By Caitlin Scarr (2012)
They are relaxing, easily obtainable and cheap, and could be fatal. Benzodiazepines, therapeutic drugs that are widely available in Australia, have been linked to hundreds of deaths, and a new federal drug policy has excluded them from being monitored.
A federal prescription drug monitoring system, to be implemented in July, will work to reduce prescription drug abuse throughout Australia. Certain drug prescriptions will be recorded on a database and will be available to doctors and pharmacists in a real-time setting.
Victorian coroner Audrey Jamieson has suggested that this system could “reduce deaths and harm associated with doctor shopping.” Doctor-shopping is the act of visiting different doctors to receive multiple prescriptions for a drug. In doing so, the patient is able to obtain a much higher quantity.
Dr Alex Wodak, of St Vincent’s Hospital in Sydney, is an expert on drug abuse and drug policy, and he believes that the real-time monitoring system is necessary to combat a growing trend in Australian drug abuse. “Consumption of opiates is increasing rapidly in Australia, almost entirely from prescription drugs,” he said.
Dr Fiona Shand, a psychologist with expertise in substance abuse, was involved with the National Drug and Alcohol Research Centre. She spent time examining the Tasmanian monitoring system, which is the model for the soon-to-be-implemented federal system.
The Tasmanian system immediately identified potential doctor-shoppers, and restricted their access to the drugs, either by providing a minimal amount of the drug, or by supervising its consumption. Dr Shand believes that this monitoring is very important.
She said: “Whilst [opioids] are really useful … in terms of managing acute pain, post-operative pain, cancer pain – there’s more doubt about how beneficial they are in terms of chronic pain – they are also capable of causing great harm, and what we’ve seen over the last couple of decades in Australia is a rapid increase in the number of fatal and non-fatal overdoses and other harms associated with schedule eight drugs.”
Schedule eight drugs are prescription drugs designed for therapeutic use that are likely to be abused or cause dependence. The federal system will only monitor drugs that are classified as schedule eight, which will include opium, oxycodone and methadone. Benzodiazepines, which are highly addictive and subject to abuse, will not be monitored because they are classified as schedule four.
Benzodiazepines, a minor tranquiliser that is commonly prescribed for anxiety and insomnia, have been popular among drug abusers for over a decade. A 15-year-old article from the Australian Prescriber reported a prevalence of benzodiazepine abuse in the mid-1990s.
Dr Tony Joseph, the Director of Trauma and Emergency at the Royal North Shore Hospital, has observed prescription drug abuse for over 20 years. “When I was in general practice,” he said, “I would sometimes get patients coming in wanting prescriptions for Benzodiazepines, sometimes narcotics … [prescription drug abuse] has never gone away.”
The 2007 National Drug Strategy Household Survey reported that nearly 10% of injecting drug users had also recently injected benzodiazepines. Benzodiazepines were the second-highest reason for paramedic callouts in Melbourne last year.
Jamieson recently released a report on drug-overdose deaths in Victoria in 2010 that found half were linked to benzodiazepines. “Overall,” she reported, “acute benzodiazepine toxicity contributed to more drug deaths than either acute illicit drug toxicity … or acute alcohol toxicity.”
Following her findings, Jamieson recommended that the federal government implement a real-time prescription monitoring system that included benzodiazepines. The Tasmanian system, Jamieson said, which had included a type of benzodiazepine called alprazolam, or Xanax, proved that such a federal monitoring system was “feasible.”
Jamieson has also recommended reclassifying benzodiazepines as schedule eight. “The major benefit of moving benzodiazepines to Schedule eight is that in Victoria, they would be subject to more stringent restrictions on prescribing and dispensing – restrictions that are appropriate and might help to reduce deaths.”
Dr Wodak believes that the system should be able to go ahead as currently planned, as it will tackle what he perceives to be the main problem. “In an ideal world,” he said, “[benzodiazepines] would be included [in the monitoring system]. This is not an ideal world… more people die from [schedule eight drugs than from benzodiazepines].”
The issue with benzodiazepine abuse, Dr Joseph believes, is the fast-built tolerance to the drug. Within a few days, the user requires a larger dose in order to achieve the same effect. “Benzodiazepines should only be used very short term … we know from the way they work that people shouldn’t be taking them long term.”
Dr Shand believes that benzodiazepines are a greater problem than many people realise. “We did an analysis of the coroner’s starter in Tasmania and others have done it for New South Wales, and [benzodiazepines] are heavily implicated in fatal overdoses.
“So I do think they’re actually killing people, and I think they’re actually probably in combination with other drugs at least as dangerous as many of the opioids out there … should they be monitored? I’d give a cautious yes.”
The relaxation effect of the drug has proven popular for drug abusers seeking a depressant experience, or hoping to work against the effects of a stimulant. A big drawcard for the drugs, some believe, is the ‘prescription’ label.
Heath*, a drug abuser and dealer, has taken and sold benzodiazepines recreationally. “In knowing they’re prescribed, you just feel a little bit safe,” he said. “I reckon if someone draws the line at not wanting to do drugs, then basically they see this prescription drug as almost a bypass to try what they want to without having that negative stigma of doing drugs.”
Heath says that there is little stigma attached to the idea of abusing prescription drugs. “I know people that draw the line, say, at [methamphetamines] … they won’t touch [Xanax]. They won’t touch them. They don’t want a bar of them … there’s a lot of negative hype about them. It’s called Jail In A Bottle.”
The appeal of selling and using benzodiazepines is obvious, Heath says. “You can make money.” A prescribed bottle of benzodiazepines, containing about 50 pills, can about $10 from a pharmacy. On the black market, that same bottle of pills can cost up to $500.
Ease of access to the drugs is one of the main contributors to the prevalence of benzodiazepines. Doctor-shopping has been common as a way of obtaining benzodiazepines, and this will not be affected under the proposed monitoring system, as benzodiazepine prescriptions will not be tracked.
Former benzodiazepine abuser John* is surprised at the ease with which they are acquired. “Considering what’s happened to me, I think it would be stupid for them to exclude [benzodiazepines from the monitoring system]. They can be so so so dangerous.”
John had some experience with benzodiazepines. He and some friends would casually take a few benzodiazepines on the weekend “just to chill.” When mixed with other drugs, such as alcohol or marijuana, the effects of the benzodiazepines were magnified.
One accident, caused by the combination of benzodiazepines and alcohol, was enough to change John’s habits. “I went to stand up to get a drink. Now there was this huge glass table in front of us, and before you know it, I felt myself tipping over. You know the moments before you fall … and your body goes into rescue mode to try and break your fall? … I had absolutely no control over my limbs…I remember I kept thinking ‘just move your arms, dude’ but…nope. Crashed face first into the glass table.”
Thirty-seven stitches later, after a stint in hospital and with a very sore face, John had a deeper appreciation for the dangers of misused prescription drugs. “What really gets me is that that stuff I was taking that ended up with me in stitches like that … that stuff is legal, you know? And that’s pretty scary. I mean, look how easily we got our stuff. Who knows what could happen?”
A common side effect of benzodiazepine abuse is memory loss. Internet forums for drug users are filled with stories of blackouts from benzodiazepine abuse. One user, called DrinkMas, reported a 19-hour blackout, in which time he drove a car.
Heath has experienced many blackouts, including one that lasted from Sunday to Tuesday. When prompted for stories, Heath cannot recall too many. “I don’t know, there’d be so many stories, but I don’t really remember any of them. That’s probably the irony of it.”
Amid the blackouts, the hospitalisations and the black market deals, benzodiazepines are yet to find their way onto a federal monitoring system. Dr Wodak believes that the introduction of a federal monitoring system, or any other preventative measures, is long overdue. “We don’t face the issue of people dying from prescription overdoses,” he said. “It’s an issue already. It’s not a threat any more. It’s happening.”
*Names have been changed or withheld to protect privacy.