2011 Study: Drug Discontinuation Effects Are Part of the Pharmacology of a Drug

[[La...]]

This study covers the topic of drug discontinuation, and while it does not focus on benzodiazepines, it does mention them a number of times.

 

Here are some key quotes:

 

"Drug withdrawal effects are usually disregarded in pharmacology and medicine until adverse clinical events force them to be noticed."

 

"When a drug is stopped, the underlying state can recur. This unmasking of the underlying state, such as recurrent hypothyroidism when full replacement dose of thyroid medication is discontinued, needs no further explanation. The other withdrawal syndromes seem to have different biological bases. In general, the body can adapt in some way to the effect of drug administered at a high enough dose for a long enough period of time to induce the adaptation. When the drug is discontinued, the body eliminates the drug more rapidly than the adapted state subsides. The persistence of the adapted state in the absence of the drug leads to the withdrawal or discontinuation effects. When the discontinuation leads to enhanced disease activity, it can be difficult to differentiate from simply recurrent disease and hard to recognize."

 

And from the conclusion:

 

"Drug discontinuation effects are well known for some classes of drugs. Opioid withdrawal was known in Roman times (170 AD), since Scarborough (1995) described the physician Galen's comments about his treatment of Marcus Aurelius with opium as not leading to addiction. This implies that Galen knew about addiction and therefore drug withdrawal. Medical focus has continued to be on psychoactive drugs with attention on selective serotonin reuptake inhibitors (Black et al., 2000) and benzodiazepines (Petursson and Lader, 1981). Even endocrine drugs have withdrawal syndromes (Hochberg et al, 2003). Recommendations have been to taper rather than abruptly discontinue all of these drugs because early studies with barbiturates indicated that the severity of the withdrawal effects was a function of the rate of fall of drug concentration in the blood of the subject (Jaffe, 1980)."

 

"Despite all of this knowledge, the possibility of drug discontinuation syndromes has usually been neglected until adverse clinical events force them to be noticed. We should consider discontinuation effects as part of the pharmacology of the drug. Attention to the possibility of drug discontinuation effects is an important part of drug safety evaluation."

 

Here's the full article:

 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3200000/

 

 

[[MT...]]

Lapis, you find great stuff. I was especially struck by this section:

"We should consider discontinuation effects as part of the pharmacology of the drug. Attention to the possibility of drug discontinuation effects is an important part of drug safety evaluation."

 

I've been reading "Your drug may be your problem" by Breggin and seeing how complex and deep this whole web of mis and underinformation is. ARgh.

[[La...]]

Yes, I keep coming across Dr. Breggin's name. He's on the right side of the divide.

 

The author of this article is a pharmacist, and I really think pharmacists can play a big role in educating people -- verbally and in print. They should talk to people at the counter. And whatever info they hand out to people at the time of sale should definitely state that benzos should be used short-term only (2-4 weeks), and it should explain the issue of tapering/withdrawal.

[[MT...]]

Yep, that wd issue should be in bold neon colors on the patient info!

[[La...]]

Such a small thing could make a big difference. It seems so easy to do.

[[MT...]]

Might affect sales though so it's unlikely to happen

[[La...]]

It shouldn't be about sales; It should be about safety. I'm not sure if there are differences between the U.S. and Canada when it comes to those information sheets, but my understanding is that they should provide instructions to the patient about how to take the medication and any warnings. Also, the pharmacist should be talking to the patient -- especially if it's a new prescription -- to ensure that s/he understands how to take it and that there are no interactions with other medications that the person is on.

[[MT...]]

From what I've read about the drug info, the pharmaceutical companies and doctors have intentionally edited the materials so that they aren't as scary to potential patients...or as honest. Plus, to many, many medical providers this whole wd thing is a bit fairies and pixie dust. I'm someone who is totally open to believing in fairies and pixie dust anyway. If they could help...

[[La...]]

Yes, let's get Glinda the Good Witch (fairy godmother) to come down and help us! I could use a magic wand right about now.  :laugh:

 

Seriously, though, it would be good to talk to some pharmacists to get their take on such things.