Abandoned for 30 years

By | 02/08/2017

The UK government have known the dangers to public health of benzodiazepine prescribing since 1981

The UK Government were warned that benzodiazepines were harming patients at a meeting called by the Medical Research Council. Measures to help affected patients were agreed at the meeting but by1985 the most of the plans were abandoned and all documents closed in the National Archives.

Now, the problems caused by benzodiazepines and the number of patients affected has escalated and the British Medical Association are calling for the same measures abandoned in 1985 to tackle what is now a ‘major public health issue’.

The Independent on Sunday reported the discovery of a Medical Research Council file named ‘The benzodiazepines’ [1] and research funded by the MRC on benzodiazepines [2] in the National Archives in 2010. The documents had been closed in the early 1980s.[3]

The documents reveal that the MRC called a meeting in 1981 to address the growing evidence of harm to patients prescribed benzodiazepines. Present at the meeting were medical experts and observers from the government and the manufacturers. Evidence was presented which showed that benzodiazepines were causing severe dependence and that up to 250,000 patients could be affected.

Worse than heroin

Professor Malcolm Lader from the Institute of Psychiatry had raised concerns with the MRC regarding the dangers of benzodiazepines which led to the 1981 meeting. He told the MRC that  symptoms from Valium (diazepam) were much worse than from many other drugs including heroin. He said that patients suffered flu-like symptoms, perceptual changes and sometimes fits or full blown psychosis. [3]

  1. Professor Lader was also concerned that benzodiazepines could cause lasting damage to the brain and submitted the results of a series of CT scans of patients taking benzodiazepines long-term to the MRC.[1]

Plans agreed  – then abandoned

Measures to tackle the benzodiazepine problem were agreed and endorsed by the MRC. [1] These included research studies to determine the scale of the problem and to find ways to help affected patients withdraw and recover.

200 GP Practices

The MRC Meeting took place on 23.09.1981 [1] and made the following recommendations:

  • Research should be done into causes of benzodiazepine dependence and methods of withdrawal
  • Epidemiological and clinical investigations should be undertaken
  • General Practitioners should be educated in the appropriate use of benzodiazepines
  • Guidance on prescribing policy should be produced.

200 GP practices attached to the MRC Epidemiology and Medical Care  Unit (EMCU) were ready to participate and the initiative was supported by its director Professor Tom Meade. By 1985, the initiative was abandoned and all records closed in the National Archives for 30 years.[2]

Research project closed for 50 years

The MRC funded research led by Professor Lader at this time. The project investigated the possible effects of long-term benzodiazepine use using computerised tomography (CT) scans and psychometric testing. This was was also closed in the National Archives for 50 years.[4]

It is not clear from the archived documents why the initiative to tackle
the benzodiazepine problem was abandoned. However, the Government observers attending the 1981 meeting said that a ‘legal arrangement’ with the benzodiazepine manufacturers was an obstacle to addressing the problem. [1]

The Department of Health told the Independent they have no record of the 1981 benzodiazepine meeting.[3]

The proposed research studies and investigations were vital to identifying how many people were adversely affected by benzodiazepines and finding ways to help them recover; these were never done and no equivalent  work has been done since.

Today

The true number of people being prescribed benzodiazepines long-term remains unknown but is now estimated to be around 1 million.[5]

A recent study based on a sample of 100,000 patient records found that at Least 250,000* people could be being prescribed benzodiazepines for a year or more (guidelines since 1988: they should not be prescribed for more than 2 – 4 weeks).[6]

NICE warn that the risks associated with benzodiazepine use include an increased risk of dementia, cognitive impairment, dependence and withdrawal problems, tolerance to the therapeutic effects  [7]

In 2016, the BMA called on the Department of Health to address the ‘major public health issue’ of prescribed drug dependence (including benzodiazepines). They identified a lack specialist support and consensus on treatment for patients suffering prescribed drug dependence, a lack of necessary research and inadequate training for health care professionals.

 

* The authors of the study [6] caution this is an underestimate as participating GPs set extensive exclusion criteria for eligible patients

References
  1. Headquarters File: Series subject: Psychiatry, File title: Benzodiazepine Dependence. National Archives File no: S1516/17 National Archives ref: FD23/4512. Closed until 2014 (opened under the Freedom of Information Act, 2005) Status: Public Record
  2. Headquarters File: Series Subject: Working Party on the Treatment of mild to Moderate Hypertension. File Title: Report of a Meeting to Discuss Preliminary Proposals From Professor Shepherd to Incorporate Studies of Psychotropic Drugs into the Machinery of the Hypertension Trial. The National Archives File Number: S702/28 National Archives ref: FD23/3609, Closed Until 2012 (opened under the Freedom of Information Act, 2005) Status: Not public Record
  3. Drugs Linked to Brain Damage 30 Years Ago: http://www.independent.co.uk/life-style/health-and-families/health-news/drugs-linked-to-brain-damage-30-years-ago-2127504.html
  4. Psychometric performance and Neuroradiological Measures in Long-term Benzodiazepine Users. Lader Professor M H, Institute of Psychiatry, London, 23rd October 1986, Status: Closed for 50 years, subject to FOI request, FOI decision 2016 –  Not Public Record http://discovery.nationalarchives.gov.uk/details/r/C2736290
  5. BMA Our Collective Voice, Prescribed Drug Dependence, Supporting individuals affected by prescribed drugs associated with dependence and withdrawal.Published.06.10.16, updated 24.08.17: https://www.bma.org.uk/collective-voice/policy-and-research/public-and-population-health/prescribed-drugs-dependence-and-withdrawal#
  6. First Indications for Long-Term Benzodiazepine and Z-drugs use in the United Kingdom, J. Davies,T. C. Rae, L. Montagu, Department of Life Sciences, University of Roehampton,London; and All Party Parliamentary Group for Prescribed Drug Dependence. Westminster, London and Department of Life Sciences, University of Roehampton. London: http://www.biorxiv.org/content/biorxiv/early/2016/11/02/085183.full.pdf
  7. NICE Guidance Conditions and diseases Neurological conditions: general and other Hypnotics Key therapeutic topic [KTT6] Published date: January 2015 Last updated: January 2017 Advice, Evidence Context: https://www.nice.org.uk/advice/ktt6/chapter/Evidence-context

 

 

 

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