FDA requires new addiction warning on benzodiazepines

There has been a dramatic increase in abuse and misuse.

xanax pills
Credit: LMWH / Shutterstock
  • Benzodiazepine usage has increased in 2020 due to the pandemic.
  • The FDA is requiring new label warnings due to increased abuse and misuse of benzos.
  • Drugs like Valium and Xanax are approved for short-term use only, yet many are on them for years and even decades.

There have been many troubling consequences of the pandemic: massive rates of unemployment, government gridlock over whether to provide further stimulus, an inability to see family members or travel, over 213,000 deaths in America, and increasing rates of anxiety and depression.

Early into quarantine rates of alcohol consumption also rose—unsurprising, given how much more time people were spending at home. Living alone was one factor, yet so was living with a partner who regularly drinks. In an interesting analysis, one European agency found decreased usage of stimulants like cocaine and MDMA in wastewater, which matches self-reported claims. Without late-night parties, people began tranquilizing instead of getting hyped up.

Speaking of tranquilization, rates of benzodiazepine (such as Valium and Xanax) use are also increasing in both the U.S. and UK. While antidepressants and anti-anxiety medications are only approved for short-term use, the uptick in prescription rates, as well as illicit use, is troubling. With no sanctioned tapering protocols available, the potential for long-term abuse—and chronic side effects—means we're in dangerous territory with drugs that we really know little about.

This news comes on the heels of an FDA announcement that benzodiazepine manufacturers will be required to update label packaging to reflect the potential for abuse and addiction. This includes brand names like Xanax, Klonopin, Librium, Valium, and Ativan.

Benzodiazepine Dependence and Withdrawal - How To Avoid This

Since the early '50s, tranquilizer and sedative abuse has been a common yet under-discussed phenomenon in American society. The first blockbuster drug was Miltown. In 1955, meprobamate, a derivative of the short-acting mephenesin, was brought to market. Discovered by Czechoslovakian pharmacologist Frank Berger while developing a penicillin preservative, he noticed mephenesin calmed rats without knocking them out. In 1950, Berger moved from the UK to Cranbury, New Jersey where he developed meprobamate alongside chemist Bernard John Ludwig. By 1957, a billion pills of this drug, now called Miltown, were being produced.

Then the fire went out. In the sixties, Miltown was reclassified as a sedative. The manufacturers were sued for monopolizing the tranquilizer market. Doctors eventually recognized the risks outweighed the benefits. Miltown addicts flooded treatment centers. Instead of understanding the risks tranquilizers pose, pharmaceutical manufacturers simply shifted focus to other drugs, such as benzodiazepines, antipsychotics, SSRIs, and SNRIs.

Every decade, more problems arise with these pills. While short-term efficacy is clinically proven (especially when coupled with psychotherapy), underlying risks have long been known and little discussed. As Dr. Harshal Kirane, medical director of Wellbridge Addiction Treatment and Research, recently said after the FDA announcement,

"Benzodiazepines will not be the next big epidemic. They have been a 'silent' epidemic for decades, intensifying consequences from the current opioid epidemic."

The FDA's decision is based on growing evidence that benzos are prescribed more frequently and for longer durations than they're approved for. This has led to increasing cases of abuse and misuse.

overturned pill bottle

Credit: Tomas Nevesely / Shutterstock

As journalist Robert Whitaker told Big Think earlier this year, drug approval regulations are looser than many assume. Drug manufacturers, which often sponsor clinical trials for their own drugs, only have to show efficacy over placebo—how much efficacy doesn't matter. If a company doesn't like the result, they can throw out the data and never report it. Then there's chronic use.

"We also don't measure long-term exposure. If you look at Xanax, it doesn't show any efficacy after about four weeks. If you're taking it on a daily basis, you really should get off it. But all sorts of people have been on it for two years, three years, five years, 10 years. We don't have a mechanism for assessing what happens to people on these drugs for that amount of time."

In fact, the original Xanax trial was for 14 weeks. At the end, the drug was under-performing the placebo. Instead of submitting that data, the company only reported the four-week data. As of 2017, Xanax was the 21st most-prescribed drug in the country, with nearly 26 million prescriptions written, even though it only shows efficacy for about a month.

Psychiatrist Bechoy Abdelmalak explains the road to addiction:

"When you start taking these drugs, the response is very positive so it becomes hard for patients to discontinue them. So patients often take them for many years and, with chronic use, the risk of side effects increases, especially in the elderly."

Overall, roughly 92 million prescriptions for benzodiazepines were dispensed in America in 2019, with an estimated 50 percent of patients taking them for two months or longer (according to 2018 data).

A label warning is a step in the right direction, but given the increasing amounts of mental health troubles in 2020, we need more protections. The only winner right now is the $17 billion antidepressant industry and the burgeoning anti-anxiety market. That money is made on our suffering. From the looks of it, these drugs are creating more problems than they're solving, and we're all paying the price.

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Stay in touch with Derek on Twitter and Facebook. His new book is "Hero's Dose: The Case For Psychedelics in Ritual and Therapy."

This is what aliens would 'hear' if they flew by Earth

A Mercury-bound spacecraft's noisy flyby of our home planet.

Image source: sdecoret on Shutterstock/ESA/Big Think
Surprising Science
  • There is no sound in space, but if there was, this is what it might sound like passing by Earth.
  • A spacecraft bound for Mercury recorded data while swinging around our planet, and that data was converted into sound.
  • Yes, in space no one can hear you scream, but this is still some chill stuff.

First off, let's be clear what we mean by "hear" here. (Here, here!)

Sound, as we know it, requires air. What our ears capture is actually oscillating waves of fluctuating air pressure. Cilia, fibers in our ears, respond to these fluctuations by firing off corresponding clusters of tones at different pitches to our brains. This is what we perceive as sound.

All of which is to say, sound requires air, and space is notoriously void of that. So, in terms of human-perceivable sound, it's silent out there. Nonetheless, there can be cyclical events in space — such as oscillating values in streams of captured data — that can be mapped to pitches, and thus made audible.

BepiColombo

Image source: European Space Agency

The European Space Agency's BepiColombo spacecraft took off from Kourou, French Guyana on October 20, 2019, on its way to Mercury. To reduce its speed for the proper trajectory to Mercury, BepiColombo executed a "gravity-assist flyby," slinging itself around the Earth before leaving home. Over the course of its 34-minute flyby, its two data recorders captured five data sets that Italy's National Institute for Astrophysics (INAF) enhanced and converted into sound waves.

Into and out of Earth's shadow

In April, BepiColombo began its closest approach to Earth, ranging from 256,393 kilometers (159,315 miles) to 129,488 kilometers (80,460 miles) away. The audio above starts as BepiColombo begins to sneak into the Earth's shadow facing away from the sun.

The data was captured by BepiColombo's Italian Spring Accelerometer (ISA) instrument. Says Carmelo Magnafico of the ISA team, "When the spacecraft enters the shadow and the force of the Sun disappears, we can hear a slight vibration. The solar panels, previously flexed by the Sun, then find a new balance. Upon exiting the shadow, we can hear the effect again."

In addition to making for some cool sounds, the phenomenon allowed the ISA team to confirm just how sensitive their instrument is. "This is an extraordinary situation," says Carmelo. "Since we started the cruise, we have only been in direct sunshine, so we did not have the possibility to check effectively whether our instrument is measuring the variations of the force of the sunlight."

When the craft arrives at Mercury, the ISA will be tasked with studying the planets gravity.

Magentosphere melody

The second clip is derived from data captured by BepiColombo's MPO-MAG magnetometer, AKA MERMAG, as the craft traveled through Earth's magnetosphere, the area surrounding the planet that's determined by the its magnetic field.

BepiColombo eventually entered the hellish mangentosheath, the region battered by cosmic plasma from the sun before the craft passed into the relatively peaceful magentopause that marks the transition between the magnetosphere and Earth's own magnetic field.

MERMAG will map Mercury's magnetosphere, as well as the magnetic state of the planet's interior. As a secondary objective, it will assess the interaction of the solar wind, Mercury's magnetic field, and the planet, analyzing the dynamics of the magnetosphere and its interaction with Mercury.

Recording session over, BepiColombo is now slipping through space silently with its arrival at Mercury planned for 2025.

Learn the Netflix model of high-performing teams

Erin Meyer explains the keeper test and how it can make or break a team.

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  • Instead of the 'Rank and Yank' method once used by GE, Meyer explains how Netflix managers use the 'keeper test' to determine if employees are crucial pieces of the larger team and are worth fighting to keep.
  • "An individual performance problem is a systemic problem that impacts the entire team," she says. This is a valuable lesson that could determine whether the team fails or whether an organization advances to the next level.
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Photo by Martin Adams on Unsplash
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