Posted by alan on August 20, 2002, at 13:41:45
In reply to Re: To...Addiction vs. Medical dependence » alan, posted by Squiggles on August 20, 2002, at 1:48:20
> Your use of words and their meaning is "pragmatic",
> i.e. it is used where convenient for the pharmaceutical
> companies.
>
> I do not have a "squabble" with the medical profession,
> i simply think that they have been taken in by some
> of the misleading rhetoric of "slight of hand" lingo,
> for a very real physical problem of addiction.Then as I thought, you do believe that pharmecuticals are confusing the medical profession - those at least that are specialists treating anxiety disorders.
It is the medical specialists that have to make distinctions such as these, not the pharmecuticals. Otherwise, there would be NO prescription of bzd's permitted at all - that is, if there were no distinction made between them and modern non-medical classifications such as alcohol, cocaine, and heroin, not to mention inappropriately prescribed drugs such as phenobarbital, seconal, or other barbituates.
>
> Though i have never done heroin or hard drugs and
> cannot say what the withdrawal is like, i can assure
> you that if you are not an epileptic getting on Klonopin,
> you may very well become one getting off. The significance
> of that is, that although addiction is slower and
> imperceptible with the benzos, the withdrawal may infact
> be harder and more dangerous. Whether you choose
> to call that medical dependence or addiction is secondary
> in my view, to the required recognition of the long term
> effects of these drugs.Actually, what is primary in proper diagnosis and treatment is the disorder or disease, not the drug. Of course, slow withdrawl is paramount when discontinuing any drug - as it turns out, especially the ssri's - a non-habit-forming drug. What's the euphemism? Oh yes, "discontinuation syndrome".
Again, there is no medical evidence or credible scientific study that me or my doctors are aware of that shows long term bzd use for chonic anxiety disorders is any more inappropriate or causes more problems than short term therapy.
That does not mean that there isn't the occasional bad reaction to these drugs just like any other. But to extrapolate for the entire population based on personal experience is simply unsound thinking as well as unsound medicine.
>
> Also, i am not so sure of your point that using
> hard drugs would be worse in terms of addiction
> than the benzos vis a vis withdrawal, spiralling
> increase in dose, etc. In Victorial times these
> drugs such as cocaine and morphine derivatives, as
> well as quinine were commonly used throughout one's
> lifetime and IF the dosage were controlled, though
> dependence would grow, it would not necessarily
> be worse than the class of barbituates and benzos.
> This is also the case with alcohol, where many
> cultures use 1 glass per day for many yrs. without
> a necessary increase for tolerance.
>
> Infact, the addiction to Rivotril in my case of
> a nature which may be new to the pharamamatorium -
> i suspect that after 15 yrs or so of use - there
> have been changes in the brain, such that they
> cannot be reversed and the drug must now be taken
> indefinitely to avoid seizure and inability to
> reinstate a physical equilibrium which once existed.All studies of the panic/anxiety population who are or have been under extended bzd monotherapy for their disorder that do not have past history of abuse or who have a predisposition or behaivour towards drugs that incline them towards drug seeking behaivour show that dosages stay the same or move downward. Rarely is there a member of this poulation that ever abuses their drug or has to discontinue because of the escallating dosage boogie monster.
"Neuroadaptation" is a whole area of emerging science that best addresses the problem of Revotril that you mention.
>
>
> As far as the drs. go, i believe most have just not
> been informed and perhaps this class of drugs being
> new after all, the drug companies themselves may
> have something new to learn about their creation.
> After all, the tests were not forecasted for 50 yrs
> into the future.I agree that physicians - mostly GP's and non specialists have a lot to learn about appropriate prescribing and diagnosing - not to mention follow-up. That is why the distinction IS important to them. Then perhaps valium won't be prescribed inappropriately for back spasms for instance which was the type of prescribing practices that got patients into trouble in the first place.
Prescribing practices that present ALL of the options for psychotropic drug therapy to the patient is what is needed along with unbiased cost/benefit analysis. This includes the presentation of AD's, bzds, and others on an equal footing. This is all the more important considering that patient reaction to a drug therapy is highly individualised in the first place.
What I am saying is that the deliberate witholding of bzds as an equivalent option to the anxiety sufferer is doing them harm by taking away their right to know and have at their disposal what is available to relieve their suffering.
The practice of witholding this option is based on misinformation, moralistic and political pressure, and doctors that prescribe psychotropics based on commercially driven pressures.
>
> I am also rather pissed off with the benzo group
> for its zeal to get off benzos. In a pardoxical
> way, I think I am far more anti-benzo than they
> are under certain conditions, i.e. when the withdrawal
> becomes dangerous to the health of the patient he should
> not be permitted to take further risks, but be
> reinstated, and started on a slower schedule, or
> not stopped at all.Yes, but this is not a reason to blame the medicine itself. One can not and should not extapolate for the entire population based on a personal experience or a small minority of cases.
If one digs a little deeper into many of these cases, there is misdiagnosis, misprescribing, and mismangement due to a lack of understanding of these drugs and of the patients themselves.
>
> Here is one of many articles that explains the situation.
>While interesting, I prefer to get my information from a broader based and more comprehensive view of the use of bzds. This is available in the review of 40+ years of study of an amalgamation of ALL of the studies on bzds in a report on "The Rational Use of Benzodazapines" by the prestigious World Health Organisation. They concluded in their summary that the short AND long term application of bzd monotherapy for anxiety disorders is by far the most safe and showed the highest rate of efficacy of all drugs used to treat anxiety disorders.
So indeed, let's be clear about the cost/benefit analysis when providing patients with their real alternatives when it comes to reducing their suffering.
Let's not exclusively scare people about bzds just because they have a tolerance/withdrawl phenomenon found in all drugs in some form or another. It is uncommon to have difficulties with this phenomenon id done properly. It places unreasonable doubt into the mind of an already med-phobic sufferer at a time of high psychological vulnerability - preventing them from assessing their options comprehensively and with perspective.
This tactic is used as a trump card as is presently represented by the anti-benzo movement - manifestly so by sites such a benzo.org and scaremongering groups such as TURN and DAWN.
Alan
poster:alan
thread:116708
URL: http://www.dr-bob.org/babble/20020814/msgs/117126.html