The hidden epidemic: How Ireland has become addicted to benzodiazepines
The online market for highly-addictive benzodiazepines is booming, but what effect is it having on our health? Katie Byrne reports on Ireland’s love affair with sedatives
When her mother suddenly died, Nicola O’Toole* was left devastated. She had no idea how she would keep it together through the ordeal of the funeral and the difficult days that followed.
Then a concerned friend had an idea. She gave Nicola four Xanax — a potent yet common sedative — and told her to take just half of one tablet at a time.
“The effect was pretty much instant,” Nicola (38) recalls. “I felt like I could get through the funeral without breaking down every five minutes.
“About a week later, I asked if she could get me some more. She was getting them from her friend who was buying them online.”
Within weeks, Nicola was putting in ‘orders’ with her friends and taking a tablet with a glass of wine in the evenings before bedtime. Then, because one wasn’t having an effect, she started taking two at a time.
“Nobody told me about physical dependency but I realised that things were escalating about six months later.
“I went on a trip to South Africa and I ran out of my supply after five days. I can only describe the last week of the holiday as ‘the horrors’. I was shaking and everything.
“I was with my auntie and when I told her that I needed to go to a doctor to get Xanax, she told me that she thought I had a problem.
“She put me in contact with her psychologist when we got home. He was amazing. He told me that I was suppressing my grief with medication and we came up with a programme that helped me gradually taper off. It took longer than I thought, to be honest.”
Nicola’s experience is frightening, but it’s not unusual. The black market for Xanax and other benzodiazepines — a highly addictive family of sedatives used to treat anxiety, insomnia and alcohol withdrawal — is booming, and those buying the pills come from all walks of life.
It was reported this month that there have been 189 incidents linked to benzodiazepines recorded in the Dublin Metropolitan Region since May of last year — inner-city TD Maureen O’Sullivan says they are being sold like “sweets” on the streets in her area.
The rapid growth in online sales is also feeding the problem. Late last year, the HPRA, Revenue’s Customs service, and An Garda Síochána released a photograph displaying a haul of illegal prescription medicines that they had seized as part of a Europe-wide Interpol-coordinated project.
The number of medicines in the teeming pharmacopoeia, valued at over €850,000, was over three times the amount seized the previous year. The most popular illegal prescription medicine? Benzodiazepines.
In a society where anxiety disorders are more prevalent than ever, but access to mental health services remains difficult, it’s no surprise that some people turn to the internet in a misguided attempt to self-medicate.
“So much of that world is hidden,” says Dr Harry Barry, the author of best-selling book, Flagging Anxiety and Panic. “You’re not seeing it and you’re not hearing about it.”
People often don’t realise that most of the benzodiazepines available on the internet are fake versions of well-known brands like Valium and Xanax. And not all the pills bought online are for medicinal use: for some young people, popping a Xanax is not all that different to having a pint.
There is growing disquiet in the UK about the use of Xanax as a ‘party drug’, and a spate of recent headlines have warned of an ‘emerging crisis’ in the use of the drug among young people.
Here, the National Student Drug Survey 2015 revealed that 30pc of students have used prescription medication for recreational purposes.
Most of these young people will be unaware of the drugs’ terribly addictive properties.
Benzodiazepines enhance the action of the ‘inhibitory’ neurotransmitter gamma-aminobutyric acid (GABA), which calms the central nervous system. They’re prescribed by GPs as a short-term solution to treat anxiety. They can be very effective when used correctly, but misuse has always been an issue.
In the past, GPs faced criticism for over-prescribing. However, as awareness grew of how addictive the drugs could be, guidelines were put in place with the aim of encouraging careful prescription.
“Everyone assumes that these drugs are being massively supplied by GPs,” says Dr Barry, “but, in practice, a lot of them are prescribed by psychiatric services and a lot of them are being bought on the streets and online.
“We have very strict guidelines so most GPs would be extremely careful about their prescriptions. They usually only give them in very small amounts and for short periods of time.”
Medical guidelines recommend that benzodiazepines should be limited to a period of two to four weeks when prescribed by a GP.
This means that, in the vast majority of cases, a person using benzodiazepines on a regular and consistent basis is either under the care of a psychiatrist or illegally procuring them.
A spokesperson from Pfizer, the manufacturer of Xanax, said they are “alarmed by the rise of counterfeit Xanax” on the internet and dark web, and they estimate that 96pc of the Xanax samples that they analyse in their counterfeit labs are fake.
They added: “Counterfeits are difficult to distinguish from the real medicines and are extremely dangerous by their very nature, given that they are not produced under regulated manufacturing conditions to ensure their safety.
“We have found dangerous ingredients such as boric acid, heavy metals and floor polish in counterfeit medicines.”
Consultant psychiatrist Dr Colin O’Gara, who is the clinical lead for Addiction Services at St John of God Hospital in Dublin, says he has noticed the number of people seeking treatment for benzodiazepine addiction at the hospital rising with the advent of the internet.
“There used to be a situation where only younger people were accessing the pills over the internet,” he says, “but now we’re seeing middle-aged and older people accessing them too.”
He says the dangers of the drugs are insidious. “It happens slowly: a person will start off on maybe one sleeping tablet at night or a small dose of a benzodiazepine and, gradually, in small increments, it goes up.
“One of the problems is that people don’t believe they are addicted. A lot of the people we see, even with a vast benzodiazepine addiction, and who might have had a family intervention, don’t realise it’s problematic.”
“Like a lot of addictions, it can be covert,” he adds. “People are buying off the internet and not telling anybody about it. And unless people are grossly intoxicated, it does remain hidden.”
Of course, there is a line between misuse and addiction, just as there is a difference between addiction and physical dependence.
Some experts believe that physical dependency to benzodiazepines can occur in as little as two weeks. This doesn’t necessarily mean that the person is addicted. However, it does mean that the use of benzodiazepines can become problematic, especially when they are mixed with other drugs, including alcohol.
According to the Health Research Board, benzodiazepines were implicated in 228 deaths by poisoning (overdose) in 2014, compared to 77 deaths in 2004.
There are also extensive side-effects, including irritability and impatience (when the effects of the drug wear off); loss of libido, binge eating, weight gain and cognitive impairment.
“They dull our cognitive capacity and people become sluggish and slow,” explains Dr Barry. “They are delayed. So then there would be a significant concern on the effects on driving.”
The trouble is that people often aren’t aware of the side effects when they start taking benzodiazepines. Health and wellbeing coach Alison Canavan (39) says she didn’t even realise that Xanax was classed as a benzodiazepine until she went back to college as an adult student.
The former model was first prescribed Xanax for anxiety when she was 16. The doses gradually increased when she moved to America to pursue her modelling career. “Sure, they prescribed me everything in America,” she says. “I didn’t know how addictive they were.
“When I started reading into them, I thought, ‘Oh, so that’s why I used to be like that! That’s why I had all those symptoms. That’s why I used to get shaky and down’.
“I can only speak from personal experience, but I used Xanax to avoid dealing with shit. When you take Xanax you don’t have to deal with anything because all is good in the world.”
Five years ago, Canavan began weaning herself off the drug. She says she found it very difficult and admits that she kept a supply of break-glass-in-case-of-emergency pills in the medicine cabinet up until a year ago. “Even though I hadn’t had an anxiety attack for years, it was for just in case I did.
“The medication put me into a cycle of need,” she continues.
“I need it to feel better. I need it to feel normal. I need it because I’m scared of having an anxiety attack. I need it because I’m going into the subway. I need it because I’m going to an event...
“I wasn’t relying on myself. Or asking: can I use my breathing? Can I face my fear? Can I look at the parts of myself that I’m avoiding all the time?”
Dr Barry agrees: “The real difficulty is that because you’re having this short-term relaxing feeling, on the days when you have stress when you’re not using it, there can be that urge. You may think, ‘Maybe if I just took one, I might calm down’.”
Benzodiazepines can, over time, make people less resilient, he adds.
“We need to teach people skills to help them deal with anxiety and panic attacks. Otherwise they can take benzodiazepines instead of learning how to deal with life’s difficulties.”
* Names have been changed to protect identities
Nicola O'Toole * (38) started taking Xanax after the death of her mother. She realised that she was physically dependant six months later
"I started taking Xanax in 2016. My mam died suddenly and I was in an awful state. A friend gave me four Xanax before the funeral, and told me that I only needed to take half of one at a time.
The effect was pretty much instant and I felt like I could get through [the funeral] without breaking down every five minutes.
About a week later, I asked if she could get me some more. She was getting them from her friend who was buying them online.
I started putting in orders and I would take one with a glass of wine most evenings before bedtime. Then I started taking two because one wasn't having the same effect.
Nobody told me about physical dependency but I realised that things were escalating about six months later.
I went on a trip to South Africa and I ran out of my supply after five days. I can only describe the last week of the holiday as 'the horrors'. I was shaking and everything.
I was with my aunty and when I told her that I needed to go to a doctor to get Xanax, she told me that she thought I had a problem.
She put me in contact with her psychologist when we got home. He was amazing. He told me that I was suppressing my grief with medication and we came up with a programme that helped me gradually taper off. It took longer than I thought, to be honest.
Now, it's the first thing I say to people when they're going through grief. Don't take Xanax, because the feelings will come back with a bang when you stop taking them."
How to get help if you are addicted
'Weaning off benzo-diazepines can be dangerous," says Dr Colin O'Gara. "If you talked to me about opioids or nicotine or a number of other stimulants, then there wouldn't be an immediate concern about somebody withdrawing on their own.
"However, with benzodiazepines and alcohol, you would be concerned about withdrawal phenomena. If your system becomes used to those drugs, you may have a problem with seizures and so on.
"It boils down to the dose: how long you've been taking them, what level of dependency you have, and how susceptible you are to certain phenomena of withdrawal.
"The first step is primary care - go to your GP.
"You could also try the mutual support world like NA (Narcotics Anonymous) - just remember that they don't offer medical advice."
A spokesperson from World Benzodiazepine Awareness Day (w-bad.org) says users can reduce the severity and duration of withdrawal symptoms by following the guidelines in The Ashton Manual, by clinical pharmacologist Dr Heather Ashton. (Ashton was interviewed as part of Shane Kenny's RTÉ documentary, 'Benzodiazepine Medical Disaster')
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