The Next Pharmaceutical Crisis Is Already Here

The fight against opioids has rightfully become a pressing issue in American medicine, although opioids, in fact, are not in this alone. There are 15 million American victims of the next public health crisis looming over the pharmaceutical industry. I feel fortunate to have recently triumphed without becoming one of 248,000 emergency room patients or 14,000 deaths during my two-year tenure with this medically-induced addiction. These are the statistics representative of a growing population affected by overzealous prescribing. So, as much as I would like to, I cannot put this behind me without becoming an advocate for those who are still in the trenches, without trying to expand our national dialogue about the coming expansion of the American pharmaceutical crisis.
The increased public health focus on prescription pain killers of late is paramount to tackling America’s peculiar addiction to dangerous pharmaceuticals. However, it would be unwise to declare victory just as soon as there is tangible reform in this area. Of course, opioids pose a massive public health threat not only due to their ubiquity, but also to their chemical proximity to deadly street drugs such as heroin and fentanyl. They also pose a criminal threat to do these street drugs’ lucrativeness on the American black market. Our goal as a nation should absolutely be to get the rate of opioid prescription down to safe and medically responsible levels, which hopefully brings down the pervasiveness of heroin use and overdoses.
But before that fight is over, while our resources are expansive and the conversation salient, we need to send resources to other looming battles in the war on American addiction. The new trending term after “opioids” declines in Google searches? “Benzos.”
“I was under the guidance of a professional and, in any case, I couldn’t complain about getting the relief I needed.”

When I was 20 years old, I began to see a doctor for intense bouts of stress which were slowly morphing into anxiety. Over the course of the next two years, I took the highest legal doses of two medications and 4.5 milligrams of generic Xanax, or Alprazolam (right). This isn’t close to some of the outrageously high doses I have heard of, but it was enough to make the other physicians I told significantly worried. Xanax pills are typically dividable by four (they look like chemical Toblerone bars). And for good reason; 0.25 milligrams will often put someone to sleep in five minutes.
I felt fine for two years. I no longer felt stressed or even worried about everyday concerns. All I had to do was to keep a steady flow of Alprazolam in my system and refill my prescription when I needed to. In fact, in the latter part of this experience, I would be able to get a new prescription without even seeing the doctor. Of course, this seemed a bit suspect, but I surmised that it was fine. After all, I was under the guidance of a professional and, in any case, I couldn’t complain about getting the relief I needed. Then it wasn’t fine.
I began having problems: sleeping for 18 hours a night, falling asleep during the day, waking up completely incoherent and dazed for hours, sleep apnea. In retrospect, this all makes complete sense; it had been about two years. The recommended treatment duration is four weeks.
I saw a sleep specialist and got so much blood work that I no longer winced at needles. Then I had to face the music. I believe I knew subconsciously that the massive amount of tranquilizing medication was at the heart of it all, though I didn’t want to believe it. I like to think I’m pretty smart, but no one is safe from cognitive dissonance.
So, I got off it all, stayed off it, and recovered. It was pure hell, which only made me more incensed and willing to fight for those less-fortunate patients whose doctors don’t mind filling even larger scripts, for decades.

Where We Are Now:
We all may have heard things, tongue-in-cheek or otherwise, such as: “Relax, take a Xanax,” or “God, I could use a Valium.” What we don’t hear as often is just how devastatingly these benzodiazepines (benzos for short) wreak havoc on our minds and bodies. Much less how many people are at risk for addiction.
Since the 1960’s, benzodiazepines such as Xanax (Alprazolam), Klonopin (Clonazepam), and Valium (Diazepam) — among many other “pams” — have been prescribed and used as a silver bullet for anxiety, depression, insomnia, restlessness, epilepsy, OCD, and bipolar disorder to name only a few indicating diseases. Why do they work so well? Because they have the same biochemical pathway as alcohol.
You know how you’re more uninhibited and happy when you’ve had a few too many? Well having that feeling constantly is an unspeakable relief for people struggling with anxiety and depression. With every pharmaceutical panacea, however, we should know by now that what goes up inevitably comes tumbling even further down.

On the question of whether benzos are addictive, the Royal College of Psychiatrists states unequivocally, “Yes. Around 4 in every 10 people who take them every day for more than 6 weeks will become addicted,” further stating that telltale signs of addiction are, lo and behold, incredibly similar to alcoholism: malaise, increased tolerance, cravings, and withdrawals. Withdraws in the mild category, can include, “odd feelings like electric shocks [emphasis mine] in your arms and legs” (In my experience, it was more like walking through an electric field every five or six steps).
More serious withdrawals can leave the sufferer in a state of confusion, hallucination, and having epileptic fits. If you withdraw from a long-acting benzo like Klonopin (Clonazepam) or Valium (Diazepam) you could be dealing with this for weeks.
Furthermore, if you’re an anxiety sufferer who withdraws from benzodiazepines, you have a high likelihood of experiencing a phenomenon called rebound: “the relative worsening of symptoms on discontinuation of treatment as compared to baseline symptoms.” It’s no wonder that mental health patients tend to stay on benzodiazepines once prescribed them; the National Institutes of Health is telling them that once they’re off it, their anxiety will be worse than it was before treatment.
This is not how medicine should work.
Where We’re Headed:
“The trouble begins when we can no longer differentiate crutches from legs.”
Just like pain pills, benzodiazepines simply mask the underlying problem and can give patients a ready excuse not to address it with effort and hard work. This is particularly pernicious because not only did they leave me worse off than before, but they stunted two years of emotional learning. In this respect, they certainly seem worse than opioids; as in my case, they can put a band-aid over a potentially brief period of stress and end up causing a systemic infection underneath the surface.
The most present danger with these drugs is that in our faced-paced lifestyle we need to be pain-free and we need to be worry-free, lest we fall behind. Can’t sleep? Stressed? Worried? You need not exercise, eat well, slow down. There’s a pill for that, until there isn’t. Enter the opioids and benzos that promise that lifestyle. The data bear this trend of co-prescription as well: from 2001 to 2013, the amount of opioid users who used benzodiazepines concurrently rose by 80%. These are your coworkers, your friends, your kids.
When the tolerance reaches a breaking point and the doctor won’t write a prescription for 20+ pills a day, the ground comes rushing in quickly and it becomes quite obvious that silver bullets rust. What we’re left with is a population of burnouts, subsidized by everyone else. I know, I was there once.

Opioids do possess one important characteristic which benzos do not: they have viable and deadly street alternatives. There is no illicit substance which is to Xanax as heroin and fentanyl are to Percocet, yet. Drug addiction is as modern-American as pervasive consumerism; if Apple goes out of business, we will fill the void before we have time to mourn. So it is with drugs, prescription or otherwise.
In fact, deadly fake Xanax is being beta-tested as I write this, getting ready for its debut. If we learn anything from the opioid crisis, we need to learn that keeping Pandora’s box slightly ajar is accomplished only when education matches accountability, neither of which is solely the physician’s responsibility. After all, opioids are among the oldestdrugs on Earth, yet we sounded the alarm far too recently and far too late.
I say “ajar” because despite the acrimony with which we speak about these drugs, they can of course have legitimate uses. Just as someone in extreme physical pain might need a short-term analgesic just to get to physical therapy, someone in dire emotional pain might need a mental sedative to get to therapy.
The trouble begins when we can no longer differentiate crutches from legs.
What We Can Do:
“The fight against dangerous addictions must be won on the fronts where we know their proximate causes.”
If we get out in front of this crisis soon, there is only good news. Changing public attitudes about and increased research on mental health are both helping to develop better therapies and drugs to treat these maladies before patients make extreme and tragic decision. Novel therapies coupled with less inimical drugs such as SSRIs — and variants thereof — have been shown to push upwards of 93% of patients into remission in as little as a year.
That is a statistic of which I’m proud to be a part.
The fight against dangerous addictions must be won on the fronts where we know their proximate causes. Changing prescribing practices through accountability and education is much more manageable than, say, eradicating the poverty from which crack and meth addictions are borne. This is not by any means a new fight; we’ve been beaten back by addiction for decades. But regardless of your position on the “war on drugs,” we can all agree that new attacks need not wear us further.
If I have learned anything while interning in both medical research and the federal government, it’s that 1) medical funding absolutely relies on federal funding and 2) despite popular cynicism, governments really do listen to their constituents. Call your representatives. Get involved in the fight to save and support federal research funding and to clamp down on irresponsible prescribing in your state.
Most important, take mental health as seriously as physical health and remove its lingering stigma by putting it out in the open as I’ve tried to do here. Most people will, at some point, hit a brick wall of mental fatigue which must be taken care of before it metastasizes. Moreover, one in five people will experience a mental health issue every year.
When my number was called, I was thankful that people had my back. If we mitigate this crisis, we can support the millions who do not have that luxury.
