IN 1976, Barry Haslam, an accountant in Oldham, Lancashire, had a nervous breakdown. The pressures of life were too great and he was prescribed the tranquillisers Librium and Valium. Later, his treatment was changed to a potent dose of Ativan. Barry, in his own words, went from a mild-mannered man to a monster, and a terrible burden for his loving wife. Somehow, ten years after his first fateful prescription, Barry weaned himself off Ativan. But due to the severe cognitive damage caused by these drugs, Barry has no memories at all from age 32 to 42.
Barry took this medication in good faith, but it blighted his life. After fighting his way through the storm of withdrawal, he committed himself to campaigning against misuse of these drugs and for proper provision for sufferers. In 1998 he joined Oldham Tranx, a peer benzodiazepine support group, founded in 1989. He went on to lead this charity, which gained a contract with Oldham Primary Care Trust, and in 2004 Barry was instrumental in launching the first dedicated benzodiazepine withdrawal service in the NHS, guided by a treatment protocol devised by Professor Heather Ashton (revised 2002).
Ashton had raised the alarm on two million Britons suffering from physical and mental adversities from taking these drugs. The government, she observed, had swept a ‘medical disaster’ under the carpet for three decades. How did so many people get hooked on prescribed drugs that did them more harm than good?
The Sixties is a decade celebrated for the birth of ‘The Pill’. But another type of pill emerged as a mass marketing success in the 1960s. Freedom brought choice, but with that came social angst. The drug companies exploited the stress of modern life, influencing the classification of psychiatric disorders to expand the scope of neuroses. Mental health was a new frontier, and depression and anxiety were presented as highly prevalent conditions which could be relieved by medication.
Although antidepressant drugs were available, they had toxic effects and could be overdosed to commit suicide. The ubiquitous solution to nervous disorders was a new class of drugs, the benzodiazepines. These drugs replaced barbiturates (eg Mandrax), a class of sedatives that had superseded bromide, which had tended to cause poisoning. Benzodiazepines were an improvement on barbiturates in producing fewer side-effects, but they were no less addictive.
Primarily used to treat anxiety, insomnia and panic disorder, benzodiazepines became one of the most commonly prescribed drugs in the world. The first was chlordiazepoxide (marketed as Librium), introduced in the US in 1960, but the best known is Valium (diazepam), released in 1963. A plethora of similar drugs appeared as other companies sought a share of the market. Each new benzodiazepine was extolled for unique benefits, but in reality, the overriding motive was profit, as described by Vernon Coleman in The Medicine Men (1975):
‘In 1971 Roche, the manufacturers of two big-selling drugs, Librium and Valium, decided to introduce a third drug in the same group, this time called Nobrium. It was generally thought that the sole reason for the introduction of the new product was the fact that the patents on the other two highly successful benzodiazepines were due to expire within a couple of years. Nobrium, launched at a very high price considering that its makers did not need to do much new research, was promoted with unprecedented enthusiasm. The difference between the new drug Nobrium (proper name medazepam) and the old drug Valium (diazepam) can be judged by comparing the chemical names. The formula for Nobrium is 7 chloro-2, 3-dihydro-1-methyl-5-phenyl-1H-1, 4-benzodiazepine whereas the formula for Valium is 7 chloro-1, 3-dihydro-1-methyl-5-phenyl-2H-1, 4-benzodiazepine-2-one. Hardly a difference likely to involve extraordinarily expensive research.’
By 1975, Librium and Valium accounted for three-quarters of the tranquilliser trade. Although generically aimed at neuroses, Librium had claimed antidepressive action, Valium was best for alleviating anxiety, and the new drug Mogadon (four times the price of Valium) was indicated for insomnia. Coleman noted that 14 per cent of Britons were taking Valium, which had 26 indications ranging from agitation to rheumatism to hypertension. Some patients were given two types of benzodiazepine, based on their claimed effects.
Glossy brochures were distributed to doctors and pharmacists, filled with impressive graphs and charts, but there was little substance to the therapeutic hubris beyond the basic tranquillising effects of benzodiazepines. The pharmaceutical industry succeeded in reframing neurotic disorder from a problem needing psychotherapy to a disease requiring chemical intervention. In the last decades of the twentieth century, Americans were diverted from the couch to the medicine cupboard. Coleman lamented the ensuing change to medical practice:
‘When the unhappy consumer goes to see his doctor, he sees a man who has been pressured into believing that anxiety and depression are pathological. The manufacturers of anxiolytics and antidepressants have to sell their wares to the doctors who can prescribe them. So a great deal of research is published to show that people who are anxious or depressed should be treated with medicines of one kind or another. As a result it is very difficult for a doctor to turn a patient away without pharmacological help.’
Millions of people have been prescribed these pills, but like antidepressants (on which I have written extensively), the result was not cure but biochemical dependence. As the Committee on Safety of Medicines belatedly advised in 1988, benzodiazepines should be prescribed for no more than four weeks, with a gradual reduction in dose after two weeks. This did not stop doctors from repeating prescriptions ad infinitum. In an interview on BBC Radio Four in 1999, psychiatrist Malcolm Lader remarked: ‘It is more difficult to withdraw people from benzodiazepines than it is from heroin.’
In his 2019 book The Benzos Story: 1960s-1980s, Vernon Coleman collated excerpts from the enormous amount of mail from people up and down the country struggling on benzodiazepines. Mrs J, from Hertfordshire, had a typical experience of dependence and medical indifference: ‘I feel so weak and helpless now that I have allowed myself to become hooked on them. I do wish someone could help me as I feel that it is impossible to come off them without any help. My GP insists that I am an anxious person. He says I am better on them so what chance have I of getting off them? They have really taken over my life and I can honestly say that I get suicidal. I was put on the pills 15 years ago for the “change”. Surely this must be over by now?’
As I will discuss in Part Two, long-term benzodiazepine use incurs serious health risks, with compelling evidence of neuropathy and brain damage. Benzodiazepines have clinical value, but without proper monitoring and timely withdrawal, they take the sufferer out of the frying pan and into the fire.