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ARTICLES:06oct03a: Susan Tuke: Benzodiazepines: A Hidden Epidemic.
(report written May 2003)
"I remember coming home from school and getting sent straight to the shops to get the shopping in. It was a case of if we didn't go to the shops, we didn't get any tea.Extract: 'About my mother' Anon (1996).
A group of drugs which are responsible for an increase in drug-related deaths and unsafe for use in pregnancy, continue to be prescribed and are now flooding the illicit drugs market.
Benzodiazepines (most tranquillisers and sleeping pills, e.g. Valium,™ Mogadon,™ Ativan,™Librium™etc.), are safe drugs when used short-term and according to the guidelines, but their 'safe' image may be their greatest danger.
40 years of benzodiazepine prescribing has brought a catalogue of problems in its wake and these are being compounded by their misuse.
As well as increased drug-related deaths and hazards to the unborn child, the immediate dangers of benzodiazepines include increased road traffic accidents, increased falls in the elderly and involvement in crime and criminal behaviour.
Longer term, benzodiazepines use can cause severe addiction and the deterioration of physical and mental health.
Much has been written, but little done, to address the problem of benzodiazepines, although the cost of not doing so, must outweigh that of tackling the issue.
Most facts about benzodiazepines are available, but have failed to reach public awareness.
The purpose of this document is to bring some of those facts together and highlight what has become, a hidden epidemic.
Incidence of Benzodiazepine use
GLOBAL CONSUMPTION RISING
Global benzodiazepine (BZ) consumption rose between 1991 and 2000,
with Europe the highest consumer.1|
Several European countries report high BZ consumption rates, Ireland being one of the highest. Belgium, Spain and Portugal also have high BZ consumption. 2
In Ireland, 10% of all adults take prescribed BZs, 20% of whom are elderly. Of these, 70% are long-term BZ users.3
Fig.2 Global diazepam consumption, 1991-2000, in billions of defined daily doses (adapted). 1
BZ-related problems are common worldwide and one international study indicates that long-term prescribing is still accepted practice, 4 for example, in The Netherlands, an estimated 50,000 long-term prescribed BZ users are created annually. 5
"The optimistic idea that chronic benzodiazepine users would soon die out, cannot be confirmed"
Van der Vaals F, 20015
In the UK, there are at least 13 million prescriptions for BZs
per year, 8 with 1 - 1.5 million people currently taking them.
Long-term BZ usersAvailable figures show at least 1 million people currently on long-term BZ prescriptions (> 4 months) in the UK,10 some of whom have been on their drugs for up to 40 years.
GP practices in the UK average 100 - 200 patients on long-term BZ prescriptions. 11 A recent audit in one UK health care trust found around 3.5 thousand prescribed BZ users amongst 29 GP practices; (average 125 patients per practice). Of these, almost 70% were long-term BZ users (>2years).
Another UK study estimated that in one District Health Authority, there are an estimated 14 thousand patients on long-term BZ prescriptions (>6 months). 12
BZ misuse is widespread. In Hong Kong BZs were rescheduled as a 'dangerous drug,' which halved prescribing and their subsequent supply to the illicit market.6 Results from a questionnaire issued by the Pompidou Group in 2001, revealed that no country questioned could provide figures on the prevalence of BZ abuse or their illegal consumption, although all countries agreed that BZs posed a public health hazard. 7
The prevalence of BZ misuse in the UK has been reported by the Department of Health variously, as 16% 15 and 90% 13, 14 for England, 55% 15 for Scotland and 23% 15 for Wales.
GENERAL HEALTH PROBLEMS
Benzodiazepines (BZs) are effective drugs used Short-term,
but long-term use brings problems with side effects, dependence
and deterioration in health.
In 1988, the Committee on the Safety of Medicines issued guidelines regarding BZs and recommended that they should only be prescribed for 2-4 weeks, due to the risk of dependence. 21
"There is increasing evidence that long-term prescribing of benzodiazepines may cause harm." SMMGP, 1998. 16
A major effect of benzodiazepines (BZs) is the enhancement of the GABA (gamma amino butyric acid) neurotransmitter system present throughout the brain and nervous system. 17
The function of the GABA system is to regulate and 'damp down' reactions to stimuli and excitation throughout the system. The enhancement of GABA is why BZs 'work' so effectively as tranquillisers and sleeping pills. BZs are also used as anti-epileptics, muscle relaxants and in hospital procedures (where their amnesic qualities/side-effects are an additional benefit). 18
Many BZ side-effects are also their 'therapeutic' sedative effects, such as drowsiness, ataxia, fatigue, confusion, weakness, dizziness, vertigo, fainting etc. 19
"Symptoms such as persistent tinnitus, involuntary movements, paraesthesia, perceptual changes, confusion, convulsions, abdominal and muscle cramps, and vomiting may be characteristic of benzodiazepine withdrawal syndrome." Wyeth Laboratories. 1990 20
The changes in brain chemistry caused by BZ use become harder to reverse over time, 22 increasing the risk of protracted withdrawal syndrome.
"It is more difficult to withdraw someone from benzodiazepines than it is heroin" "the withdrawal symptoms are so intolerable that people have a great deal of problem coming off". Lader M.1999 23
Dependence on BZs can occur after 3 weeks of continuous use, and after 3 months in nearly half of users. 24 The BZ withdrawal syndrome lasts from four weeks to a year or more 25 (British National Formulary, 2002) and can be severely disabling.
Multiple neurological symptoms are associated with BZ use, particularly during withdrawal. These include disturbances of perception, sensation, co-ordination and consciousness.
"Most benzodiazepines impair and compromise a wide range of basic skills which are absolutely necessary for coping with the intellectual and psychological demands of everyday living." Hindmarch I. 1999 26
A major effect of BZ use, is cognitive impairment, with memory functions such as information processing, specifically impaired.27 Memory "blackouts" are also common; the sufferer may have performed complex tasks such as driving a car but have no recall. 28 The consequences of this impairment can be a deterioration in behaviour and day-to-day functioning, which tends to reverse after withdrawal of BZs. 29, 135.
Cognitive and other coping mechanisms are vital for
negotiating busy streets etc. With these abilities
impaired by BZs, many long-term users find themselves
increasingly housebound with agoraphobic-type symptoms.
This has a significant impact on both the sufferer and
those around them.
In one study, 20% of long-term BZ users developed incapacitating agoraphobia, which largely disappeared after withdrawal from the drug. 31
the benzodiazepine tranquillizers and hypnotics, more than double the risk of injurious accidents/ the use of the most frequently prescribed impairing medication, the benzodiazepine tranquillizers and hypnotics, more than double the risk of injurious accidents 32 De Gier 1998/9.
Psychomotor impairment caused by BZs increases the risk of falls (particularly in the elderly)33 and road traffic accidents. 32,33
"Striking deterioration in personal care and social interactions has been reported " [with BZ use]. WHO, 1985 34
Depression, aggression, irritability, mood swings, impaired response to stress, excess anxiety, general dysphoria - all are adverse effects of BZ 18 use and may be mistaken for mental health problems.
"This hatefulness was of a peculiar type. The patients were unhappy with it; they realised that it was unnatural and without basis, but were impotent to do anything about it "Feldman P., 1962. 35
An increase in suicidal thoughts and tendencies associated with BZ use has been reported since the early 1960s. 36,37.
" even small anatomical, biochemical, or physiological insults to the nervous system may result in adverse effects on human health". Environmental Protection Agency, 1997 38
Long-term BZ use is associated with an overall deterioration in general health, reflected in increased use of health services 39 and increased prescribing for other health problems.
In 1989, findings from a large UK survey revealed high rates of ill health amongst long-term BZ users. These users were prescribed on average 3 types of other medication. The medications most commonly prescribed were for pain relief, gastrointestinal problems and heart problems. 136
In 2001, a report from The Netherlands, reflecting the above, showed long-term BZ users being prescribed twice the amount of medications for other complaints as short-term BZ users. 5
An improvement in general health after withdrawal from BZs reflected in reduced use of health services has been reported. 40
BZ-related problems can manifest in all bodily systems including the endocrine 41 and immune system. 42
"PWS (post withdrawal syndrome) is likely to be a genuine iatrogenic complication of long-term benzodiazpine treatment" Higgitt A, 1990 43
Symptoms persisting long after withdrawal from BZs; a 'Post-withdrawal syndrome,' has been identified by several authors, indicating that these symptoms are not a return of the original problem. 43,44.
The drug flumazenil, a BZ antagonist ('antidote') has been found to eliminate or reduce many 'post withdrawal symptoms'. 45,30.
Recovery from BZ withdrawal can continue over months or years in some patients. 39,40. 135.
"repeated insult to the nervous system could lead to an adaptation. There are, however, limits to this capacity, and… further exposure could lead to frank manifestations of neurotoxicity at the structural or functional level" Environmental Protection Agency, 1999.38
Reports are increasing in some long-term BZ users of problems consistent with the Environmental Protection Agency's criteria for functional neurotoxicity listed below: 38
Adverse effects in somatic/autonomic, sensory, motor and cognitive function, together with measurable alteration in BZ receptor function in the brain, 22 suggest that BZs can cause neurotoxicity with long-term use.
DRUG WITHDRAWAL AT BIRTH
RISK OF COT DEATH
"Exposure of our most valuable resource, our children, to harmful developmental effects of drugs is a problem of staggering proportion." Huestis M. 46
It is accepted that there are dangers to newborn babies exposed to 'dangerous' drugs such as alcohol and opiates during pregnancy, but the risks of prescribed drugs during pregnancy are rarely examined. In 1978, the Australian National Drug Information Service stated that benzodiazepines (BZs) were contraindicated during pregnancy. 47
Benzodiazepines are classified by the US Food and Drug Administration (FDA), as pregnancy category 'D', 48, 49. which should not normally be taken during pregnancy and category 'X',50 which should never be taken during pregnancy (opiates are category 'B' or 'C'). *See FDA categories below.
BZs readily cross the placenta reaching high levels in the foetus 51,52 and are also present in breast milk. 53.
Worldwide, an estimated 85% of all psychotropic medicines prescribed to pregnant women are for BZs. 54 The incidence of BZ use during pregnancy is unclear and figures varying from 1-3%, 55 to 40% 56 have been suggested. These figures do not include women who misuse BZs, 90% of whom are of childbearing age 57.
BZs were detected in 18% of infants born between October and November 2000 at a Glasgow maternity hospital 58
"We noted a high rate of prescribing of benzodiazepines to pregnant women in spite of documented evidence that this may lead to the so-called "floppy baby syndrome" of neonatal drowsiness, hypotonia and withdrawal symptoms" O' Shaughnessy P., IMJ, 1993 59
|It is a legal requirement that all prescribed medicines in the UK are dispensed with an attached Patient information leaflet. 60 Information leaflets for BZs state that they should not be taken during pregnancy, but not all women receive this warning. Although illegal, some prescriptions are currently issued without leaflets. 61 The Committee on Safety of Medicines issued a reminder warning of the dangers of BZ use in pregnancy in 1997, 53 but prescribing of hypnotics and anxiolytics to women of childbearing age rose between 1994 and 1998 (fig. 1). 62||
Babies exposed to BZs during pregnancy are at risk of the following:
Prenatal BZ exposure can cause toxicity and/or withdrawal effects at birth. Affected babies may need months of treatment, sometimes in special care, 68,69,70 whereas the adverse effects of prenatal opiate exposure lasts 2-4 weeks. 70
Flumazenil, a BZ antagonist ('antidote') that can reverse many effects of BZs (licensed for use in surgical procedures and overdose), has been used in emergencies (outside of license) in some BZ-exposed neonates, successfully reversing most of the above adverse effects. 71,72,73,74
"The baby might have died on a postnatal ward of an apnoeic episode had he not been admitted to a special care nursery." The Lancet, 1977 70
BZs are a risk factor in cot death as they can interfere with breathing regulation 64,65. and the drug can remain active in the baby's system for long periods. 51,56
No specific investigation appears to have been done into prenatal BZ use and cot death.75 Instances of cot death in BZ-exposed infants have been reported 76,77 and in one study the use of nitrazepam has been implicated in sudden unexpected deaths in children. 78
"Diazepam should be avoided in pregnant or lactating animals… in humans, it has been shown to be teratogenic when used during the first trimester of pregnancy. Diazepam crosses the placenta and is present in milk." Veterinary advice, 2001 89.
Conflicting reports of the incidence of cleft palate and other malformations have continued to emerge since the 1970s; the results remain unclear. A recent meta-analysis (2000) of 13 studies showed no increased risk of BZ-induced malformations from cohort studies and slight increased risk from case-controlled studies. 79
Animal studies show that BZs can interfere with foetal development including neurodevelopment, 17, 80 and development of the immune system. 81,82
Current human research 83,84 reflects many animal findings, as do the growing anecdotal reports.
An informal study amongst self-reported parents of 63 BZ-exposed children 85 revealed high rates of neonatal and later developmental problems; e.g. 30% needed treatment in special care at birth and 31% developed learning difficulties. Unexposed siblings were reported to be unaffected, indicating that further research is needed.
Cognitive and other health problems due to parental BZ use can impair parenting skills 86 with negative consequences for the children and the family. Research shows a direct link between parental BZ use (mainly maternal), and subsequent BZ use/misuse in their adolescent children. 87,88
Category X benzodiazepines include: Flurazepam, Estazolam, Temazepam, Quazepam, Triazolam
Definition of FDA pregnancy categories: The FDA-assigned pregnancy categories as used in the Drug Formulary:
FDA Pregnancy Category A
FDA Pregnancy Category B
FDA Pregnancy Category C
FDA Pregnancy Category D
FDA Pregnancy Category X
INCREASED DRUG-RELATED DEATHS
INCREASED RISK TO THE UNBORN CHILD
HIV INCREASED RISK OF HIV
Harder to withdraw from than heroin, 16 benzodiazepines ( BZs) are also more dangerous to the newborn, 90 and can cause more cognitive impairment during use. 91
Largely unrecognised as "dangerous drugs," the BZ group of drugs have encroached the illicit market, becoming major drugs of misuse worldwide and the low priority given to this problem has compounded it. 92
BZ dependence can underlie many drug misuser's problems, which may be being wrongly attributed to more notorious 'hard' drugs.
High rates of BZ misuse are reported worldwide, but accurate figures are scarce. In a questionnaire on the prevalence of illicit BZ use issued by the Pompidou Group for the Council of Europe, no country questioned could provide accurate figures.7
Diazepam and flunitrazepam are the main BZs abused worldwide, 92 but it has been shown that all BZs have the potential for misuse. When prescription of temazepam was restricted in 1996, misuse of this drug reduced, but there was a corresponding increase in the prescribing and misuse of diazepam. This was reported in both Scotland 93 and North West England. 94
In England, official figures for BZ misuse range from 16% 95 to 90% 13,14 There are probably over 100,000 illicit benzodiadepine abusers in the U.K., and the number is still rising. 96
Misuse of BZs is endemic throughout the illicit drugs scene, being used mainly as a 'secondary drug'. 94 BZs are used by drug misusers with alcohol, opiates, methadone, amphetamines, cocaine, and ecstasy, 97 for many reasons, including:
"benzodiazepine abuse caused considerable harm among the illegal drug-using population, opiate users suffered the most serious harm." Department of Health & Children, Ireland, 2002.3
with increased risk of heroin overdose,101 higher levels of HIV risk-talking behaviour, 102 poorer physical health and psychological functioning. 103 BZs are used with opiates for several reasons including:
Several countries report high levels of BZ/opiate use:
"Benzodiazepine abuse is common among injecting drug users as indicated by studies in Europe, USA, UK, Australia and India and is associated with markedly worse outcomes." SAHAI Trust, India 108
High rates of BZ use are also common amongst injecting drug users. In Australia for instance, up to 78% of injecting drug users use BZs (2000). 106 In the UK, Up to 49% of attendees at drug misuse centres had injected BZs. 107
"Benzodiazepines are a major contributor to drug deaths and are not a safe substitute for methadone." Keen J., 2001 109
BZs are commonly prescribed to treat addiction to other drugs and alcohol, particularly in combination with methadone, creating further problems and addiction.
In 1988/89, 24.9% of prescribed opiate users in the Northwest of England, used BZs, and 89.6% of those had been prescribed them. 110
BZs are the drug of choice during alcohol withdrawal, but if continued long-term, can cause dependence and compromise therapy due to cognitive side effects. 3 30 - 50% of alcoholics use illicit BZs. 111.
The primary sources of illicit BZs are from legitimate supplies, such as diverted prescriptions, warehouse and pharmacy thefts and prescription forgeries. 92,97.
"Polydrug deaths contributed to the overall rise in heroin deaths, especially benzodiazepines." Keen J. 2001 109
BZs are involved in a large proportion of drug-related deaths. Taken alone in overdose, BZs can cause death, but more commonly, it is their effect in combination with other drugs, which is responsible for most of the deaths.
Over 90% of women attending for drug treatment in the UK are of childbearing age. 112 These children face the same risks as children of prescribed BZ users, but they are compounded by increased dosage and other drug use, particularly opiates; a mixture known to be lethal in adults. 113
An increased incidence of cot death in babies born to opiate users is well established; 114 A risk compounded by the addition of BZs, which can cause multiple problems at birth, including apnoea (stopping breathing). 115
Drug misusers who use BZs have poorer general health, 98 increased incidence of hepatitis C, 116 increased HIV risk-taking behaviour 102 and greater risk of heroin overdose. 101 Where BZs are being injected, BZ users risk venous/arterial damage and amputations. 98
Amnesia, disturbed behaviour, aggression, depression, anxiety and general psychological impairment. 98
Educational failure, unemployment, imprisonment, poor social functioning. 98
BZs are implicated in a wide range of criminal behaviour, due to their behavioural effects, they can induce criminal behaviour in the user and be used against the victim to disable them, e.g. 'date rape.' 100 (section 6).
"As in England and Wales, opiates and benzodiazepines were the types of drug most often mentioned on death certificates in recent years" Drugscope Report, 2001 117
In 1999, the Advisory Council on the Misuse of Drugs (ACMD), noted that sub-lethal amounts of BZs and opiates when taken together are a fatal cocktail, acting on different respiratory mechanisms in the brain and that this was responsible for an increase in drug-related deaths. 113
High rates of BZ involvement in drug-related deaths, particularly in combination with opiates are widespread. Fig.1, shows drugs involved in drug-related deaths in Scotland, 1996-2000.118
In England and Wales, similar high rates of BZ involvement in drug-related deaths were recorded, until 1998, when opiate-related deaths escalated and BZ involvement fell (fig.2). 119 The reason for this is not known; possibly, the habits of opiate users in England and Wales differ from those in other countries.Combined benzodiazepine /opiate-related deaths
In Victoria, New South Wales, BZs were found in 50% of all deaths involving heroin use from 1997 to 2000. 120
A breakdown of the drugs implicated in opiate-related deaths in Dublin City is given in Figure 3. In the years 1998 and 1999, the most common drugs involved in opiate-related deaths were BZs. 121
INDUCE CRIMINAL BEHAVIOUR
USED TO FUEL CRIME
USED AGAINST VICTIMS
HIGH LEVELS OF USE IN PRISONERS
Benzodiazepines (BZs) can cause violent aggression, memory loss, disinhibition and suggestibility and they are implicated in a wide range of criminal behaviour 123
"The implications of the combination of anti-anxiety agents and aggressiveness are astounding." Canadian Family Physician, 1975.122
Unlike most other sedatives, BZs alter behaviour and memory without causing loss of consciousness 28 and users can perform complex tasks, but have no recall.27
"Instead of prompting the appearance of delusions and/or hallucinations, many of the patients themselves deliberately used the term "hate". Feldman P., 1962 35
Violent crimes, including murder, have been attributed to the adverse behavioural effects of BZs. In 1980, a woman who stabbed her husband to death was acquitted, due to the effects of the diazepam that she had been prescribed. 124
"Professor Michael Rawlins said that he believed the tragedy [murder] was probably precipitated by the excessive amount (30mg prescribed diazepam which the defendant had consumed in the preceding twelve-hour period before her husband's death" Law Society Gazette, 1987. 124
BZs are used to enhance/fuel the mood of perpetrators of crime, as 'Dutch courage,' the loss of inhibition, sedation and disassociation imparting a sense of invulnerability. 99
"As soon as I took the drink- I'd say within three minutes- I didn't remember anything that happened, until I woke up during the rape." victim of 'date rape, 1996 125
BZs are used against the victims of crime such as, physical assaults (indecent assault, rape, incest) and violation of property (swindling, theft etc), 28 as they induce amnesia, disinhibition and suggestibility. 126 Usually the victim's drink is spiked with a BZ. 125
The amnesia caused by BZs makes it difficult for the victim to recall events, which protects the perpetrator from detection. 28,125
"Benzodiazepines were the commonest drug found by health care staff urine screening new receptions to Swansea" HMIP Swansea Prison,1999.127
High levels of BZ use amongst arrestees and prisoners are common. Figures in the UK range from 13% of arrestees in England and Wales testing positive for BZs ('99-2000) 128 to 45% of prisoners entering Scottish prisons (2000). 129
Many prisoners, typically young prisoners, were coming into the prison with a history of high levels of benzodiazepine use some of whom were the result of GP prescribing." Chelmsford Prison, 130
"9 out of 12 suicides at HMP Greenock were connected to heroin or benzodiazepine abuse". 131
A direct connection between BZ consumption and aggressive behaviour in prison inmates has been reported since the '70s. High levels of riots, stabbing, cuttings, murders, self-mutilation and attempted suicide in inmates were attributed to BZ consumption in a Utah prison.132
In 1995, clonazepam (a BZ) was restricted by the New South Wales prison service, as it was causing emotionally reactive aggression, self-harm and suicide attempts in inmates. 133
"the conventional view that symptoms of violent disorders should be tackled by increasing medication has been stood on its head" 134 In 1975, a Canadian prison reported less aggressive incidents on days when inmates were off diazepam medication.122"81% of inmates involved in aggressive incidents had taken diazepam (Valium) and 3.6 times as many acts of aggression occurred in inmates while on these drugs.". 122
A study at Parkhurst Special Unit also showed a direct correlation between the reduction of sedative consumption (mainly BZs) by inmates and the reduction of physical assaults from between 1990 and 1995. 134
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Phil Woolas MP., (Oldham East & Saddleworth), Chairman of 'Beat the Benzos' Campaign, opening speech, 'Beat the Benzos' campaign launch, Croydon, November 2000.06apr03a: Teenager A: Benzodiazepines on the street in Yorkshire.
Blues (valium) are available on the streets in Yorkshire for £1 each. I know of load of youngsters on my estate that take them. I don't want to take them again I first tried them with extacy and booze - it was a bad experience. I don't remember much. I just woke up in the morning feeling dreadful.
Kids start on diazes at thirteen - I remember a kid coming with a big tub of them and ten of my friends took them and they just fell asleep. Whenever someone gets a prescription they sell them on . I see people with big tubs containing a hundred tablets. Sometimes I see them sold from big tubs sometimes in boxes with pop out packaging.
The junkies love them. They sell them for heroin or take them themselves.
Wobbly eggs, tamazepam, I don't see so often but when they are around there are lots of them.
I think the government lets them in because they have Xray machines that can look through lorrys. They spend so much on Customs and Excise that they must be stop them if they want to. I've seen it in the paper - a camera that could see every thing inside a lorry.
The kids have been shown that drug taking is a way of having fun. But they don't see the full picture. They don't see that when you run out of money you're addicted and you have to steal. You depend on them to have a good time and socialise.
Life goes in circles. you go around and come to the same point again until you see where you are going wrong. You can't break out.
Drug use is wrong because you start using and abusing people.
No-one I know will use diazes, temazes, for what they should be used for. People get a weekly script - 7 tablets and be able to sell them for #20.
People that use them rely on them. I did a couple of years ago. I was on smack as well. I had a subutex detox. These are tablets you put under your tongue and let them dissolve. They have stopped me from taking smack.
Smack gives you a very bad look at life. Temazes and diazes stop the rattling - they are very good at that. You can be on smack feeling terrible and a temazepam makes you feel its not so bad after all - but it only lasts a few hours.
Some of the content from www.faxfn.org follows
For Your Diary: 19th October 1999
Serious questions are being raised about drugs prescribed by the medical profession. BENZACT (and similar organisations) has distressing contact with the problems this causes. It is decades since the damage these drugs do has been known. It is a fast growing problem amongst young people as these drugs are finding their way onto the streets from GPs prescriptions.
Look at parliamentary questions tabled by Phil Woolas MP.
Contact Susan Bibby (0771 441 1558 and 01670 517397)
(See my section on www.faxfn.org for updates)
Coming soon : The Health Select Committee Report.
(Also featuring Benzodiazapines. Chaired by David Hinchcliffe. Looking for some answers.)
Notice of questions given on Monday 26. 07.'99.
(For Tues. 19. 10. '99).
RE: Phil Woolas
21. To ask the Minister for the Cabinet Office what plans he has to review the classification of benzodiazepine drugs.
22. To ask the Minister for the Cabinet Office what action he is taking to prevent the illegal trade of benzodiazepine drugs.
157. To ask the Secretary of State for health if he will establish respite care and detoxification units for people who are addicted to benzodiazepine drugs.
158. To ask the Secretary of State for Health what plans he has to carry out research into the effects of long term use of benzodiazepine drugs.
159. To ask the Secretary of State for Health what plans he has to implement the advice of the Commitee on Review of Medicines on the prescription of of benzodiazepine drugs.
160. To ask the Secretary of State for Health, what plans he has to implement the advice of the Committee on Review on Medicines that benzodiazepines should not be prescribed to pregnant women.
161. To ask the Secretary of State for health what plans he has to request the Medicines Control Agency to review the use and prescription of benzodiazepine drugs.
162. To ask the Secretary of State for Health, how many newborn babies in each of the last five years have been damaged by the prescribing of benzodiazepine drugs to their mothers.
230. To ask the secretary of State for Social Security, what advice he has issued regarding the handling of disability and incapacity benefit claims by people suffering from addiction to benzodiazepine drugs.
08dec99a: Susan Bibby: Letter to the Secretary of
State for Health on Benzodiazepine.
Alan Milburn MP,
Secretary of State for Health,
Department of Health,
There are two matters which I feel urgently require your attention: One is regarding warning the public of the dangers of prenatal benzodiazepine exposure and the other is the subject of a recent Radio Four programme, 'You and Yours', broadcast on Wednesday 27th September (copy enclosed).
Firstly I must explain my own involvement. For the past five years, I have campaigned to alert people to the dangers of benzodiazepines in order to establish help for people damaged by them and to lobby for more effective safeguards against them.
The two matters referred to are a follows:
1. Warning of dangers of BDZs to babies prenatally.
It has been known since the early '70s that BDZs cross the placenta and accumulate in the developing foetus causing problems at birth which can be life threatening. Nothing has been done to warn the public directly.
Babies exposed to BDZs before birth, can suffer withdrawal symptoms, more severe and lasting longer than those caused by heroin and methadone.* Treatment in special care baby units is often needed. Recovery may last for up to three months, whereas babies withdrawing from heroin and methadone recover within two weeks. Evidence of developmental damage, sometimes not manifesting itself until later, is only now emerging.
Information and warnings have been availalable to medical practitioners for some time, but not all doctors warn their patients of the dangers of BDZs in pregnancy. I am frequently contacted by pregnant women today.
In 1997, I was the consultant for a film about the effects of exposure to BDZs before birth ("Benzo Babies" enclosed) and voiced my concerns to the then Chairman on the Committee on Safety of medicines. He was concerned and a reminder was issued in September 1997 concerning the use of BDZs in pregnancy.
After viewing "Benzo Babies", Dr Ennis Lee, head of pharmacovigilance at the Medicines Control Agency wrote that Patient information leaflets (PILS) would be available with all BDZ prescriptions by the end of 1998 (please see enclosed).
Your own answer May '98 to Audrey Wise MP who asked what information is issued to patients taking BDZ drugs in respect of contra - indications during pregnancy  was that patient information leaflets produced by the manufacturers carry warnings. (please see attached). In fact, to date, only BDZs which are dispensed in packets carry Patient information leaflets, not the bottles.
I understand that this is because some manufacturers do not produce BDZs in packets. Surely it is the responsibility of this government to ensure that all women who may become pregnant, are pregnant, or are breastfeeding, are warned immediately, and if not, why not ?
Warnings now could be issued by providing leaflets in GPs' surgeries, ante natal clinics etc. so ensuring that all women are informed of the potential dangers to their children of BDZs.
2. Dangerous prescribing and accountability.
Simon Hervey, the young man whose death was investigated by 'You and Yours', contacted me as a result of a Radio 4 programme last year. He was desperate for help with the drugs he had been prescribed, in particular diazepam. He had tried all official avenues but specialist help is not available. The only advice he got was to go back to his GP.
Three of the drugs he was prescribed; - diazepam (Valium), chlormethiazle (Heminevrin) and sodium valproate (Epilim) were all prescribed outside of their licence (off label) and contrary to guidelines. Warnings of interactions between these three drugs are given respectively. The cause of death stated at the inquest was respiratory depression caused by the combination of diazepam and chlormethiazole.
Alarmingly, prescribing in this way is not unusual, and is reflected in the calls I receive from all over the country. A substantial proportion are from people whose doctors have prescribed outside of the guidelines and/or outside of the product's licence. Few deaths are brought to public attention, but I am frequently contacted by those whose health has been damaged as a consequence.
There is no help for people damaged in this way and the procedures for complaint are inadequate.
The findings of the Health Select Committee on 'Procedures Related To Adverse Clinical Incidents And Outcomes In Medical Care' (HC5491), to be published on Tuesday 23rd this month will hopefully cover this area.
It seems that at the root of this problem is "doctor's clinical judgement" and consequent lack of accountability. The area of prescribing is particularly open to abuse and the question must be asked, what are ABPI data sheets, The BNF, Medicines Resource monthly bulletin and the Committee on Safety of Medicines for , if a doctor's "clinical judgement" simply overrides them? The death of Simon Hervey illustrates what can happen when warnings are ignored.
Neurological damage spanning three generations is the result of three decades of uncontrolled long term prescribing. Benzact and similar initiatives have distressing daily contact with the problems this causes.
Far from a diminishing problem due to decreased prescribing, the growth in illicit street use at high doses guarantees a magnification of the existing problems caused by prescribed use.
BDZ damage is an iatrogenic illness presenting as a specific clinical syndrome. As you will be aware, there is no centrally funded effective help for people with BDZ problems. Local agencies do exist, but cannot cope with the scale of the problem. Specialised information and training are not available to the relevant agencies so substantial resourses are wasted on inappropriate and ineffective treatments, often exacerbating the condition.
One million people still on long term prescriptions is a consevative estimate and constitutes a considerable chronic problem which must be addressed. Effective help is possible and relatively simple. It could be achieved if consultation between experts in this area and the relevant agencies was made possible. A coordinated approach, particularly from the medical profession is crucial to resolving this (now) escalating problem.
A full review by the Department of Health, of policy regarding BDZs is urgently needed and long overdue. With respect, the problem, far from diminishing, is increasing and a dangerous precedent is being set if nothing effective is done.
Please could you address these issues as a priority.
If it is of help I can provide you with the results of a survey done in response to TV and press coverage highlighting the dangers of BDZs in pregnancy. Although not strictly empirical, it presents a strong case for further research. Several paediatricians have indicated that this should be undertaken as a matter of urgency.
Please let me know if you require any further information or references. I have also enclosed copies of two other films, "Mother's Little Helper" (for which I was also consultant) and "A Bitter Pill" and can supply the relevant information upon which they were based if needed.
Please accept my apologies for the length of this letter. Unfortunately it only represents the tip of an iceberg with BDZs.
I look forward to hearing from you.
Susan Bibby (Benzact).
cc. Audrey Wise MP.
04jan00: Psychiatrist A: Clinical judgements on benzodiazapines.
I am a psychiatrist and I see many patients who have become dependent on benzodiazapines. Some have been taking them for a decade or more, mostly prescribed by their GPs, with some patients augmenting their intake from illegal sources.
These are drugs that most psychiatrists would use very sparingly and keep their use to short term: 2-4 weeks. Whenever possible, I get dependent patients to stop using them, but I bear in mind that the withdrawal process can be a painful one for disturbed patients It may induce various symptoms - from fits and depression to suicidal ideation and suicidal attempts. Benzodiazapine dependence often masks the underlying problem: it is after the patients have been successfully detoxed that it is possible to see what their problems are.
Hence, it is very important for GPs to be aware of potential hazards precipitated by benzodiazapine dependency and be selective and precautious while prescribing them.
04jan00b: Susan Bibby: Benzodiazepine use and damage to developing foetuses.
(See also Susan's website www.benzact.org)
Is There Really "No Proven Link"?
John Hutton MP on behalf of the Dept. of Health in a parliamentary debate on benzodiazepines, states that "there is no proven link between benzodiazepine use and damage to developing foetuses."
The evidence linking benzodiazepine (BDZ) exposure to damage to the embryo, foetus and infant in the first few months after birth is still growing. Major malformations such as cleft palate remain an area of contention, but other adverse effects in the neonate have also been well documented for decades and recent evidence of long term neurological damage has emerged and is increasing.
As 30 - 40 % of all pregnant women will be given an antianxiety drug (usually a BDZ) at some time during pregnancy(1) it is vital that all women of childbearing potential are warned of any dangers to their children from BDZ exposure. Presently they are not.
Recent patient information leaflets from the manufacturers warn about the use of BDZs in pregnancy, for example: "benzodiazepines including lorazepam, may cause damage to the foetus,"(patient information leaflet from Wyeth re. lorazepam). They also warn of many adverse effects in the neonate.
1 Adverse effects at birth.
The brain undergoes massive developmental activity and fourfold increase in bulk in the last two months of gestation and the first months after birth. This is a vulnerable time.
Research showing that BDZs pass through the placenta causing effects such as "floppy infant syndrome", respiratory depression, hypothermia, feeding difficulties, abnormal heart rate, abnormal EEG (2) and withdrawal syndrome has been in the public domain since the early seventies.
Paediatricians, from Sweden and England voiced their concern in letters to the Lancet in 1977 (3,4)
Many research papers were published over the years warning of the dangers of BDZs to newborn babies, but the public were not informed.
BDZs can accumulate in the newborn infant and may remain active, (sometimes for months). Symptoms ranging from: "mild sedation, hypotonia, and reluctance suck, to apnoeic spells, cyanosis, and impaired metabolic responses to cold stress " have been reported "for periods from hours to months after birth."(1) The high risk to the neonate from apnoeic spells and the accumulation of BDZs in infants unable to metabolise them, together with the danger of impaired mental development was stated. [Rowlatt 1978] (see 5)
Warnings of the above have been available from the manufacturers for over ten years and newborn babies so affected may need treatment in special care baby units, (sometimes for months). Flumazenil, a BDZ antagonist which reverses the effects of BDZs (licensed for use in surgical procedures and overdose), has been used at birth in emergencies, (not under licence) successfully reversing most of the above adverse effects in neonates.(6,7,8,9)
2 Neurodevelopmental effects.
Extensive animal, and more recently human, research has shown that BDZs affect neurodevelopment in animals and humans, some of which is not manifest until later in development.
Again, flumazenil was found, when administered to pregnant rats concomitantly with diazepam (2.5 mg/kg) to reverse the effects of diazepam in the hypothalamus of the adult offspring.(10)
Animal research is now reflected in human research, for example:
(i).The enzyme Na,K - ATPase holds a key position in the biochemical development of the brain. Its activity is changed in mice after exposure to diazepam [Weber and Schmahl,1983] and it was also inhibited in vitro in human foetal brain tissue [Das et Al.,1979].(see 5)
The evidence is increasing that behavioural disorders may be linked to prenatal BDZ exposure.
(iii). Diazepam (Valium) is implicated in a wide variety of regulatory disfunctions in the newborn and may exert long range deleterious influences, as some forms of learning disabilities or attention deficit disorders.(11)
Evidence that prenatal exposure to drugs such as diazepam (Valium) has profound effects in the mammalian brain on a range of adaptive responses of a kind that are often not expressed until adolescence(a stage when many clinical behavioural disorders appear) was published in 1995 (12)
Recent results from prospective Swedish studies revealed for instance :
"infants born to mothers exposed to the long term regular use of BDZ in therapeutic doses run the risk of an overall deviation in neurodevelopment during their first 18 months of life, seen most prominently as a delay in voluntary grasping. This finding was not thought to be explained by disturbed social interaction between mother and infant alone. A teratogenic effect by BDZ on the developing brain is supported by the presence of craniofacial anomalies found in several children. Many studies show that infants with transient neurologic deviations in the first year of life are a high risk group for attention deficit disorder in early school years. A follow up of our series is urgent and in progress for evaluating the long term hazards of BDZ."(13)
And: "mothers using BDZ alone continuously throughout pregnancy do not deviate much from others in general in social terms, and that their newborn infants tend to be wasted, have a significantly increased frequency of perinatal complications and a significantly deviating neuro-behaviour." (14)
It should be clear from the above evidence that the statement "no proven link" is at best unhelpful.
At present the public have not been warned of the danger of BDZs to the unborn child and prescribing to women of childbearing age continues.
Additionally, the recent trend to prescribe BDZs (outside of licence) to opiate and alcohol misusers guarantees a corresponding increase in the number of babies exposed to the above dangers. Many substance misusers are of chilbearing age and the increasing illicit use of BDZs at very high dosage is a growing problem (15) The in utero damage potential of BDZs increases with dosage.
It has been left to "the clinical judgement" of prescribers as to whether they choose to warn the public or not.
Unless empirical data proving that BDZs do not damage the developing foetus and neonate exist, avoidable exposure to the above dangers remains the responsibility of this government.
Today, only women who are prescribed a BDZ that comes in a packet receive a warning. This is left at the discretion of the manufacturer.
We ask that immediate action be taken to inform the public so that all women of childbearing potential are warned and make an informed choice.
References: No Proven Link
1. Patricia R. Mc Elhatton: The Effects of Benzodiazepine use during pregnancy and Lactation. The Teratology Information Service, The UDMS, St Thomas' Hospital, London. Reproductive Toxicology, Vol 8, No 6 pp. 461 - 475. 1994
2. Patrick H T, Tilstone WJ and Reavey p.: Diazepam and Breastfeeding. Lancet, 1972 :i: 542 - 3.
3. Christopher Gillberg: Department of Paediatrics, East Hospital, Goteborg, Sweden. "Floppy Infant Syndrome" and Maternal Diazepam. The Lancet, July 30th 1977.
4. Dr A N P Speight, Children's Dept, Newcastle General Hospital, Newcastle Upon Tyne, NE4 6BE. The Lancet, October 22, 1977.
5. Weber - L - W - D; Benzodiazepines in Pregnancy - Academical Debate or Teratogenic Risk ? Gesellschaft fur Strahlen - und Umweltforschung m. b. H. Munchen, Institut fir Biologie, Abteilung Nuclearbiologie, Ingolstadter Landstrabe 1, D - 8042 Neuherberg, FRG. Biological Researgh in pregnancy, Vol 6, No 4 - 1985 (pp. 151 - 167 ).
6. Shibata - T. Kubota - N. Yokoyama - H: Dept. of Anaesthesia, Tokyo General Hospital, School of Medicine, Kawasaki 211, Japan. Japanese Journal of Anaesthesiology, 1994, Vol /Iss/ pg 43/4 (572 574 ISSN: 0021 - 4892.
7. Stahl M - M - S; Saldeen - P; Vinge E. Reversal of fetal benzodiazepine intoxication using Flumazenil. British Journal of Obstetrics and Gyanaecology, Vol 100, Pages 185 - 188. 01 - February, 1993. Case report.
8. Richard - P, Autret - E, Bardol - J, Soyez - C, Barbier - P, Jonville - A - P. Dept. Of Neonatology, Tours Cedex, France. The use of Flumazenil in a neonate. Journal of Toxicology, Clinical Toxicology, Vol 29, Page 137 - 140, March 1991.
9. Cone - A - M; Nadel - S: Sweeney - B. "Flumazenil Reverses Diazepam - Induced Neonatal Apnoea and Hypotonia". Dept. of Anaesthetics, Southampton General Hospital Tremona Road, Southampton, SO9 4XY, England. European Journal of Paediatrics, (152 - No 5, 458 - 59, 1993.
10. R. D. Simmons, C. K. Kellogg & R. K. Miller: Prenatal Diazepam Exposure in Rats: Long lasting, Receptor - Mediated Effects on Hypothalamic Norepinephrine - Containing Neurons. Departments of Pharmacology, Psychology, and Obstetrics- Gynaecology: University of Rochester, Rochester, NY U.S.A. (Accepted June 14th 1983).
11. Grimm, Veronika - E; A Review of Diazepam and Other Benzodiazepines in Pregnancy. The Hebrew University of Jerusalem and The Weizmann Institute of Science, Rehovot, Israel. Neurobehavioural teratology, Elseveir Science Publishers, BV 1984.
12. Kellogg, Carol- K; Neurotransmitters and the developing Nervous System. Professor if Brain and Cognitive Sciences, Neuroscience Track Coordinator, Dept. pf Brain and Cognitive Sciences, University of Rochester, Rochester, New York, 14627. Selected publication from lab. Monday October 2, 1995.
13. Liv. Laegried, Gudrun Hagberg and Anita Lundberg. neurodevelopment in Late Infancy Aftre Prenatal Exposure to Benzodiazepines.- A Prospective Study* Received December 21st 1990, accepted January 1991. Department of Paediatrics 11, University of Goteborg, Gothenburg, Sweden. Neuropaediatrics 23 (1992) pp. 60 - 67.
14. Liv Laegried, Gudrun Hagberg and Anita Lundberg. The Effect of Benzodiazepines on the Fetus and the Newborn* Department of Paediatrics 11, Gothenburg University, Gothenburg, Sweden. Received September 11, 1990, accepted September 25 1990. Neuropaediatrics 23 (1992) 18 - 23.
15. Professor Heather Ashton, Professor of Psychopharmacology, Department of Psychiatry, University of Newcastle Upon Tyne, England. Benzodiazepine Abuse. Unpublished draft document.
10jan00a: Patrick Michael: The Prisoner.
They did not know the prison they had locked me in. My parents did it out of love and care, following the best medical advice. The effects stay with me today, fifty years later. I was diagnosed "Epileptic" from the age of 18 months old. Not even the full blown "Grand Mal", I only had "Petit Mal". I did not fall on the ground and thrash around, I did not lose consciousness, or almost bite my tongue off. But as a "high forceps" baby I had momentary lapses, my left arm and right leg would stiffen temporarily. The answer was medication, medication, medication. I can only remember two of the medicines I was forced to live on, phenobarbiturates and epenutin (I'm not sure even if that's how you spell it, but its right phonetically). Added to my daily doses, I was not allowed to play football, ride a bike, do P.E at school, swim or any other physical activities that most children take for granted. Life through my early years, my teenage years were all dictated through a barbiturate haze. I was a junkie, before it was fashionable to be a junkie. Socially I was isolated from my peers, I didn't hang out with the other kids on the street corner. I was isolated at school, I had few friends. How could I gain some street cred? I turned to theft. I was the "best" thief in school, I was audacious. I was caught.
I had to change. One advantage about being isolated from others is that you find time to think. I realised that my only way out was to stop the drugs. Without my parents knowledge or approval, I stopped. How I did it I can't remember. I was 14 or 15 at the time, all my life these drugs had been my constant "companions". It was not easy.
I loved my parents, but I would not have inflicted almost thirteen years of drug induced topor and slavery on my kids, why did they?
17dec02a: The Sunday Post (Scotland): "One in six [babies] had been fed benzodiazepine tranquillisers in the womb."
Sunday's edition (15th December 2002) of the Scottish Newspaper The Sunday Post has a front page story "Scandal of Babies on Drugs." It reports a study "the first of its kind in the UK" and starts
One in eight babies born at a large maternity hospital have been exposed to cannabis before birth, says a shocking scientific study.
And more than one in six had been fed benzodiazepine tranquillisers in the womb - some prescribed to their pregnant mothers, others obtained illegally in the street.
The story, by Janet Boyle, can be found in The Sunday Post news section.
On this subject see Sue Bibby's pieces above.
05mar03: Man on the bus: My sister was on benzodiazepine for 15 years.
When my sister was in her mid teens she was diagnosed as being hyperactive. She was sent to institution for behavioural problems and put on a well known benzodiazepine. She stayed in the institution for 3-4 yrs but She stayed on this drug for 15 years, possibly more.
She lived a normal life until the medics recognised that patients should not be on this drug for such a long time We were told that after five weeks a patient would be hooked for life and we have heard the drug may now be banned . The drugs were withdrawn suddenly and within days she developed both agoraphobia and claustrophobia. Fifteen years later she is still not right.
She is now on other drugs but has a panic attacks, has no self-confidence and still does not like going out much. She is rather paranoid and thinks every body is talking and out to get her.
She did work before coming off original drug but has not felt confident enough to work since.
It has ruined her life.
16jul99: Residential care worker A: Using the chemical cosh.
(also in the Dangerous Prescriptions section)
In the summer of 1998, I answered an advert in a Job Centre.
The job advertised was for Night Care assistants in a residential home for elderly mentally infirm: no experience required and training would be given.
I attended an interview and the manager offered me the post of Senior Care on day shifts. When I explained I had no qualifications, I was told it did not matter as it would only take six weeks to train me. I was employed immediately at £3.50 per hour.
The nursing home had twenty four residents, most of whom suffered from dementia or Parkinson's disease, a third of these were high dependency patients.
My shift was managed by myself with three members of staff. In addition to that there was a manager in the office. All staff including the manager were working under pressure at all times. I usually worked a forty/fifty hour week. Within the first week of working there I had two consecutive fourteen hour shifts but as Senior Care I had to take a mobile phone home to be on call. It was after these two shifts I was called in to escort a resident to hospital which meant spending twelve hours unpaid at the hospital. (About once a fortnight Senior Care (me) or Head of Care was called out for emergencies. I was on call two weeks in every four.)
The first week was typical of the three months I worked there. General conditions for the residents were pretty dire i.e., no activities, no empathy from members of staff.
On the day shift starting at 7am all residents would be washed, dressed, and escorted downstairs where one member would serve breakfast. The remaining three would make beds, clean sinks and commodes and collect laundry. This all had to be done by 10am, in time to serve residents coffee and for toileting duties.
After breakfast residents would be sat in chairs, but were free to wander if they wanted to. The staff did laundry, distributed clothes back to residents rooms, at 12pm served lunch, after which residents would be toileted again and sat back in the chairs watching TV. Staff would clean dishes after each meal.
All staff breaks were taken in the home and were often disrupted by residents needs.
Staff also escorted residents on hospital appointments in either taxi or ambulance; there were one to five appointments weekly.
After tea residents would be washed and put into night-clothes in time for night staff coming on and would be served a hot drink. Day staff would put as many residents as possible to bed before two members of night staff come on duty.
Residents rarely went outside except for hospital appointment and occasional escapes. I understand there were occasional trips out for selected residents in the summer, but generally life for residents was spent in chairs and wandering around, which was quite chaotic.
When several residents behaved irrationally they would then be sedated sometimes because staff found it easier to control and less irritating. One lovely little lady who suffered from dementia was refused her cigarettes if she refused to take her medication, which was basically given to keep her quiet (when she couldn't have her cigarettes she used to cry like a three-year-old).
One lady had Parkinson's disease and used to wander round making a funny noise in her throat that used to annoy other residents and members of staff so she would be given medication to quieten her. My stay there I objected on several occasions to residents being given drugs when it wasn't really necessary.
Within the first week I was shown how to distribute drugs to those residents that required them by a girl who had severe learning difficulties and worked under a great deal of stress because she was bullied by both management and staff. The drugs used were Thorizadine, Warfarin, Lythium and many others. But the one I was concerned about was Thorizadine, a bit of a chemical cosh.
Many of the staff weren't very caring. Perhaps that was because they were young and naive. A typical example of verbal bullying or misunderstanding: one lady constantly asked what day it was and on one occasion a member of staff snapped - "You do realise you are getting on my nerves".
This really upset the old lady, she said: "I'm sorry I'm frightened".
When I confronted the staff member about the way she spoke to the lady she replied: "I said it with a smile on my face."
The problem was we didn't have proper time to spend with residents, so often the chemical cosh was an easy solution to a stressful day. When I got home I used to feel stressed, guilty and worried and sat and cried.
But clearly this was a successfully run business as it was expanding and buying more homes.
I challenged the lack of personal care the residents received (ie. inadequate bathing and denture hygiene) also what I considered bullying (eg. not being allowed cigarettes if they refused to take medication).
When I turned to the owner and the management for support they closed ranks and accused me of being radical.
Quote: "You've had no formal training, so where have you gained your knowledge of Care Work."
"These are basic human rights", I answered.
I worked at this home until the autumn of 1998. I resigned as Senior Care and 4 days later I was sacked.
I must say not all the staff I worked with were abusive. Shifts were often 14 hours long, 2 or 3 days in a row with inadequate break times.
How can these places be allowed to exist? These people are placed in residential care to be looked after because both they and their families aren't capable of doing so. Their families trust that their loved ones are receiving a humane quality of life for however much time they have left. Aren't the vulnerable people of our society entitled to spend the last days of their lives with respect and dignity?
In comparison, the place I work in now is in a different town, residents are respected and happy. Staff are loathe to leave the establishment. I'm not allowed to give drugs in this home but my impression is that not many liquid coshes are going round. There are many varied activities for residents too. And shifts are no more than seven and a half hours.
But when I last heard my old employers were still expanding their business.
23oct99a: The residential care delivery man: KILLING YOUR PARENTS SLOWLY
If, like me, you look forward to the ultimate day of reckoning, you may enjoy the fruits of my twisted thoughts of life's sweetest pleasure - killing your parents.
Don't get me wrong - I don't hate my parents. They loved me and raised me to the best of their abilities. They nurtured me, suffered my teenage years of rebellion and anger and even supported me through university and my first years in the real world beyond full-time education.
The trouble is that I no longer need them. I earn enough money to get by on my own, I am in a stable relationship, have a decent job and no doubt will soon have a mortgage and children, just like the rest of decent society.
The truth is that my parents have gone from guardian angels to embarrassing burdens. If they visit me they insist on dressing in nauseous shades of brown, green and grey. They want to kiss me in front of my friends. Worst of all, they expect me to stay in touch - make occasional 'phone calls and remember their birthdays.
So I find myself considering my revenge. How do I rid myself of my parents whilst causing them as much physical pain and mental suffering as possible?
I could tie them up and mutilate them. Perhaps begin by cutting their toenails out and bleeding them to death, or better still force them somehow to mutilate each other. Rape them? Drip acid on them for a period of weeks?
Well, they all sound pretty good but which of us is really prepared to take such a hand-on, time consuming approach?
No, the solution is simply to put them into a nursing home. Not just any home, but one of those homes you hear about where old people are beaten, systematically abused, screamed at by sixteen-year-old care assistants and left for hours in their own excrement. Imagine the pain and mental anguish if your own child left you in a living hell where you might survive another twenty years. Imagine a world so unbearably terrifying that you wouldn't dare complain to outsiders for fear of unspeakable retribution. Imagine having years to consider your future, attempting to consolidate your memories of a happy family with your own awful, lonely bleak future.
How to find the right nursing home? What are the telltale signs? Firstly, don't expect nurses with fangs or residents screaming at the windows. Don't go looking for a home where you are treated with contempt, or the staff look miserable. Don't think you can walk into a home and find fat matrons screaming at the cripples. You won't find any of these - they all pretend to care about the frail inmates.
I know the answer. I know how to find the perfect home from hell. Walk around to the back of the building in question. You should find a laundry room, back door, or fire exit. Open the door, step inside. If you are punched in the stomach by the unique smell of piss, shit and death, bingo, you've struck gold.
01nov99: Faxfn: Residential care questions.
Faxfn is looking for answers on the topic of Residential Care.
My experience of nursing homes was not a happy one. As an auxillary bank nurse I was left in situations where it was impossible to cope with the responsibility. There was not a team ethos between the full-time carers and bank nurses. It was a 'them and us' philosophy. This meant ultimately the patients lost out.
The places of work on the whole were largely understaffed. A bank nurse gets a higher level of pay the so the full time carers left the bank nurses to 'hold the fort'. Most, like me, as newcomers, had no idea of the routine. The patients were often left in states of distress needing toileting, help with feeding or plain company. The time factor meant that it was impossible to deliver an acceptable level of care - or even time to reassure or strike up a level of professionality.
I worked at several different places and the range of conditions was primarily the same. The daytime shifts were often managed by the 'full time' carers yet on the evening shifts, where bathing, undressing and applying creams were necessary, this was quite often covered by students earning college funding money. The students were mostly non nursing students. On the occasions that nursing students did help on the shifts they became flustered and unable to cope because their learning had been based on chalk and talk technique rather than hands on patient care.
During visiting hours, the appearance was that the homes offered stability - this was not the case in the evenings. The reason for this was that many of the carers were mothers who were needed to cope with childcare responsibilities during and around school hours. The students, like myself, did not have such responsibilities and therefore were left to cover the demanding shifts of putting to bed and then starting to get the patients out of bed and help with breakfast in the morning.
My training involved catching a train to a nearby town to do a one day course on 'lifting and handling'. The tutor failed to turn up so we signed a piece of paper and went home. As a student in need of money I did not want to jeapodise the opportunity of earning a good hourly wage.
01feb03a: Experienced worker in care: NVQs - forcing good people out of important jobs.
Recent legislation has ruled that 50% of workers on any shift in a registered care home must have an NVQ. This has had the consequence that many good and experienced workers are leaving.
If these workers are replaced at all - and many homes will have to close - they will be replaced by "professionals".
The typical worker that will be forced out will be an older woman who has worked for decades. They are not interested in doing qualifications which involve lots of tedious theoretical knowledge.
I believe the people in government who are setting up the qualifications genuinely believe they will improve the situation but the people responsible, the Care Commissioners, are out of touch. Previously standards were checked by an inspection regime, which worked satisfactorily.
For people coming out of school, NVQs may be a good start into care work. In other areas I have seen NVQs work well (eg. for secretarial work) but they should not be used to force good people out of important jobs.
25feb03a: Recruitment for care: NVQs - we will loose some of the best workers.
I work in home care. I am aware that many of the staff I work with must have NVQs by 2005 - 60% must have it by then. Many of them are older ladies who just won't do this - it's to academic. By 2005 we will have a real crisis.
I recruit and select people for these jobs and it is a waste of skills and experience to set up this situation where many will leave to avoid this imposed pressure.
I don't think the government will change their "minimum care standards" and we will loose some of the best workers. The relevant document is "National minimum standards for ancillary care" by the Department of Health.
Student: Hazel Blears, Parliamentary Under Secretary of State for Public Health
Assignment: Compare NHS provision for addicts of illegal drugs vs. addicts of prescribed drugs.
Your text: From the man on the bus.
My sister was diagnosed as being hyperactive in her mid teens. She was sent to an institution for behavioural problems for 3-4 years and put on a well known benzodiazepine which she stayed on for at least 15 years.
She lived a normal life until it was recognised that patients should not be on this drug for such a long time. The drugs were withdrawn suddenly and within days she developed both agoraphobia and claustrophobia. Fifteen years later she is still not right.
She is now on other drugs but has panic attacks, low self-confidence and still doesn’t like going out. She is rather paranoid and thinks that everyone is out to get her.
She has not felt confident enough to work since coming off the original drug.
It has ruined her life.Practice your PQs:
Do only those that break the law get the help?
Note: We await your assignment on Patient Information Leaflets.
John, three years ago your assessment read:
Student: John Hutton MP
Practical Assignment: PQs on Benzodiazapines
Notes: John, we all know you're not a lying bastard
so why use the old "there is not proven link" line. The
Great British Public still remember tobacco and BSE.
Otherwise it was a credible performance.
As you know, this arose from your answer to a parliamentary question from Phil Woolas (You can find it in Hansard here):
My hon. Friend raised the issue of the side effects of pregnant women using benzodiazepine. I understand and am currently advised, that there is no proven link between benzodiazepine use and damage to developing foetuses. Current advice is that all drugs should be avoided in pregnancy if at all possible. The Government keep the issue of benzodiazepine use in pregnancy under close review, as we do the use of other drugs, through organisations such as the Advisory Council on Drug Misuse.
John, we see from your employers website that your job is "The NHS and delivery". As you said to health-news.co.uk
“The resources and reforms that are going into the NHS mean that on virtually every indicator waiting times for treatment are going down.
“While this progress is welcome, there is still a long way to go. But we are on course to deliver the targets we set out in the NHS Plan.”
We wish you well. But, for old times sake, could you pass on the assignment to your fellow student, Hazel Blears, who now has responsibilities including drugs, embryology and health inequalities, to take up the benzodiazepine question. I know this is asking allot because we all realise that, as Phil Woolas put it in his question
"The impact is so large that it is too big for Governments, regulatory authorities and the pharmaceutical industry to address head on, so the scandal has been swept under the carpet."
Obviously, lifting this particular carpet could put a big hole in the NHS budgets, which may have consequences for your ability to "deliver the targets". But your grading will certainly improve if you show that you can be a man of principle in difficult circumstances.
Hazel, your assignment is as follows: Consider the statement
"The benzodiazepine hypnotics are classified in Pregnancy Category X and their use is contraindicated in pregnant women"
Initially we would like you to
We appreciate that these are not central to your Lessons in Politics course but the real assignment will follow.