From Librium to Xanax

From Librium to Xanax, promises were made my marketers that each new form of benzodiazepines would be safer than the previous form, but problems continue with abuse, dependence and addiction. Here’s a short history from the British Journal of Medical Practictioners:

The advent of benzodiazepines in the late fifties was met with great excitement by the practicing physicians around the world. Their range of actions – sedative/hypnotic, anxiolytic, anticonvulsant and muscle relaxant – combined with low toxicity and alleged lack of dependence potential seemed to make them ideal medications for many common conditions. The drugs were prescribed long term, often for many years, for complaints such as anxiety, depression, insomnia and ordinary life stressors. They began to replace barbiturates; drugs known to be dangerous in overdose, which tended to cause addiction and were associated with troublesome side-effects. Previous compounds including opium, alcohol, chloral and bromides were similarly burdened.

The first benzodiazepine, chlordiazepoxide (Librium), was synthesized in 1955 by Leo Sternbach while working at Hoffmann–La Roche on the development of tranquilizers. The compound showed very strong sedative, anticonvulsant and muscle relaxant effects when submitted for a standard battery of animal tests. These impressive clinical findings led to its speedy introduction throughout the world in 1960 under the brand name Librium. Following chlordiazepoxide, diazepam was marketed by Hoffmann–La Roche under the brand name Valium in 1963.

The benefits of benzodiazepines and the apparent lack of discouraging factors led an alarming rise of benzodiazepine prescriptions. In the late 1970s benzodiazepines became the most commonly prescribed of all drugs in the world.¹ In1980, Tyrer reported that each day about 40 billion doses of benzodiazepine drugs are consumed throughout the world.³ This figure is staggering by any standards. However, towards the end of the 1970s, awareness begin to grow that benzodiazepines were being unnecessarily over-prescribed and it was noticed that certain patients might become dependent on benzodiazepines after chronic use.⁴ In particular, patients found it difficult to stop taking benzodiazepines because of withdrawal reactions and many complained that they had become ‘addicted’. Several investigations showed quite unequivocally that benzodiazepines could produce pharmacological dependence in therapeutic dosage.^5-9

In 1988, the Committee of Safety of Medicines reacted to the concerns by spelling out emphatic guidelines about the use of benzodiazepines drugs. For anxiety and insomnia, benzodiazepines are indicated for short term relief (two to four weeks) only if the condition is severe, disabling and subjecting the individual to extreme distress.¹⁰

I’ve also written here about mixing benzodiazepines with other drugs. Benzodiazepines can be effective with short-term use, but when they’re used long term the benefits are questionable except in the most extreme cases of medical necessity. Benzos certainly are a problem when they’re abused, used with other drugs, and when there’s dependence and addiction. What started out as a “helper” to relieve stress and enable insomniacs to sleep turned into something with many unintended consequences. This is just one more drug that should be taken with caution and knowledge of possible side-effects.