Posted by Quintal on February 5, 2007, at 20:35:47
In reply to Re: Just a question, posted by bassman on February 5, 2007, at 19:58:15
There are plenty of reports of benzo tolerance and addiction in the medical literature, but as it's 2:30AM in the morning here in the UK I'm going to bed after I finish this post :-)
The same is also true of opiates given for pain in a medical context - most people can take them at the same dose for years, as in treatment of chronic arthritis pain with low dose codeine and propoxyphene. It's probably true to say that in a substantial number of these cases the perceived continued beneficial effect is mostly placebo, with the drug producing some low-level grogginess that the patient interprets as analgesia/anxiolysis.
I have no problem with the idea that people can take the same dose of a benzodiazepine for years and even lower the dose at times - I've heard of too many people doing that to doubt it; and indeed I managed to do that myself for a while. Again, I'm not sure what exactly are you getting at bassman? Neither I nor Heather Ashton have ever advocated people being encouraged or forced to stop taking benzos against their will, or that they may be beneficial to some people. As Heather herself said in a quote I posted further up the thread:
__________________________________________________The advantages of discontinuing benzodiazepines do not necessarily mean that every long-term user should withdraw. Nobody should be forced or persuaded to withdraw against his or her will. In fact, people who are unwillingly pushed into withdrawal often do badly. On the other hand, the chances of success are very high for those sufficiently motivated. As mentioned before, almost anyone who really wants to come off can come off benzodiazepines. The option is up to you.
http://www.benzo.org.uk/manual/bzcha02.htm
__________________________________________________The major clinical advantages of benzodiazepines are high efficacy, rapid onset of action and low toxicity. Adverse effects include psychomotor impairment, especially in the elderly, and occasionally paradoxical excitement. With long term use, tolerance, dependence and withdrawal effects ***can*** become major disadvantages. Unwanted effects can largely be prevented by keeping dosages minimal and courses short (ideally 4 weeks maximum, and by careful patient selection. ***Long term prescription is occasionally required for certain patients.***
http://www.benzo.org.uk/asgr.htm
__________________________________________________>My point is that there are two sides to the discussion; nothing more.
It seems we're in agreement. Ironically the whole point of me posting that original letter was to show Heather was fair and sympathetic to the needs of long-term benzo users in the way she cut Rosie Winterton and our Chief Medical Officer down to size over their handling of his shoddy letter advising GPs to reduce their benzo prescribing.
Q
poster:Quintal
thread:729587
URL: http://www.dr-bob.org/babble/20070201/msgs/730165.html