all, prescriptions have side effects. Why are they singling out this type now? People are depending on relief from deliberating symptoms. Sure, there are people addicted to anything or most anything, but leave the rest of us alone will you. I've successfully used Lorazepam for a decade and that is because it does as is prescribed. I don't abuse it. That is the key. Why not write weekly articles about the hazards of addictive drugs such as alcohol and tobacco?

  54. You are incorrect in thinking that someone must be addicted to benzos. There are very few who are taking these drugs who are addicts, and most are using them "as prescribed." GABA is a very important neurotransmitter, that brings calm to the body, that benzos "hijack" in order to create the calm that is so prevalent in benzos. This creates an upset in the delicate balance of the nervous system and causes glutamate (an excitatory neurotransmitter) to flood the system when a person becomes dependent on benzos, which often happens, especially when using Ativan and Xanax. That is why people feel more anxious as time goes on. It has NOTHING to do with addiction. You are probably one of those who can go for years on the same dose. Lucky you. But there are many who would go through horrific withdrawals in your shoes.

  55. I only read a few of the comments,so I may have missed this. However, it is astonishing to have an article about problems with abuse of medications that does not mention the pharmacuetical companies. It is no accident that car and drug ads dominate TV. These are two of the major money makers in US society and both have discovered that advertising pays. Curious that we dont allow hard alcohol ads on TV, considering it a moral issue, but drugs are fine. the pharamceutical companies have also invested heavily in physicians to convince them that abuse of pain or anxiety medications is not a big problem. Why is there no control of this societal scourge? Could it be the massive contributions these companies provide to politicians. That also happened with tobacco, but eventually public awareness started to overcome the political cash pipeline. Could that happen with drugs?

  56. There are more than enough hard alcohol ads on television. There's Jim Beam, rum, Crown Royal, Jack Black, a variety of vodkas . . . sweet cocktails in cans . . . I'd choose marijuana if I had to. I don't drink or smoke but who knows what I'd do without Ambien? Prescription drugs can do as much harm as good. So can water. We should be allowed to make informed decisions regarding what we choose to take for health issues that affect the quality of our lives.

  57. Glenda, Good correction of my note that hard liquor ads are actually allowed on TV. My bad, I guess I need to watch more TV. I still disagree with your view that avoiding the nanny state and allowing us to make informed decisions about what to take is the correct way. It is very clear that the deliberate misinformation of the pharmaceutical houses on issues such as pain relief, drug treatment of ADHD and statins for avoiding heart disease are very effective, some say by deluding a minimally informed public. I get it that you feel Ambien is not in this class, although there are certainly some drug avoidance people who would disagree.https://www.theatlantic.com/health/archive/2013/06/ambien-the-good-the-b.... The issue is definitely whether federal agencies like FDA should help guide public choices or if they should leave us all on our own against the relentless barrage of ads. https://www.nytimes.com/2017/12/24/business/media/prescription-drugs-adv...

  58. Ok. Here is another situation where genetic testing would be helpful for many patients. Each patient may have differing levels of enzymes necessary to metabolize certain benzos. DNA can be a generally accurate indicator of these enzymes. So, a patient may produce enzymes such that he or she metabolizes klonopin in such a way that a .5 mg dose is really more like a 1 mg dose. If you give that patient even a .5 dose of klonopin, they will struggle to quit using it, even after a short time (although it can be done). Unfortunately, the testing is very expensive, and I doubt insurance reimbursement would ever cover it for a benzo alone. Maybe some practitioners could shed some light on that subject. As far as I know, patients are never asked upfront whether they would like to have this testing. It generally comes only after the fail on a course of SSRI/SNRI, antipscyhotics, or mood stabilizers.

  59. This may not be a solution for many, but to cut my anxiety, I more than halved my coffee consumption, boosted herbal tea consumption started taking melatonin for better sleep, and exercised. I also worked to sleep longer and took up meditation. This is not a panacea but most if not all these activities do not require regular checkups on the kidneys and liver-which most modern drugs do. The side effects of modern drugs terrify me. I also do nutritional supplements because whatever I spend on them is part of my food budget. oh, and for those dire situations, I insist on valium, not any of the newer slower antianxiety meds that build up in your system. Everyone says that valium is highly addictive but I love it because it is fast acting and, for me at least, easy to stop. Helps that I do not have an addictive personality. Bottom line, get to know your own body and environment. No one knows it better than you. I truly applaud everyone in the article working to get off modern antianxiety and antipain meds. I can't imagine how hard it is.

  60. Valium is highly addictive precisely because it is fast acting. The slower benzodiazepines have reduced risk of addition because the "speed" at which drugs take effect tends to determine the "high" a person experiences with the drug.

  61. LB: You seem to think the elderly take valium to get "high." Nothing could be further from the truth for this old-timer, who takes it occasionally to get to SLEEP, not "high."

  62. Valium is one of the slowest-acting benzos there are. In my experience, reading many posts from sufferers, some people are able to go many years on Valium without problems. Ativan and Xanas are very fast-acting. Usually, at some point, a person will realize there is something wrong when taking these drugs. Again, it varies with each person. With Ativan, I was dependent very quickly. I never experienced any high from the drugs. There are some who do, but they're in the minority. There ought to be a genetics test someone can take to find out how quickly one metabolizes these drugs because no one wants to experience the type of withdrawal you can have from them.

  63. Try "Free and Easy Wanderer" teapills (Xiao Yao Wan) before you turn to drugs which might pose serious addiction and side-effect problems. This Chinese herbal remedy makes me feel like a normal person, able to get through each day and take what comes. The Plum Flower brand is safe, reliable, and effective. Check out the Amazon reviews of "Plum Flower Economy Size - Free and Easy Wanderer - Xiao Yao Wan" (Do not confuse this remedy with "Free & Easy Wanderer Plus".)

  64. alice, The product you recommended has fillers. One of the fillers is talcum, which is carcinogenic.

  65. This article is misleading. I have been taking Klonopin for many years with zero problems. I never needed to keep increasing my dose. Cognitive therapy was not effective in reducing my chronic anxiety. I also take Effexor for depression. I am getting sick and tired of all this fear mongering against benzodiazepines. The media is obsessed with people's drug use. It sells.

  66. It's all well and good for you then, but what about the people who suffer such bad withdrawals that they cannot work, communicate with people, drive a car, even get out the door because they develop agoraphobia? Some are beset with such bad nerve pain that they can barely do anything. Some are bedridden. Some cannot parent well. Losing everything just because they tried to get off a drug that was causing damage. I couldn't even read the computer because I had such bad vertigo spells. I couldn't even walk far because I was too dizzy. We need informed consent. We need to be recognized so that others don't fall into the same trap. We need to be recognized by doctors, for one thing. They usually say that in one month, symptoms are gone. But that is a lie. It's all about the nerves. And nerves take a very long time to heal. Sure, there are people who don't go through any withdrawals. I would have loved to have been one of those. But I was not lucky by a long shot. And I'm sick of hiding from my doctors for fear of being rebuffed.

  67. Write an article about the drastic drop in overdoses among the elderly after they legislate assisted society. These articles about reducing the deaths in the elderly due to benzos, guns, opioids, lack of basic needs etc are running from the truth. People want to die for many truths in our sick neglectful society. If you want our elderly to think carefully about their end of life choices, then make their needs not met by a maze of Heath insurance nightmares and high costs, make their lives affordable, make them welcomed in your community, appreciate their lives and allow them to die humanly.

  68. This is ageism and sexism. I use Ambien for insomnia and have done so for years. I have never increased my dosage and soon will have to go to Tijuana or the dark web to get a prescription because of this hoopla concerning opioids. I have had insomnia since I was a child. Do these researchers really think I have not tried everything to get a night's sleep in the last 50 years?! I came of age during the Sixties and managed to not become an addict. I don't drink or smoke. I will not be denied a good night's sleep because people are overdosing on fentanyl or pain killers. I am in the later part of my life and I am not going to be in pain or be awake all night. Researchers, put that laser focus on deaths from alcohol, guns or real addiction and leave us alone. You know that saying, "the kids are alright" well, the "older" people are alright. By the way my husband can walk into any doctor's office and get anything he wants, but oh those older women, we really have to keep an eye on them. Meanwhile the side affects of all the drugs that doctor's want "older " people to take are staggering. Let's talk about that.

  69. Spot on comment! Especially the " old women" who are, you know, "crazy." But the old geezers, not so much.

  70. My sleep issues are mostly solved by: using clothes pins every night to put up black out sheets over my bedroom windows, turning on a small fan as a white noise machine, keeping my thermostat (for A/C) at 74 degrees at night, not eating anything after 7pm - or more than a few sips of water, using a small amount of melatonin at bedtime on occasion, having the head of my bed elevated 6-7 inches for GERD, sleeping on my left side for GERD, putting a thick gel foam pad on my bed so I won't slip down so much, avoiding monosodium glutamate (in canned soups, etc.) and caffeine after early afternoon and more. Also following endocrinologist's bloodwork schedule so that I don't become hyperthyroid.

  71. This is yet another precise example of why the overall approach to 'health' by Western medicine, is repulsive. Everything is a bandaid solution, with most doctors never considering or wanting to understand WHY someone has a particular ailment in the first place. They never want to dig deep, ask questions, suggest lifestyle changes, etc. It's always just 'here's a prescription'. Positively disgusting. Thank god we now have the internet, where we can do our own research and be our own advocates. Clearly, many doctors are not our advocates, but rather, are those of big pharma.

  72. Ha! My father in law just passed away at age 95 . He usually had a stiff gin martini or two at happy hour, then his sleeping pill, and a couple of vicodins for his pain before bed. He lived for 20 years with a urostomy. He could drink me under the table! And why not? For two years after his urostomy ar age 72 we thought he was going to commit suicide. His demise had nothing to do with his alcohol or drugs, or his prior bladder cancer for that matter. I took ativan .5 every night for two years for esophageal spasm, it was the only thing that helped. It eventually went away, I stopped the ativan without problem. I think anti anxiety drugs can be titrated and an informed patient can use them prn instead of every 6 hours like they prescribe. That is a big part of the problem. Some of the responses here indicate that is just what people do. I think us older folks are entirely capable of managing this and each case is a little different. My fear is they are going to reschedule these drugs now to schedule 3 just like they did with hydrocodone, then you wont be able to get it at all anymore.

  73. So what happened to him that he got worse, and then got better? I don’t understand your narrative

  74. our bodies make many chemicals that would be illegal to sell without a prescription . people need to be modified to fall in line with DEA and federal laws

  75. when you can't sleep due to pain issues from old age, financial issues, personal loss, it all adds up, burdens that even a young adult has trouble dealing with. S0.... what else can society expect. Just wait until the Republicans cut Social Security and Medicare. What's needed are safer sleep and anti-anxiety meds. If developed though, the drug companies will be charging an arm and a leg for them; even more financial strain will follow. Time for more socialistic policies, like price freezes on drugs, wage freezes on medical professionals, and corporate executives.

  76. Thank you for mentioning this and the future cutbacks which I believe will happen no matter what unless as you point out there are socialistic policies with regard to pharmaceuticals and medical care. I am an insomniac who wrestles with sleep issues every day know that ambien is not the answer but feel trapped because there's no other solution and know that I'm in a vicious cycle. Best responses I've come across are from people in Oregon and Vermont. You live in progressive states and if there's any improvement in our system, I believe it will come from people in your states.

  77. Before you start taking any drug, do some serious reading. It's your only body. Act accordingly.

  78. Sometimes the long term effects of a medication become known too late--reference Nexium, a medication that was widely prescribed in the 90's, which has been found to be almost impossible to stop because it causes a physical change to your stomach lining (proton pump inhibitors turn out to lead to the production of more proton pumps, leaving you with more proton pumps than you started out with before you started taking the medication). The current Rx on OTC labels recommends taking Nexium for no more than 14 days. Curiously, these OTC 14-day bottles are provided in packs of three . . .

  79. A major issue here of the people defending benzos is that they don't know they are EXACERBATING THE REASONS THEY TAKE THEM. Yes, that is unbelievable! Simply ask the many, many thousands of us for whom it took years to figure that out. A good place to start is the online, victim created community "Benzo Buddies" which as 38k members. Or You can look at the research. Here's some. You're going to want to pay special attention to the Pharma funded Marks study whose longterm results were obscured in the original journal abstracts. https://www.benzoinfo.com/2017/01/07/upjohn-study-shows-xanax-alprazolam... Ashton, H. (1987). “Benzodiazepine Withdrawal: Outcome in 50 Patients”. British Journal of Addiction Burke, K. et al. (1995). Medical Service Use by Patients before and after Detoxification from Benzodiazepine Dependence. Crowe, S. et al. (2017). The Residual Medium and Long-term Cognitive Effects of Benzodiazepine Use: An Updated Meta-analysis. Fixen, A. Ridge, D. (2017). Stories of Hell and Healing: Internet Users’ Construction of Benzodiazepine Distress and Withdrawal. Marks, I. (1993). Alprazolam and Exposure Alone and Combined in Panic Disorder with Agoraphobia: a controlled Study in London and Toronto. British Journal of Psychiatry. There's much more but I'm getting cut off by the word limit. I'll give a million dollars to anyone who can provide solid research which supports longterm use.

  80. I became horribly dependent on klonapin for sleep and anxiety and the withdrawal, totally mismanaged by a treatment center, nearly killed me and did long term harm. But, and this is a big but, the suggestion that non drug treatments can be effective for severe insomnia is a cop-out, just plain BS. Sleep hygiene and CBT nibble around the edges of sleep, and this may be enough for mild issues, but a drop in the bucket for major problems. It is kinda sad that the NYT keeps pushing this stuff on the vulnerable and unsuspecting public. This is an arena where medicine has been remarkably impotent.

  81. Thank you for your comment. I suffer with insomnia and keep asking my psychiatrist what alternative is out there for me after he reluctantly fills out a prescription for ambien. He warns me that it can impair my memory. He tells me that it may be linked to dementia and not to take it every day. But when I tell him that my lack of sleep impairs my day to day functioning, he says that while he'll give me a script, there's nothing else he can do for me. I am at my wit's end, cause I follow sleep hygiene protocol and know that CBT "nibbles" but is not a true solution. Why is this issue which affects so much of our population not being effectively addressed?

  82. The Ambien has ruined your sleep hygiene. It's not surprising that you now can't sleep without it. The Ambien is the problem, not the solution. It puts users in a vicious cycle.

  83. People with severe insomnia are seriously sick, but doctors either don't believe this of just don't have anything to offer. Other drugs are out there that can be used with much lower potential for dependence, although some have side effects of their own--I would list them, but then the Times would probably not publish the note. I now get by fine on a combination of really low dose Seroquel and melatonin. Important to keep the seroquel really low to avoid bad side effects. Docs will say no, bad drug--yes, at higher doses, where it acts as an antipsychotic, not at 25 mg. Sleep medicine is "stone knives and bear skins". I feel your pain.

  84. I don't see a quiet drug problem at all because I don't see how occasional use of a benzo or pain pillar for chronic conditions lead one to become an addict. Seriously, there is a difference between addictive behavior and responsible use. It's the medical profession that can no longer make the distinction. The problem actually started with them doing the overprescribing. I have taken opioids for osteoarthritis and facial neuralgia occasionally years ago and never became an addict. But for the past 5 years, I've had to suck it up because now the mantra is live with it. But I have been accused of being a drug addict just because I talk about pain when asked. So I stopped going. Why take another MRI or x-Ray when the treatment is the same which is to say nothing. I'm fed up and in pain.

  85. 99/100 people use opiates and never become dependent or addicted. The other 1% suffer tremendously and their lives may be forever changed for the worse, or they may end up dead. A good deal for society? Depends on which side of hte coin you live. But you gotta see both sides to get the whole picture.

  86. Opioids are not the preferred treatments for either of your conditions. Osteoarthritis is better treated with NSAIDs and trigeminal neuralgia is better treated with carbamazepine. I am not your doctor but I would not begrudge your physicians for not giving you medicines that are third or fourth line treatment for your conditions.

  87. But what if you can’t take NSAID’s? As you must know they are extremely hard on our digestive system and can cause ulcers and GI bleeds. People with history of such should not take NSAIDs. Always exceptions to the rules. Opioids have always ranked higher in pain relief until recently. Hysterics now have produced a study ranking OTC pain reliever over opioids. To each their own because the different ways our body utilized drugs. They also tell me Excedrin Migraine takes migraine pain away. LOL on that one. Maxalt other hand works extremely well on pain and photophobia.

  88. I truly understand the frustration of people taking these meds with all of the recent press regarding these drugs. I had a terrible anxiety and sleep issues at menopause and thought for many years that Ativan was a miracle for me until I reached tolerance, and then it became my worst nightmare for many years. Running from doctor to doctor with other heath issues and rebound anxiety from tolerance withdrawal. Because the anxiety would go away after I would take another pill, I assumed it was the underlying problem and didn't understand what the drug was actually doing. People who assume they have these addictive substance "under control," are not understanding how it impairs your judgement even when you think it isn't. You will have a ball and chain for the rest of your life, or the withdrawal could be the worst experience you will ever go through. After taking me seven years to get off all of this crap I no longer have anxiety or sleep issues. However, I have a host of other problems from down regulated GABA that I don't know will ever go away after over two years off. Ultimately it's up to you, but I wish someone had sat me down and told me what these drugs were going to do me. I have few regrets in my life, but taking Ativan is one of them. I have to live like a recluse now due to head trauma I had from blackouts that the drug caused. We need to look at what the undying cause of our anxiety is instead reaching for a pill every time we have a problem.

  89. “ . . but I wish someone had sat me down and told me what these drugs were going to do to me.” But that’s just it, Merry. THEY DON’T KNOW.

  90. You're right......they don't know. That is why I'm doing this: www.FollowYourBlissFoundation Our organization has seen an incredible increase in traffic over the last 6 months. People are sick, and they are looking for answers they aren't getting from their doctors. We educate and help the public understand the problems we are up against with 90 million people on this drug worldwide. Mainstream medicine has trained us to pop pills and not how to deal with our human emotions. We're not allowed to have emotions anymore without needing a label so they can prescribe a pill. Man did I learn the hard way.

  91. At 68, just finished almost seven months of every pain management injection in the bag for chronic spinal pain. Now on daily dose of moderate opioid for daily pain while new MRI awaiting review of neurosurgeon. Had major disc fusion surgery five years ago. The pain has worsened depression, anxiety and insomnia - thus on benzos, too. The pain has taken away my life. The benzos help manage the day to day living and provide some sense of hope. Know all about how insurance wants to use cheap opioids and won’t cover more expensive alternatives. Also know about MD pill mills and growing abuse. Clearly there is no easy answer but no regulation will stop a person who wants to break the law. Don’t make it nearly in possible for those of us in pain to get help.

  92. I agree with you. The view in the article and many comments is a blanket condemnation of benzos. Sometimes they do a lot of good, just as opioids do. Life is complicated, and answers are not easy, no matter how polemicists would like it otherwise.

  93. I developed extreme anxiety after a series of major life changes. All my anxiety centered centered around dying and not being around for my two young kids. I refused my doc's offer of meds and instead focused on diet (eat to live) and exercise, meditation, and chamomile tea when it starts to get overwhelming. I've lost 30 lbs, eliminated prediabetes and high blood pressure, and have all kinds of energy to be there for the challenges of parenting. When my anxiety builds up again, I drink chamomile and hit up the local zen center if possible. My doc doesn't even know what chamomile is, even though there are clinical studies showing its efficacy on reducing anxiety.

  94. God bless you and your family. Melatonin can help with sleep also.

  95. If you are at or beyond age 65, the medical industry, regardless of provider, looks at you as a liability that will eventually co$t them $ignificantly. It is far easier to prescribe pills than work with us (indeed, I am well beyond 65) to improve our lives by way of therapies - mental & physical. Until the medical industry executive decision makers looks beyond their quarterly P&L statements and their vesting stock options valuation, more and more 'oldies' in need of good medical care will be sent off with a promise, a prescription and a pat on the head with kind words 'be well old thing'.

  96. In and out of office quickly so I can document in computer in such a way as to maximize billing while avoiding fraud. This takes away time from patients. But oh well, Americans accept this.

  97. Thank you for telling it like it is!

  98. I am unsure why some people feel they must be put “in charge” if you will, making sure people conform to their why of thinking, because, by God, they are right. How many of you wake at 3 AM, maybe feeling you are unable to breath, visited by all your dead relatives and literally shaking in fear? To you that never have experienced a panic attack I say, lucky you. But, until you do, please don’t mandate what medication a person may or may not use that helps them deal with this crushing debilitating illness. While people need education on what they take, you should not lose your right to use a medication that helps you just because you reach a certain age. It’s rule number 65, “Opps, I see you are 65, no more angyolytics because you are old and may pass out. Of course we have nothing else for you to take that is completely safe, so go home and suffer in silence”. Really???? Age doesn’t necessarily make you stupid but it sure makes people think you are. I have used Alprazolam 0.5 mg about 5 times a month for severe anxiety for several years, never passed out, never needed to increase the dose, all it does is help when I need it. Now a constant fight when I need a refill. Talk about going overboard! I have just decided to get some meds in Mexico, a lot less hassle, and still cheap and I won’t have to deal with the “Elderly people are stupid” crowd who know everything about everything but go back to “Just Say No” even with nothing offered to help you. Sad 4 America

  99. Perhaps 90% of the elderly should not be on these drugs but 10% do benefit with minimal risk. It is the physician's responsibility to sort this out and not to blindly follow guidelines as if they are infallible and apply to everyone instead of to most.

  100. In some jurisdictions guidelines are hard rules that threaten docs's licences...i.e. computerized rx records. Or why patients needing pain meds and relaxants are tossed into the street to purchase chinese fentanyl. Rumor has it that every opiod rx is followed by a query letter from the powers that be in some jurisdictions.

  101. "Numbers from the Centers for Disease Control and Prevention tell the story: In 1999, it tallied just 63 benzodiazepine-related deaths among those aged 65 and older. Almost 29 percent also involved an opioid. By 2015, benzo deaths in that age group had jumped to 431, with more than two-thirds involving an opioid. (Benzo-related deaths in all age groups totaled 8,791.) Look at the numbers. Ask why this article was written as an admonition for older Americans. Consider the concept of sensationalism ... and watch what Rx combinations you might consider taking. Then wonder again why NYT chose to target older American as higher risk folks.

  102. Anyone tried a nice fat doobie? -or an indica pill for those who don't like smoke? Well at least for those of us who live in a marijuana legal state.

  103. While I would wager that a majority of new physicians are aware of the problems with benzodiazepines and are reluctant to prescribe them for outpatient use, many are still unaware of the downsides associated with other sleeping medications in older adults. The nonbenzodiazepine sedative-hypnotics ("Z-drugs" inclduing Zolpidem, Zaleplon, Eszopeclone) can increase risk of falls and delirium in adults over 65. Even over-the-counter drugs that people use for sleep (Benadryl, Tylenol PM, Nyquil, other allergy medicines that produce drowsiness) have high anticholinergic effects that can increase risk of delirium and worsen memory and cognition if taken regularly in older adults. The best treatments for insomnia are good sleep hygiene and cognitive behavioral therapy targeted for insomnia. However, if sleep hygiene does not reduce the insomnia and CBT is not available, then melatonin, ramelteon, or trazadone are better medicines than over-the-counter sleeping aids that contain diphenhydramine (the active agent in Benadryl). The American Geriatrics Society publishes a list of medications to avoid in older adults, called the Beers Criteria; thankfully more and more physicians are knowledgeable about the Beers Criteria now that our population ages.

  104. Thank you for mentioning drugs that contain diphenhydramine (the active agent in Benadryl). This drug is ubiquitous and is in countless over the counter meds. And the majority of consumers have no idea about the dangers--"anticholinergic effects that can increase risk of delirium and worsen memory and cognition if taken regularly in older adults." Alzheimers' stats rose with the use/over use of this drug. But this goes unreported among the obsession with opioid painkillers and benzos. Taking choline supplements can help counteract some of the very real damage; many people are also already deficient in this essential brain nutrient.

  105. Unrelated to ALL of these drugs is the fact that many older adults don't sleep well because they have sleep apnea, and might also need supplemental oxygen to get a good night's rest.

  106. Supplemental oxygen is rarely prescribed for sleep apnea although you are correct, it is under-diagnosed.

  107. I was prescribed trazadone, an older pre-Prozac anti-depressant as a sleep aid. It works. No next day drowsiness. I recommend trying it.

  108. Does it make you sort of shaky on your feet in the morning? Foggy headed?

  109. tried it as I am a chronic insomniac. Unfortunately, it didn't work for me. I've been on ambien for far too long but it's not that effective anymore and I don't want to increase the dosage. I can't seem to find the solution and know or have read about the potential connection between dementia and ambien. I am trying to stop taking ambien but it's so hard. wish I knew where to turn and what to do.

  110. Not really, but it can cause orthostatic hypotension, when your blood pressure drops suddenly as you get up. That would be an issue with the elderly.

  111. My mother is 87, suffering with a fractured pelvis and restless leg syndrome. The doctors and the nurse practitioner wanted to treat the pain with steroids and Tylenol and the restless leg ( that kept her up all night ). She gets to pay for all the over prescribing the other doctors and nurses have done and for three weeks they left in her pain. I finally threatened to sue the hospital if they didn't help her and they capitulated. She has opioids when the pain is insurmountable and medicine to help her sleep. Finally! We fired the doctor and the nurse practitioner and finally she is getting the care she needs and is beginning to recover. Our new care doctors are finnaly treating the patient. This hysterical bs the Times like's to promote hurts people. My mother worked out twice a day and was in better shape than most soccer moms. This new conservative approach won't work any better for patients, perhaps worse if nurses and doctors take the time to get to know their patients and stop treatment by the numbers..

  112. Many physicians are incapable of individualizing. They just follow algorithms. Sad. Sorry your mother had to suffer needlessly and thank you for your reporting this.

  113. This is another article that again, invites ignorant readers to inaccurately exchange the terms anxiety attacks with panic attacks. They are not the same at all. It is a very frustrating misconception that leads most, even those who work for EMS and most doctors to respond incorrectly to those having a panic attack. Anxiety attacks are very different. Panic attacks mimics different diseases. When someone is having a panic attack, they feel incomprehensibly ill. No medication will help. It is hard to tell if one is having a panic attack or is really sick. They usually last 20 minutes, strike unexpectedly, and the symptoms are not always the same. Anxiety is not the same at all, it is easily identified, and it is ongoing, unlike panic attacks. Stop insulting those of us who suffer from it and who are constantly misunderstood because not even doctors know much about panic disorder.

  114. We're elderly because we managed to survive. If we are not a bother, don't concern yourself. We can decide how to live or not.

  115. You are free to decide. You are free to make healthful decisions or dangerous harmful decisions.

  116. But there is no law preventing you from putting the gun to our heads because we may have made a "dangerous harmful decision." Dangerous tp you? If not, whose business is it to determine the reasonable cause of death was "not natural"? Sometimes I just don't go out because I am more comfortable in my gracious space. So far, I have been able to fend off those who would invade my space so as to create the illusion that they are justifying their own existences. and for whose benefit do they exist? The certainty of death is not nearly as frightful as life for some.

  117. Yes but if you are on Medicare we all pay for your healthcare and the consequences of your bad choices. We get to comment.

  118. I am getting awfully tired and very frightened about all the hysteria about opioids. Most of us in chronic pain don't abuse them and are not addicted. What is going to happen to those of us in chronic, severe pain when we are denied pain relief? All of the holier than thou types would be singing a different tune if they were in my boat.

  119. Everything you say is contrary to the evidence. The evidence doesn't support the use of opioids for chronic pain. I have heard very few addicts admit to an addiction. I could give you a dozen suggestions starting with a mental health evaluation but find most people addicted to opioids are content continuing to use.

  120. I read about any drug before I take them, but continue to drink a couple of glasses of wine at night against medical advice to limit to one glass. Benzos fry your brain, moderate wine simply relaxes. Why are we steered away from a medicinal food toward a drug. Is the pharm industry more powerful than the wine lobby? Call me crazy.

  121. It's good to stay away from Benzos. I agree with you on that. Surely you can moderate the amount of wine, however, to more like 2 glasses a night?

  122. There are so many alternatives to starting down the benzo cul de sac. It is a pity maybe a shame more HCPs aren't aware of or schooled in them. Looking at illiopsoas tension, gut flora issues and metabolic toxicity are the avenues of exploration most likely to yield long~lasting results. Acupuncture can be quite helpful as well. And finally,there are several fantastic Chinese or hybrid Chinese~modern herbology formulas that work well once the drug dependence issue has been resolved.

  123. As MS Span writes, zolpidem (the most popular sleeping pill) is part of the opioid problem. The risk of overdose deaths is 4 times as high among those also prescribed zolpidem with an opioid. However, the FDA has not added a "black box" warning about opioid risks to the zolpidem prescribing information, nor has it warned about the very high mortality risks associated with zolpidem. There are over a hundred rather new studies about the risks of zolpidem and other sleeping pills. For detailed information, please see http://dx.doi.org/10.12688/f1000research.8729.2 Daniel F. Kripke, M.D.

  124. Hasn’t the number of people over 65 risen a great deal in the time period for which an increase in benzo-related deaths is reported? A jump in number doesn’t say much unless the respective numbers of deaths are reported as percentages.

  125. This article cites percentages and the percentages cited indicate an increase over time.

  126. And you think if we had the incomes of experts we wouldn't sleep more easily? Really. we are tired of having to battle the experts to get some relief. They caution the general practitioners against prescribing palliative medications because a patient whose life expectancy is not even a year may become dependant? Small children who are unrelated are cautious. Is it because we look like we have a serious communicable disease? So now the do-gooders are out to help us leave this earth sooner no matter how we feel. See you in the after life.

  127. Many years ago a kind physician prescribed 2 meds: Desyrel aka Trazodone and an anti depressant called Efexor, generic Venlafaxine. My dosages of both have increased but they are non-problematic as far as addiction goes. I have nights when I have trouble getting to sleep. My meds are not a panacea. Because of my severe neck pain, the same wonderful physician prescribed cyclobenzaprine. When I have a crisis I take it more frequently but, I can use it as a sleep aid as it makes one sleepy if that's necessary. I am 71 and I've always had careful and wonderful physicians. I want Adderal for my ADD but my doctor won't give it to me! I do have ADD that has been a livelong curse but, at my age, she's put her foot down!

  128. Physical pain, trouble sleeping, depression are symptoms. Each may have a dozen different underlying conditions. It is not surprising a pill for all does not work, not to mention a pill that targets the symptom without probing the specific underlying conditions.

  129. Reading the comments is so frustrating. Users of these drugs--which impair/sedate and affect cognition--literally seem unable to comprehend that the drugs are not helping them. They can't comprehend this because the drugs impair their brains. They can't comprehend that the reason they feel so bad when they aren't taking the drugs is because they're addicted and experiencing withdrawal. They can't comprehend that low doses (like .5mg) are low because the drug is so potent. With impaired cognition, they think .5mg is no big deal. I personally don't care how drugged up people want to be as long as they don't ever get behind the wheel of a car. Paula Span is trying to help, but good luck with that. It's like trying to pry poisoned candy out of the hands of toddlers.

  130. And it's frustrating on the other side, because some people don't seem to comprehend that there's a REASON people seek relief from anguish, pain, and debilitating symptoms. Everyone saying "Well, goodness, just don't take these bad drugs" seems to not understand that things were pretty bad BEFORE the person started taking (insert name of evil drug), and none of the "Well, just don't take them then, stupid" replies seem to show any compassion for the suffering. Your post amounts to, "Told you so."

  131. I use pot now. used to use Oxycontin and benzos. Marijuana is a wonderful drug if you use it correctly. Also suboxone saved my life when I was addicted to Oxycontin. That drug is a lifesaver and I wish it didn't cost me $300/month even though I had a gold level Obama care plan I was paying $400/month for.

  132. Add some refer and I could better deal with this miserable president and chaos.

  133. I started benzos when I was 13 years old having panic attacks in school. I followed the doctor’s direction and when the panic attacks abated I stopped taking Valium. This was in the 70s. Fifteen years ago I was diagnosed with an auto immune disease with no cure but immense pain. Prior to that label, I was taking a benzo because the anxiety of not knowing what I had (misdiagnosed for ten years), caused panic attacks. I’ve been on and off benzos for more that thirty years. I’ve been on opioids for ten years. No one ever said don’t combine them. No one ever said how to stop taking these drugs. It was here handed to me and a get better comment. I’ve tried withdrawal from both at different times. I was unsuccessful as the brain craves the medicines and causes all types of harrowing feelings when it doesn’t have the medicine. Interesting fact is my family won’t have anything to do with me, along with some long time friends, as they think I’m an addict. LOL. I take my medicines according to the directions. I see both pain doctor and psychiatrist monthly. Until there is another method, besides death or comma, I will continue my medicines. They keep me functioning. It’s sad that educated people such as my family, doesn’t get why I take these medicines. I guess they would rather see me in bed squirming from the auto immune disease’s immense pain and laying in hiding under the blankets due to my anxiety. Sadly I don’t think I’m the only one I this situation.

  134. You give the perfect reason to eradicate the word addiction once and for all. People are dependent on a certain drug, not addicted to it. Thank you for writing down your story.

  135. hear, hear Maria Bierens. the "addiction" label obfuscates the real problem we're facing, which is tolerance. the desire among many in the benzo community is to get off these drugs asap.

  136. My wife has incurable, metastatic breast cancer. I'm her primary caregiver. Is this a stressful situation? Does it cause anxiety? I eat healthy, exercise vigorously and regularly, meditate as best I can and see a therapist. I also take an antidepressant and a little Ativan. Try it without the meds and see how far you get. You can do it, of course, but it's not about you.

  137. Terry, your story is heartbreakingly familiar to people on the Benzobuddies.org board. People who were prescribed "a little something to help" while they coped with what seemed like the more serious issues of a family member. Then these poor souls spiral downward on their own, and looking back, so wished they'd not accepted this pharmaceutical help. It's not about whether you deserve all the help you can get, it's that these drugs so often lead to your own downfall. I'm so sorry about your wife. Linda Crew Corvallis, Oregon www.lindacrew.com

  138. When I was 7 months off 4 years of klonopin use, my husband suffered a spinal cord injury rendering him a tetraplegic. He's been in the hospital for almost 9 months and hasn't recovered any function. I am his caregiver and will be when he comes home. I'm anxious and depressed, but I will not again go through the the damage done by benzos. I exercise, eat well, meditate, and see a qualified cognitive behavioral therapist. So, I do know what it's like to go through unbelievable stress unmedicated, and it can be done.

  139. After reading an article in the NYT in 2014 (https://www.nytimes.com/2014/09/14/opinion/sunday/should-we-all-take-a-b..., I started taking lithium orotate to address chronic low-level anxiety. It's OTC and safe and I've been so grateful many times for this low-cost and highly benign supplement. It restores for me the sense of "at peace with the world" that I recall from childhood, and I sleep like a baby, regardless to what's happening in my life. It's not addictive, it's beneficial at many levels; only side effect is moderate dry mouth. It's neutral as to pain. I associated lithium with bipolar treatment and was wary. But we're talking a trace element amount, something like 1/50th of what is prescribed for bipolar. So tiny there's no worries about longterm use, etc. I find 1/2 the recommended dose works wonders for me, and take 1/2 a tab before sleep every night. My alternative meds doc tells me he finds that some people don't experience much benefit from LO, but that a percentage are tremendously benefitted. This supplement is so cheap and so non-damaging that I think it's worth a try for everyone to see if you're in the lucky category. There's no downside and the upside potential is huge. Read comments by users on Amazon for lots of personal testimonies.

  140. I have used Xanax sparingly for years. It has helped tremendously to quell debilitating obsessive thought patterns. There is a place for such drugs. Unfortunately so many people fail to use them appropriately.

  141. Susan, it's not that they fail to use them correctly, it's just that their systems are different from yours. Xanax is very short-acting. Someone else in your shoes would have developed tolerance long ago. You sound as if you're one of the lucky ones. It has nothing to do with failing to use them correctly. Maybe you metabolize them differently from other people. We don't know why someone in your shoes would be suffering greatly and you aren't.

  142. Oh, yes, Xanax works wonderfully well. That's the trouble with it. I would have considered my use of it sparing too. What a shock to go off and find the gates of hell wide open before me. I had no idea that some of the symptoms I'd been dealing with--intrusive thoughts of suicide, weird chest clamping episodes, and even my first in my life panic attack, were actually interdose withdrawal symptoms. I'm well and happy and sleep through the night now, so glad I stumbled onto my cure for myself: getting off Xanax. Linda Crew Corvallis, Oregon www.lindacrew.com

  143. To control your anxiety and deal with the side effects, and for fun, take swimming lessons and swim hard and every day at the same approximate time. It's likely more affordable than medication and psychologists, has no side effects, and 'swimming friends are the best friends.'

  144. Anti-anxiety meds, used alone, will make anxiety worse unless it is coupled with a SSRI. CBT, hypnosis and/or acupuncture should help alleviate anxiety so that a person may eventually taper off the medications. Do not self-medicate on alcohol or smoking. There is no quick fix but there is hope with persistence and support and moving (i.e. swimming like a reader mentioned). Great article!

  145. Yeah! Swimming. THAT'S the ticket!

  146. I have to push back a little. My mother has had terrible anxiety and depression starting in her mid 80s, and no doctor would do anything to help her. They all just shrugged and said, well that’s what happens when you get old. I wish one of them had given her a happy pill to lighten her load a little. I don’t fear “addiction” this late in life. I do fear the day after day of weeping and despair. Maybe legal pot is the answer.

  147. Maybe I missed something... Where can one obtain the advisory booklet on tapering off these drugs over a 21week period? I’d like to try. I take both clonazepam and zolpidem at bedtime (and have for many years). I know going cold turkey would be very hard, but at age 67, after reading this, I think staying on them might be too risky. Thanks.

  148. Where do you obtain the advisory booklet for tapering off the drugs? There isn't any! I have contacted both the drug manufacturers, and addiction specialists,and they really don't have a realistic protocol, considering the terrible withdrawal syndrome. Unfortunately, the best thing you can do is look at the Facebook groups for benzo tapering, they have more realistic tapering programs than what you will get from a medical professional. The biggest problem is that dosages made by the pharmaceutical companies are not made small enough, or able to split in small enough pieces to get off safely. Hopefully, at some point they will be mandated to provide tapering size doses for people who are trying to get off these drugs.

  149. There's The Ashton Manual www.benzo.org.uk/manual as one resource

  150. You can go on BenzoBuddies. They have people who are doing different kinds of tapering methods and micro-tapers, titrations. There are many in your shoes, wondering the same thing. I would caution you to go very slowly at first to see how you do. Some people can handle a faster taper and some people simply can't. A 21-week taper period would be way too fast for some people.

  151. A most interesting article. For many years I was dependent on Immovane /zopiclone as a result of a workplace discrimination incident. For Canadian readers of this article, I would recommend a treatment program available through Pharmacy.ca of Toronto. In essence, it is a blinded tapered withdrawal program and can be prescribed through medical specialists. Not all family doctors are aware of it. I found it to be a great help

  152. "Despite warnings from experts, older people are using more anti-anxiety and sleep medications..." Hmmm. And just who is facilitating this behavior??? This sub-headline makes it sound as if the "older people" are ignoring the "warnings from experts" and rushing out and getting those pills! There's a middle-person here. The doc. The gatekeeper. The wielder of the mighty prescription pad. This is especially pertinent when the population involved is 65+. People raised in a time long gone, when the Doctor was seen as all knowing, all wise, with time to listen and consider before acting.

  153. Similar to issues with steroid I was prescribed for my poison ivy....tapering. “You never, ever recommend that someone stop cold turkey,” Dr. Maust said. That can bring withdrawal symptoms that include nausea, chills, anxiety, even delirium. “You taper down very gradually.”

  154. Weren't you prescribed steroids in a taper-pack? i.e., 6 pills the first day, 5 the next day, etc. I have used them this way several times for eczema and there was always a built-in taper. Unfortunately, even with a taper, there is often a rebound effect.

  155. Being on benzos is like playing the roulette wheel with your health. It is simply NOT KNOWN who will suffer terribly and who won't. I think that is one of the most dangerous aspects of benzos. You're taking a chance by taking it long-term, meaning over two weeks. You can't depend on doctors to lead you down the correct path because the medical community has been extremely slow to understand these pills. This has continued for decades! I would wager a bet that often people don't know that they have symptoms because they're often buried beneath polypharmacy. In other words, a person visits the doctor for insomnia, a very common withdrawal symptom of benzos. They're given a drug. This goes on and on for whatever ails the patient. But the underlying problem has been the benzos. It's important to do your own research on this. Doctors won't, most likely, present the facts to you. After all, they're the ones who prescribed the drug and they've mostly turned their backs on the negative consequences.

  156. The article talks about persuading patients to not use these drugs for long periods, but patients need prescriptions from doctors to obtain these drugs. The language of the article is telling in other ways: it talks about the use of the drugs among older adults, and about people taking them for years, rather than the use of the drugs by doctors, or about doctors prescribing them for years. The problem is doctors, pharmaceutical companies, and insurance companies that prefer drugs to therapy or other alternatives, not patients.

  157. Since the dawn of time, we humans have used various substances to alter our consciousness. If you have an ailment (anxiety, pain, the generalized heebie-jeebies) it is natural to want to feel better and function normally. Come off your high horse and have some compassion. Tomorrow it could be you.

  158. Many years ago, after I stopped drinking, I suffered massive anxiety and panic attacks, so bad that my teeth chattered. I took 3 mg. of Klonopin, which was my standard dose for several years. When I changed psychiatrists, my new one wanted me to stop taking it. I was extremely resistant, but I did agree to lower the dose to 2 mg. My next psychiatrist (I've had to change frequently because of Medicare) didn't think it was a problem, but I decided to taper off some more, down to 1 mg. I have some minor brain damage that already causes cognitive problems and balance issues, and more than one doctor had told me the Klonopin was making it worse. That psychiatrist retired. My latest psychiatrist isn't particularly interested in my treatment. However, I lowered the dose to .5 mg, now to .25 mg. I'm hoping to wean off of it in the next month. It has to be a time where I'm okay with insomnia and nausea. I'm taking other medications, so I don't want to start with a non-benzo anxiety drug before I know how my health is without Klonopin. I'm extremely lucky that I was an alcoholic before I started meds. I dislike being dependent on anything. This process has taken several years, as advised by this article.

  159. Elisa, why does Medicare force you to change psychiatrists so often? The minor brain damage, do you mean that was caused by the drugs or something else?

  160. I am guessing that many psychiatrists don’t accept Medicare.

  161. Three industries benefit from pushing pharmaceuticals: the pharmaceutical industry itself, which has successfully sold the public on the idea that mental illness is nothing more than a “chemical imbalance”; allopathic medicine, which is well suited to a prescribing model as a means of addressing patient concerns; and the health insurance industry, which seems happy to pay for unlimited pills but is obstructionist toward other treatment models such as psychotherapy that are based on interpersonal relationships and which require work on the part of the patient. Pharmaceuticals have their place but there are big gaps in our knowledge of how these chemical treatments work and unforeseen consequences of using them long term, or stopping them after long-term use. The brain is not the simplistic cartoon one sees in ads.

  162. You are right, Mary Ellen, about the fairy tale of "chemical imbalance". That is just something the medical establishment made up on zero evidence. We don't know what a "chemical balance" would be for a "normal" brain. We cannot even measure these things and even if we could would not know what they mean. But this wild "chemical imbalance" claim is used mainly for other drugs, I think, not benzos. Then the medical practitioners all start parroting like members of a cult stuff about those other drugs being "the same as insulin for diabetes". They're not insulin for diabetes. That's a terrible analogy. And they never warn about all of the risks and side-effects.

  163. "They're not insulin for diabetes. That's a terrible analogy." Why? are they not (the same as ) 'insulin for diabetes?" Why? is it a "terrible analogy?" Please explain.

  164. Ian, for starters, please scroll up and read the comments of me & babymf, CA, both below (in reply to) Paul Chomiak's comment. There are just far more differences than similarities. We understand insulin and its role in the body. We understand the pancreas and what it's supposed to do. We don't understand the brain at the chemical level. And benzos, etc. are certainly not a normal part of the body produced by the body. Normally, when medicos pull out the insulin/diabetes tale, they also talk about "chemical imbalances" in the brain. We don't know what a "chemical balance" is in a "well-functioning" brain. We cannot even measure brain chemistry. The flaws in the analogy go on and on. As I said, please also scroll up & read the other comment on this.

  165. Dr Humphreys is labeled a "researcher" but not labeled a psychologist. In truth, he is both. So? Evidence suggests cognitive behavioral therapy, a psychological intervention, is more effective and safer than medication but is also rarely available. Why? Because it is delivered and was largely created by psychologists (e.g., Meichenbaum, 1977). Nationally there are nearly 3x as many licensed psychologists as there are psychiatrists (107k vs 40k). They nevertheless remain poorly integrated into standard health care. So? Unless we start calling things as they are, "psychopharmacology" will remain in place to protect medicine's hierarchy, psychiatry in particular, & pharmaceutical profits more broadly. But as you and many others point out, it will not protect patients. All doctors know disciplinary turf can be deadly.

  166. Sadly, many or most psychologists are not well acquainted with cognitive behavioral therapy. It should be made a priority in training clinical psychologists. As for psychiatrists, they often show disregard for psychologists and any non-drug intervention. Their whole goal is to bully their patients into taking dangerous drugs such as SSRIs (more so than benzos). What a tragedy.

  167. I have been exposed to cognitive behavioral therapy in an alcohol inpatient program. I still don't even know what it is. It made absolutely no sense to me. Is that because the "therapists" didn't know what they were doing, or because there really is "no there there?" Have there really been serious and reliable studies of this technique, whatever it is? To me all it seemed like was snake oil. Before you dismiss that, keep in mind that, to the best of my knowledge, no psychologist has ever "cured" anybody of anything.

  168. Bob, I have not heard of it being used for alcoholism, if that is what it was used for in that program, so I don't know about that. But certainly it has been studied for mental health issues like anxiety, depression, PTSD, OCD, ... The skill/knowledge of the "therapists" definitely matters. If it made "absolutely no sense to you", that's a bad sign. Unless your state at the time made it difficult to make sense of anything. (If that was the case, it'd be hard to use too.) Actually, even things that don't work will probably "make some sense" in the sense of being possible or plausible. e.g. some old-fashioned Freudian stuff that's out of favor nowadays.

  169. Great article. My grandmother (84) has been taking Ativan for years and complains of memory and other cognitive issues. Her prescriber has even expressed to her that he's not totally comfortable prescribing it anymore, and yet he continues to do so against his better judgment. Also, this is not just a problem for the elderly. I took Klonopin as prescribed for a single month in 2014 at 26 years old and tapering off of it was the most harrowing experience of my life. It took close to a year to feel remotely functional and I still have neurological and cognitive issues that I can't be sure aren't some lasting, unresolved damage. It is the greatest regret of my life and thousands of other people of all ages are going through the same thing; it's not hard to find their accounts on Youtube and various support groups. The NYT should do a piece about this as well.

  170. People are different and react differently to drugs. Consider all the generalizations and hearsay evidence iin this hysterical article and the ones on the "opioid epidemic." Prohibition was a failure and so will this present campaign. Scaring patients and doctors into the idea that everyone, no matter what their condition, is at risk from these drugs will do more harm than good.

  171. My mother has taken Ativan for sleep for forty years. She's leveled off at 2mg because the doctor won't let her have any more than that. The idea of trying to "wean" her off her drug at 92 looms as impossible as flying by flapping my arms. She knows the risks, so I say...not my problem.

  172. I don't understand why, at 92, the doctor wouldn't just want to make your mother comfortable in whatever way he/she could. Weaning someone that old from Ativan is too serious of a matter. This is where I definitely would draw the line.

  173. What would be the point at age 92?

  174. I believe I said exactly that.

  175. I'm stockpiling mine for that time when I've had enough, medicine can't help me, and I can move on so they can unplug the damn machine. Dr. Jack was a hero!

  176. I’ve been on benzodiazepines for 14 years and have changed my dosage twice in that period. I have multiple sclerosis, insomnia and anxiety. With the medication I get a good night’s sleep and am a relatively pleasant person. I’m 50 and have no signs of cognitive decline. Without them—I’m a nightmare to be around. They were prescribed by my neurologist who is picking the lesser of 2 evils—chronic insomnia carries its own health risks and lack of sleep/anxiety can cause MS to flare up. Do I like that I have to take them? No. Will I continue to take them? Yes. This article overlooks the complex physical and mental health issues many people face. The N.Y. Times can do better.

  177. Based on evidence, cognitive behavioral therapy is the most efficacious and safest treatment for insomnia disorder. But in practice, it is generally unavailable. Why? Because it is a psychological intervention. Which U.S. healthcare does not provide standard access to. Why? Because those trained to deliver it, like those who largely created it, are psychologists. The remedy? Integration of psychology & medicine.

  178. I wonder if that technique is on the internet?

  179. Yes, there are lots of ways to teach yourself CBT. Look first for the book "Feeling Good", by Dr.Robert Burns. A very good guide to CBT.

  180. If this "evidence" is the same as the rigorous tests new drugs and medical treatments have to undergo, and the results are as you claim, I would think insurers would be happy to make CBT available. Psychologists may help some people and provide other useful services, but to the best of my knowledge they have never cured anybody of anything.

  181. I keep waiting for the article announcing the wonderful, and completely safe, substitutes for opioids for pain, and now, benzodiazepines for anxiety. What? There are no wonderful, safe substitutes? The unhelpful advice accompanying the urgent warnings say we should try exercise, meditation, various unavailable or expensive therapies, or better yet, just accept a life with pain and anxiety. These alarmist articles consistently conflate the problems and issues of criminal DRUG ADDICTS, with the legitimate health issues of old, sick people. A significant proportion of old people suffer pain associated with normal aging, for which they DESERVE pain relief. Ditto for depression or anxiety. These are not the people overdosing and dying. Read the article in today's NYT about palliative care and how the demonization of opioids is making it difficult for doctors who serve dying patients.

  182. I take strong issue with your description of this article as "alarmist." I am an ordinary, now elderly person currently tapering off of a dosage of .5 mg of klonopin prescribed for me for anxiety years ago. Describing it as the worst nightmare imaginable doesn't begin to tell the tale. These medications are not effective forever, and when they lose their effectiveness, whether it be weeks or years, they can cause an extreme version of the very symptom they were prescribed to alleviate: horrible, unrelenting anxiety. And that is not the only symptom tapering off of them, or remaining on them without continually increasing the dosage, causes. A few of the ones I am experiencing are depression, crippling nerve pain, fatigue, depersonalization, derealization, fear, tinnitus, sleeplessness, and extreme sensitivity to sensory stimuli. This is a real and devastating health crisis for many, many thousands of other ordinary people of ALL ages in our country and around the world.

  183. people 'deserve' solutions for their pain and anxiety that are not worse than the original problem that they are trying to alleviate.

  184. Drug addiction is also a legitimate medical problem, and drug addicts also DESERVE help and relief. You speak as if "the people overdosing and dying" are just throw-aways.

  185. I took SSRIs for 25 years. The only time I felt anything was when I forgot to take my pills. If I forgot my pills the next day was like a triple hangover. I took 2 migs of Ativan for about five years. Last year I decided I had had enough. It took a year but I’m clean for a month now. I sleep like crap so I smoke a little pot at night. Does the same thing as the SSRIs and Atavan as far as I’m concerned. I’m gonna start walking for exercise when the weather warms up a bit more. That’s what I know.

  186. SSRIs are handed out like candy and they can have devastating effects. A friend of mine from the gym disappeared for a few years after a hip implant. The next time I saw him he had probably almost doubled his body weight, and in a very unsettling and unusual type of way. This was not normal obesity, which in men, tends to start in the gut. He had massive flaps hanging from his arms. And he looked awful. Before, he barely had an ounce of fat on his body and walked 3 to 4 miles per day. SSRIs also come with warnings to not stop taking them abruptly. It seems to me there are few drugs that are safe to take long term, and they all have side effects. But regarding bezos or opioids, when were speaking of elderly people, if these drugs improve their lives by their own estimation, why don't we let them live the way they choose for the few years they have remaining?

  187. I have witnessed benzos kill over 50 people, usually due to suicide. Not because of reemerging mental disorders, but due to the devastating, crippling tolerance withdrawal, withdrawal, and Benzodiazepine Withdrawal Syndrome which slams into some attempting to stop benzo use, or recover from being prescribed. I'm speaking of lawyers, doctors, nurses, Veterans, law enforcement officers, chefs, BioChem engineers, etc.. All dead. Gone. Destroyed. Left in their wake are the many thousands who avoided suicide, but are left completely disabled due to taking a medication prescribed to them by the doctor they trusted. I, too, am a Benzo Victim. I learned by fate in 2012 when my latest doctor fired me as a patient as I insisted I be taken off of Klonopin. His words? "I will not be responsible for what is going to happen if you attempt to get off this medication." I joined online Benzo Support Groups a few hours later. I studied for 2 1/2 years before starting my taper which is now in it's 40th month. Currently at 0.0063mg of Klonopin using a compound liquid. I am mentally and physically disabled with the worst Hell coming once I am completely off. Stop this Madness. Benzo Buddies on the Internet has over 40k members, all in the same Hell. This is not rare. This is not acceptable. This is killing and maiming patients who were never warned or afforded Informed Consent. In Canada and the UK victims can sue. We, in the U.S., cannot and have been abandoned. Please Help

  188. Paul, I understand. I have been to the depths of despair. No one can imagine such terror unless they've been through it. And it seems to never end. Some people give up. This affects every facet of one's being, and yet no one "gets it" unless they've been through it. We're relegated to labels such as mentally unstable and "anxious." If they only knew. I agree that we in the U.S. have been abandoned. But there are websites (Benzo Case Japan and Benzodiazepine Information Coalition) that one can research through and get help. It's unfortunate that the very doctors who are prescribing these drugs remain in the dark or refuse to acknowledge the terrible problems. Congratulations on slow tapering! I wish you the best!

  189. So true, Paul, all of it. And I commend you for tapering off on your own very carefully!!

  190. I find your post particularly moving, Paul, because my most horrific side effect of getting off of a very small dose of Xanax (1.5 mg PER WEEK) was periodic bouts of suicidal depression. And I was a happy, non-depressed person before this, put on Xanax initially by a doctor who thought he was being kind in making my trip to China for my son's wedding a little easier. Now, whenever I read in the news that someone committed suicide or went off the wall, my first thought is, "What was he on? What was he trying to NOT be on?" I've been particularly frustrated that all the New York Times articles about PTSDiand suicide in vets, the connection is never made between these bleakest of mental states and what happens to person's brain when they come off of these drugs. People need to know what these drugs can do. Hang in there. Just stay alive. But only people who've been through this can understand how what an appalling assignment that can be. Linda Crew www.lindacrew.com

  191. Take no drugs like these unless you would die without them, or nearly die. It is not like say insulin which you have to have. Pain and mental meds are very dangerous, don't use them.

  192. For those looking online for the Canadian informational brochure, which includes a 21-week tapering schedule for benzos and z-drugs, here is a link: http://www.criugm.qc.ca/fichier/pdf/BENZOeng.pdf The initial study showed that 27 percent of patients, many of them long-term users, were able to discontinue the drug within six months using this tool, compared to five percent of a control group. Another 11 percent were able to reduce their doses. The brochure advises proceeding under the supervision of a doctor or pharmacist.

  193. Ms. Spahn, I guess you haven't had personal experience with becoming dependent on a benzodiazepine. The 18 week tapering schedule in the recommended Canadian brochure is totally inadequate for people who have been taking benzodiazepines for more than just insomnia. This schedule of halving a daily dose would throw many into severe, screaming withdrawals. A 27% success rate, for people who presumably want to reduce the medication, is not very good. I would suggest that people who are looking for tapering plans google the Ashton Method, developed in England by a trailblazing woman who ran a clinic to help people off these drugs. Her success rate is much higher.

  194. Why is no one seriously studying the issue of post-menopausal insomnia in women? Sexism? Sleep difficulties after menopause are rampant and the best that medicine has to offer is "sleep hygiene" (or CBTi, which is not widely available) -- truly is insulting as most (educated) women tried sleep hygiene long ago and found little relief. Older women who are active and busy and often still working can not afford, and should not have to tolerate, chronic sleepless nights. We take benzos, or similar, in order to maintain some quality of life. If men were having this problem, would it get more attention?

  195. Postmenopausal... yes, insomnia, yet another medical problem caused by estrogen deprivation. Havent there been enough studies showing that the natural healthy state for women requires estrogen? Abdominal fat distribution, increased LDL cholesterol, osteoporosis, dementia, heart disease -- all are preventable if estrogen levels are maintained. Instead, women are prescribed a pharmacopea of workaround drugs with their own dangerous side effects. Menopause itself is treated as nothing more than hot flashes that women are expected to tough their way through. Medicine has extended life expectancy beyond 50, but somehow the cessation of a key hormone at that age is now overlooked: estrogen is no longer replaced, thanks to the narrow, misplaced, focus on its effect on breast tissue, based on a poorly designed, decade-old study that has since been largely discredited. Like the persistence of the "fat is bad" notion from the 1970s, the rap against estrogen has been slow to change, to the great detriment of women's health.

  196. I totally agree with anonymous. Why is there no help.

  197. There are some things that help, such as going to bed earlier, and accepting the idea of a two-stage sleep. I am writing this at 2am and will soon go back to bed for my second sleep of the night. Anything you ingest to help you sleep messes up the sleep stages and makes the problem worse.

  198. It is not just benzos that are a problem for older folk. I am currently severely disabled from lamotrigine and seroquel which were prescribed by a neurologist/psychiatrist who continued to urge me to take them. I reported numerous falls - at this point I have had over one hundred. He ignored the falls,

  199. Benzodiazepine and alcohol are probably the most dangerous substances to withdraw from. Even if its done gradually Benzo withdrawal is one of the most painful substances to withdraw from. Unknown to many Benzo detox takes considerably longer and is much more uncomfortable than heroin withdrawal. Ask Stevie Nicks (who came off Klonopin) how bad it can be. Benzo withdrawal brings with it not only insomnia and anxiety (which ironically is what they are prescribed for) but also depression, agitation, hypertension, muscle aches, extreme fatigue. The depression is resistant to antidepressant medication. Its literally a nightmare process and sometimes requires hospitalization.

  200. Perhaps someone should pass that info on to doctors; they seem to know nothing about it. Mine sure didn’t, and the results were catastrophic.

  201. Recent reports say that clinical use of psylocibin (the magic in magic mushrooms) can end depression and anxiety among people, even making them feel spiritually uplifted, and deeply connected with the world. Perhaps the effect of psylocibin on the prisoners of Big Pharma should be studied.

  202. Really hope there is one or more follow-ups on US detox programs on this topic. The warnings have been sounded over the last several years, but where is the help? It seems hopeless -- senseless? -- and downright dangerous to try to taper or get off completely ... as it appears to be an interminably long process with only pain and debilitation all along the way. What a terrible trap to be in ... and from this comments section, it seems there are a lot of trapped people out there. Praying for all affected for a breakthrough that offers some reprieve from what seems a constant waking (and sleeping) nightmare.

  203. Most alcohol and drug treatment programs will not even accept patients who need to withdraw from benzos unless it's from relatively small doses. It takes too long and presents a risk of serious complications and liability. And insurers probably would not cover it. Opiod or alcohol addiction they will treat. Benz addiction they will not.

  204. Oh, yes, they do. But the results are poor. The person is usually left in a wrecked state, probably worse off than before detox.

  205. Detox is a very, very bad idea. To be taken off the drugs and to be put on other drugs causes the central nervous system to go crazy. It simply SHOULD NOT be done. Sensible tapering can take place. Yes, it can take years. But it's better to be functional and able to drive, interact with people, not be agoraphobic, and be able to work and to function in society as a real member than a crippled mess in your bedroom, afraid to turn on the light or have any music playing because of extreme sensitivity, being afraid to step outside the bedroom door. I wish I had gone slowly now. But it's too late.

  206. Next, we'll be trying to wean diabetics off their dependence on insulin. Really, the bias against any medication to relieve pain and anxiety has reached Prohibition proportions. If benzodiazepines are that widely prescribed, the vast majority of people taking them are not falling, not increasing their doses, not sleepwalking through their days, not walking into walls, not abusing them. If that happened in most cases, we'd be witnessing a zombie apocalypse. No, the concern isn't about falling or overdosing, its the moralizing judgement against people who can't buck up and will their stress away.

  207. PL, Benzos are not insulin and insomniacs are not diabetics. That a stupid analogy invented by the medical establishment and then parroted out by all of them like members of a cult. There's no moralizing about people "bucking up". It's not the patients fault if the medical establishment cannot cure them safely and reliably. That's the medical establishment's fault. Who here has blamed the victims?

  208. "Drug problems are deeply stigmatized." Ya think? Exhibit A: this article. Maybe anti-anxiety drugs and insomnia medications have become so widely prescribed to older people in recent years because (a) there are more older people, and (b) they need the medications. The aging brain goes through many changes, and insomnia is one of them. Is this a problem? Only if the person can't get medication. Benzodiazepines are old, cheap, and overall have a good safety profile; they are far less likely to result in fatal overdose or other serious adverse events than the barbituates common in the 1950s.

  209. Ah, the 60 year old 'benzo slogan', aka marketing ploy of They're less likely to kill you than barbituates which makes them safe. Perhaps some more current research would be in order. A simple google search will give you 60,000 or so documents listing the serious adverse effects of benzodiazepine use and the common life-threatening withdrawal from them. Emergency dept. physicians would be good sources as well, they see 80,000 people suffering from those rare and unlikely serious adverse events each year in the U.S. Public Health England began a full investigation into them last month, the Scottish Parliament has followed, Massachusetts is hearing a bill right now. That "good safety profile" is no more.

  210. "Life-threatening withdrawal"... so don't withdraw. It is the push to take people off the medications that is killing them. The stigma is killing them. The War on Drugs 2.0 is killing them. The benzodizepines themselves address a very real medical need in the elderly, insomnia and anxiety. And how many non-withdrawal ER visits are due to combining with opioids or other meds, as was recently noted in another Times article?

  211. PL, just read all the comments here with people's personal stories. Benzos have destroyed many people's lives. Both people trying to withdraw from them and people whose lives were destroyed before they got any chance to think about withdrawing from them.

  212. Reading this article, one of several I’ve read lately, about benzo's - terrify and worry me about the safety of these drugs and the knowledge of my doctor. A sleep specialist (MD) prescribed two benzo’s; Clonazepam and Temazepam after my sleep study showed restless leg syndrome and nocturnal leg jerking. These are to be taken an hour apart before bedtime. I’m over 70 and have been taking them for over a year. I asked the doctor recently about the safety of these drugs and he said they are safe when taken as directed and that the negative comments are not backed up by reliable scientific studies. But as I said, I’m worried now and afraid to take them. I will look in to titration from them and think seriously about getting off both of them. They work well, I have never upped the dosage and have no obvious side effects. But I’m worried.

  213. Where you would be in trouble would be if you needed a knee replacement or broke your hip and they put you on the usual Percocet as the pain medicine and you are on those two benzodiazepines.

  214. Restless leg syndrome is extremely uncomfortable for people and lack of sleep is dangerous. I highly recommend you seek medical support if you’re going to go off of two benzodiazepines you have been on for years. There is an Anxiety medicine that is not a benzo and is highly effective and safe called Buspar. I don’t know why this is not used more.

  215. I tried the Buspar you are talking about. It gave me terrible migraine headaches. One reason to avoid Buspar.

  216. At this time I am unable to collect my thoughts well enough to say anything more than benzodiazepines hurt me.

  217. Medical Marijuana. End of story.

  218. And the NYTimes strikes again. No drugs for anyone. Ever. 'Cause drugs are, you know - bad! Big Pharma!!

  219. Ian, instead of just sneering, why don't you read through all of the reader comments here, many of which document how benzos have destroyed readers' lives.

  220. I and other non-MD professionals, especially those of us with a background in addiction counseling, have known about the severe addiction caused by benzos, for years. I'm glad the Times finally wrote about this widespread problem. --Anne Rettenberg LCSW

  221. It's not an addiction, Anne. You've got to realize that. Almost all of us took the drugs as prescribed. Benzos, especially the fast-acting ones, foster dependency quickly because of their half-life. Addiction puts the onus on the patient. It relegates us to labels. Iatrogenic dependence is the phrase that needs to be used. We were following our doctor's orders. We weren't using them illegally or downing a whole bunch at one time. There is a distinction, and it must be made.

  222. There is no shame in having an addiction. It's a disease.

  223. Physiological dependence is NOT "addiction" Anne. The brain makes adaptations to the benzodiazepine and when the drug is taken away, the brain/CNS no longer functions normally. Most of us took the drug as prescribed by the doctor, sometimes less. Most of us never craved the drug, never upped the dose, were never drug-seeking. I often took less than prescribed because who wants to be on pills? I stayed on them and thought it was difficult to come off because I was told by the doctor that the "anxiety" I felt when I stopped meant I “needed” them. I didn’t know that what I was feeling was withdrawal. I still have pills left over from tapering because I am too upset at the pharmacy (who also never warned me) to return them calmly and don't want to flush them down the toilet. I have no desire to take them. Calling iatrogenic dependence an "addiction" is incorrect and not helpful to understanding the insidious nature of these drugs, how they hijack the brain unbeknownst to the person taking them and it is a disservice to your patients when you cannot understand the distinction. It is insulting to anyone to be called an addict when they are not one. Otherwise, no, there is no shame in it.

  224. We are becoming a nation of addicts thanks to a medical profession that believes that pills are the solution to every ache, every pain and every emotional problem. I have had a rough menopause and it will never occur to me to pop any of these mind altering substances. It is called life, you move on, you deal with it. I have found that meditation is a great help and so is exercise.

  225. I have chronic anxiety related to my bipolar condition. I have taken Ativan for 30 years. I am aware that I am addicted, though at a very low dosage level (1 mg). I am aware of other mild side effects. But what is left out from this article is that severe anxiety is a life-threatening condition and nothing treats the condition like benzodiazepines. These drugs work for countless Americans and they save lives. Those with bipolar illness commit suicide at a high rate. Ativan keeps me, and many others, from anxiety levels that could make the numbers of suicides mushroom. When drugs are tremendously helpful for many and harmful for some, it is wrong to ignore their positive contribution and to only speak of the negatives.

  226. That is why we need informed consent. You have chosen to take benzos, knowing that they cause problems. Others knew nothing about them and trusted their doctors to give them good advice. They are stuck in an endless loop of terrible symptoms that seem never-ending. Without researching on my own (since I chose to listen to my doctor), I would never have known that the incapacitating symptoms I was going through was from the Ativan. For you, the drugs may be fine. For others, not.

  227. Hi, I'm a reporter working on a project about benzos. I was wondering if you would be open to talking with me about your experiences.

  228. I WANT to talk, too! I have been trying for 2 years to recover from > 8 years of benzos taking less than prescribed!!

  229. If the negative comments are not backed up by reliable scientific studies (as one commenter says she was told by her doctor), it is because those in a position to do studies have refused to conduct them. No studies EXIST on the long-term effects of benzos, or on the effects of withdrawing from them. Those of us who are living with those withdrawal effects, and painstakingly titrating our dose reductions, and supporting one another in the process, would welcome with open arms some reliable scientific studies. We want to know what percentage of those who take benzos are likely to suffer as we do and why, whether as the result of tolerance while taking the drug or during the course of withdrawal from it. We want to know how to prevent that from happening, because a sheer glance at any online support group will speak to tens of thousands of unacknowledged cases. And, more than anything, we would welcome with gratitude any real scientific help in getting us off these drugs safely, as we (the vast majority of whom have taken the drug only as prescribed, as good patients, never raising our doses unless told to) are not only summarily dismissed by the scientific community, but more often than not left to fend for ourselves.

  230. Yes, I wholeheartedly agree, Lina! Most of the clinical studies are done in the earlier stages of benzo use, when things seem to be going well. And there is so much bias in them that one wonders if a clinical study is ever done WITHOUT bias. The medical community tells people to get off these drugs much too quickly, causing devastating effects on the nervous system. They don't realize, out of ignorance, what havoc they're wreaking. The pharmacists aren't much better. An overhaul of the entire system concerning benzos, as it stands now, is desperately needed.

  231. Too many people jump to anti-depressants, etc. when they should be finding the root of the problem. Physicians are too quick to write prescriptions. As a senor I would not want to be on drugs unless absolutely necessary for my health. People age and become diabetic, hypertensive, have cholesterol, thyroid and other issues. Your liver can only metabolize so many drugs. Americans like to remain oblivious to the damage they are doing to their bodies as they are only interested in the now and not the future and the long term problems with all of these ingested drugs.

  232. The root of the problem is aging. You can’t pretty it up.

  233. The overwhelming majority of older people use these drugs without problems. They are extraordinarily helpful in addressing many issues that can destroy the quality of life experienced as we age. We really do not need a passel of younger “nanny doctors” tut tutting that we elders are having entirely too much fun and should not be taking drugs because - well, just because it is unseemly and some small number of people will have adverse reactions. If doctors would do their jobs and monitor the patients to whom they give these drugs, fewer people would be taking inappropriate doses.

  234. Cecilia, have you actually read the comments? All of your assertions are refuted there, by people with lived experience--people who take "appropriate doses" as prescribed. While this article may happen to fall in a series geared toward the older years, the problems cited in it related to benzodiazepines know no age boundaries.

  235. Have you read the comments? Have you looked at statistics? No, people taking four and five Xanax a day and more are not taking an appropriate dose. The overwhelming percentage of older people who take these drugs take them safely and derive a great deal of benefit from them. People who cannot or will not take them safety need to be monitored by their physicians and should avoid taking them. The quality of life of the elderly is too important to dismiss by saying no one should have access to these drugs.

  236. The assertion there are people taking 4 and 5 Xanax a day in the comments and that's where the problems are is just simply not true. Nor is "nobody should have access to these drugs" said in the article. Talking about a drug having problems, which this class of drugs does, is completely appropriate. I wish they did discuss statistics more. The APA Task Force on benzodiazepine dependence found 40-80% have dependence and withdrawal from discontinuing this mediation. Additionally, about 1 in 6 go on to be disabled by the drug while on, during and even after coming off. I agree, the quality of life for the elderly is important, and having all the information when starting and stopping a drug is critical to retain quality of life. If patients are not getting good information, then it is imperative to ensure they do.

  237. Regarding the EMPOWER trial, which was cited in the article and led by the Canadian geriatrician Dr. Cara Tannenbaum: the link is not provided for the 21-page booklet to empower patients to taper their sedative-hypnotics/benzodiazepines (only the study itself). The link to the booklet is a very useful resource for seniors. It would be great to add it to the article. Here is the link to the brochure: http://www.criugm.qc.ca/fichier/pdf/BENZOeng.pdf

  238. You can take away my alprazolam when you can pry it from my cold dead fingers.

  239. Interesting and important article, but I want to make the author and others aware that VA actually stands for Veterans Affairs not Veterans Administration as it is called multiple times in this article. If you're going to un-abbreviate something, please know what it stands for (US Department of Veterans Affairs and its local subsets). Thanks!

  240. I have two clients who use benzos to help them sleep and they CANNOT get off them. It's a problem, as they are both falls risks, but their doctors aren't too eager to find solutions. I have also found that doctors are now prescribing either Gabapentin (which I think has horrible side effects) or seraquel to help with sleeping... to stay away from the benzos.

  241. Read the Ashton Manual free online and also join benzo groups on Facebook.. There is one called "Benzo and "GABA Drug" Use and Recovery Experiences" which already has doctors, RNs LPNs, med students, etc talking to us about our experiences and learning how to safely withdrawal clients.. Make up a profile if necessary.. We're okay with that.. Thanks

  242. This is such a criminal epidemic. Having to read an article like this makes me even angrier. The elderly do not have the strength to cope with the side effects of a benzodiazepine let alone tolerance with drawl. I have been brain injured from 7 years due to a benzodiazepine. I have been tapering since mid 2015. I have spent two years of my life in bed and homebound trying to wean myself off this drug with absolutely no help from my doctor. Diabolical symptoms physically and mentally that I have sustained nobody in the whole world not even the worst criminal deserves this. Would've been easier to get electrocuted all at one shot or burned at the stake. I've been gutting it out just to survive and make it through another day. Like my other bands the Warriors, we will keep fighting until we heal and then we will make so much noise that we will blow the roof off this benzodiazepine epidemic.

  243. Benzodiazepines down-regulate the GABA-A receptors, up-regulate the Glutatmate receptors, clog up the Voltage Gated Calcium Channels (VGCCs), throw off the HPA Thyroid Axis, damage the Limbic System of the brain and most of the time cause Adrenal Fatigue, which complicates the HPA Thyroid Axis dysregulation. You need not take my word for it, there are plenty of research papers available on the Internet which will all lead you to the same conclusion.. Other systems are impacted, but this what the bulk of Benzo Withdrawal Syndrome is and why nobody can really figure it out.. Feel free to contact me. Thank you. P.S. Do not give benzo victims fluoroquinolones. quinolones or progesterone as it causes more damage. Look that one up as well, the info is out there.

  244. You are absolutely right, Paul. I wish I would have understood all that before I took Ativan. There are posts from people riddled with all the symptoms you list. The autonomic system is profoundly affected, too.

  245. Thank you Paul. Benzodiazepines are dangerous drugs and, in my opinion need to be more tightly controlled. I was on a "low" dose (.5 mg 2 times a day as needed) for four years. It nearly killed me, and even 17 months off of it, I still suffer from neuromuscular side effects, agoraphobia, gastrointestinal issues, and rebound anxiety. I habituated to a low dose quickly, and then used alcohol more and more. From the benzo forums I've been on, this is not uncommon. My doctor never explained that benzodiazepines and alcohol work on the same GABA receptors, and that drinking while on benzos is dangerous. Some of the damage done to my body can't be undone. I've found cognitive behavioral therapy and meditation to be helpful in dealing with my anxiety disorder.

  246. The article is not representative of the clinical/scientific literature. The comments might best be described as the anecdote wars. What is clear is that it would be good to have effective anxiolytics that do not cause physical dependence. It is also clear (but not addressed adequately in the article) that untreated anxiety disorders cause enormous suffering and early-onset ones can shorten the life span by many years- best estimates are 10-20 years. There is almost no good data on post-withdrawl syndromes being medication effects vs relapse. I am no fan of big pharma, but the numbers being thrown around by experts and publicly available "big data" are enough to have big pharma drooling at the thought of developing a patentable new molecular entity not Schedule 4, 3 or 2 (not subject to abuse) anxiolytic as effective as benzos.

  247. Whatever drug is manufactured to relieve the effects of anxiety is going to cause more anxiety once the drug wears off. What comes down must go back up. I can't imagine a drug that would relieve anxiety and not have a rebound effect. I think all pills do have a rebound effect. If there would be such a drug without any rebound whatsoever, it would be amazing. But I still wouldn't take it.

  248. Well that's great Delia, so I guess you just recommend people suffer.

  249. Riverrunner, I think what Delia is recommending is that we not repeat the mistakes of the past. Drugs such as Xanax were initially hailed as being "safer" than Valium (aka Mother's Little Helper). Clearly that did not turn out to be the case.

  250. As a geriatrician, I have cared for people who suffered negative outcomes both while taking them and while attempting to discontinue them. The risk of falls, delirium, and cognitive decline are real for those taking benzos, particularly as they grow older. I understand that some people started these drugs for disabling anxiety or panic disorder. However, now in their 80s, 90s or beyond they can't remember why they were started and tapering may bring its own risks. There a geriatrics saying which I learned in training: "there is no pill for every ill." Unfortunately, the faith in pharmaceuticals in our culture can be inappropriately intense.

  251. A separate study needs to be done on the elderly who have more medical problems and lack of a support system. They can't just shape up and not take meds for anxiety, sleeplessness or whatever when they are suffering on a daily basis.

  252. This is not an I am better than you comment, but I have been meditating on Headspace for over a year now and it really helps with anxiety and stress. I also may take one miligram of melatonin if I have additional stress and it really helps. I hope these two suggestions can help others. My doctor told me you cannot get addicted to melatonin.

  253. You cannot become addicted, and I know several people for whom it has been a great help. However, it can have drug interactions and disease interactions and people should talk to their physicians before taking it on a regular basis.

  254. What is Headspace?

  255. I was able to replace Ambien with 2-4 mg Tizanidine before bed (non-narcotic muscle relaxant), I'd be interested if anyone else has experience with this medication.

  256. And stop with the lumping all people over 65 into the one-size-fits-all elderly category. I've had generalized anxiety since birth and have had to live through cycles of the treatment de jour. Went through the talk therapy back in the day where you lie on the couch and they try to root out the non-existent cause, antidepressants, SSRIs, CBT. The only thing that works for me are those "nasty" benzodiazepines. I never take them every day, I take them as they used to be prescribed 30 years ago - as required. Unfortunately now I'm supposed to be cured of this illness the moment I reach 65 because all seniors are one and the same. My mother is over 90 and I inherited my disorder from her. She still doesn't have any dementia, she's never fallen and has had no consequences of taking these drugs "as required" for 60 years. Nothing but a good, decent quality of life. Enough already.

  257. Glad this comments line is still open. And thank you NYT's for featuring my previous comment. Will just state again: where is the help, from within the medical (prescribing) community, to help people who are trapped by having taken these meds for a long time, and now are getting older, and are trapped in a parallel nightmare and will find them to be a real health hazard in other ways? Don't those prescribers owe their patients some type of support and assistance, for instance, with setting up and monitoring a safe taper system? Going it alone seems to set the stage for disaster. And fundamentally a dereliction of their sworn oath.