I have battled with severe anxiety and panic disorders for years. At my worst, I was often unable to get out of bed for days at a time due to fear of having a panic attack outside the safety of my home.

Taking an SSRI has helped a lot, but there are times where I can feel a panic attack coming and know the only way to stop it is with a Xanax.

I regard benzodiazepines with a lot of respect. Their power is a blessing and a curse. Used responsibly, I believe they can be a very effective and safe tool to live a normal life free of panic attacks.

At this point, I rarely take them - one dose every month or two at most. But the knowledge that I have a tool to quell a panic attack, should I need it, has actually done more for me than the pills themselves. Knowing I’m not powerless gives me the strength to overcome the panic attacks on my own.

Recently, I’ve noticed doctors becoming more and more apprehensive about prescribing benzodiazepines. This is definitely a good thing - I think they should be reserved for severe cases as a last resort. But I also worry about a future where people who could have benefited greatly from them without abuse are denied a prescription.

I was taking 3mg Lorazepam nightly for almost three years. Weening off of it safely took almost an entire year of miserable work, and the final stages I had to do while I had no other significant life responsibilities because of the incredible rebound insomnia and background anxiety you experience withdrawing off benzodiazepines. The only upshot is that when you finally do manage to get yourself off of a drug like this, you sort of feel like you can tackle most other challenges life throws your way.

So yeah, this stuff is serious. And of course, my Lorazepam was prescribed legally, by a responsible, well regarded psychiatrist, with very little warning regarding how quickly one builds both tolerance and physiological dependence on this chemical.

Taking 1/4 pill of Xanax occasionally together with 1200 mg piracetam + 3 mg sunifiram + another 1200 mg piracetam pill some hours later is amazing for concentration (but that's my personal experience, just sharing it, I don't recommend this to anybody, also neither piracetam nor sunifiram are approved by the FDA). Almost cures my ADHD and anxiety altogether and makes me happy and super productive (as compared to my baseline which is severely hindered by untreated ADHD and anxiety). And no addiction ever (perhaps people that take higher doses get addicted but I don't). God save the black market and the grannies who don't mind sharing a pill. I really believe people should stop this witch hunt and embrace the BLTC (better life through chemistry) philosophy and start developing ways to fight the bad effects (physiological addiction, withdrawal syndromes, tolerance development, liver/kidney harm, receptors disregulation etc) instead of outlawing substances that improve quality of life. A person mood/attitude and performance is 99% chemistry and demonizing the very idea of seeking to improve it (even above what is considered a norm) is madness.

Serious question: as we make opiods and now bezos increasingly difficult to prescribe, what are the alternatives for people with chronic pain or chronic anxiety?

I have friends and family members with chronic pain and, through them and their communities, have become aware of many people who use opiods on a long-term, occasional basis to manage their pain. A family member of mine who suffers from chronic migraine lives in fear that she won't be able to get an opiod which she uses as a last-ditch rescue treatment before she ends up at the ER (not to mention that she gets treated like a drug seeker when she does end up there).

I don't really see an alternative for acute intense pain; likewise an alternative for acute, intense anxiety. Meanwhile the crackdowns on these drugs also create a chilling effect for physicians. What do we do for people who fall in those categories?

(Edit: not to claim that abuse of these drugs is not a problem... It just seems like the people these drugs are inteded to help are being sidelined in the dialog on the topic.)

What is the thesis here? Benzodiazepines are commonly prescribed and have the potential for abuse; these things are both true; I hadn't heard the rate of prescription was rising, but I'd believe it. There doesn't seem to be any evidence presented for a trend or rise in benzodiazepine abuse, or evidence of general harm from the use of the drugs. It highlights parallels between the existence of this prescription drug class and another class that is associated with significant issues, and makes it sound as if there were an issue here... and then leaves it at that, the literary equivalent of a wink and a nudge. Are they arguing that prescription of drugs with abuse potential is inherently a problem? Because that would be a very extreme position, one which would challenge a sizable fraction of the medications available to modern psychiatry.

And this is a "journalist's resource," one associated with the Harvard Kennedy School? No wonder journalism is garbage these days.

GABA receptor modulation is no joke. I was prescribed Xanax for panic attacks. My PC kept increasing my dosage, until I decided I had had enough. Withdrawal was nightmarish, but luckily I hadn't been using it that long (only for two weeks or so). My brain chemistry was never quite the same. I ended up looking for substitutes like Phenibut and Etizolam. With these I was addicted to the confidence they gave me in approaching women, so not quite physiological like Xanax. What finally cured my anxiety was a macrodose of LSD-25 (111-150 ug). Even then I wouldn't recommend it. Meditation is the best tool - our bodies naturally produce Anandamide. In my case, due to certain traumas, LSD-25 allowed me to see the beauty of this World and Universe once again. It is a powerful catalyst that allows one to See with clarity.

Fun facts, in county jails (and I'm sure in hospitals) there are 3 classes of drugs that you will get detox medication for: opiods, benzos and alcohol. The detox meds for alcohol is benzos. The detox med for bezos is more benzos (although is a controlled, tapered manner). Both these two are much more dangerous to detox off of than opiods, with alcohol being the most dangerous. Everything else, cocaine, meth, etc is not particularly dangerous to withdraw from and usually these patients will not get specific detox medications.

I've seen plenty of doctors who prescribed benzos and not a single one had any idea how to taper off their patients properly. Nor was a single one interested in it. This is a money-making machine for them and they have no interest, regardless of what's best for the patient. On the other hand, I've gone to doctors who wanted to stop these cold-turkey risking seizures and death. Those doctors clearly never heard of the hippocratic oath. I have never seen a doctor willing to work with a patient to taper off properly. Until we get to that point, talking about reducing prescriptions is akin to signing possible death sentences for patients or pushing them to the black market / pill mills. My own withdrawal took a few months and I did it on my own. It wasn't pleasant, but it wasn't as horrible as some others' experiences. Basically, the medical establishment says 'fuck you' by putting you on these meds long-term, and another 'fuck you and die,' by not knowing how to taper you off properly or even knowing when it is appropriate. We have a long, long way before solving this problem, and reducing prescriptions by itself is an incredibly stupid and cruel way to go about this. I can see why it's being done this way. Once you become dependent on something like benzos, most doctors and most of society does not think your life is worth living and they try their hardest to make it so.

It seems like benzos, while sometimes quite powerful, can have really nasty side effects that some doctors irresponsibly don't disclose, including the rapid tolerance, rebound properties, and withdrawal in general.

It also seems that, like opiates, it can vary a lot from person to person.

I've been fortunate, and the few times I've had occasion to try taking benzos for a non-hospital interval, they didn't do anything for me - positive, negative, or otherwise, without any sort of visible withdrawal effects when we stopped.

Conversely, there are people I know who have reported nasty side effects and dependency issues rather rapidly (in my own family, even).

I really think the way to move forward and minimize this see-sawing of public opinion on necessary evil versus unnecessary tool will be gaining better insight into people's personal response profiles to these things before and after giving them the drugs, so you can try to notice "huh, that's a lot higher concentration of those metabolites than I expect, I guess they process it fast" or "well that opioid sure is lighting up the reward parts of the brain, guess they're at decent risk for addiction."

(Unfortunately, I'd speculate we're at least 20y out from anything like that being ubiquitous/useful, so ...)

GABAergenics (the class of drug which benzodiazepines fall under) in general are pretty much the sole class of popular recreational drug which have a very real possibility of lethal withdrawals.

In the case of alcohol, it often takes years for addicts to reach a point where withdrawal becomes lethal. In the case of short acting benzodiazepines/barbiturates, this point can be reached in less than a month.

Of course, benzodiazepines are in schedule IV, which means they are viewed as being rather benign with no/low potential for abuse. In the eyes of the federal government, alprazolam (xanax) is far less dangerous than marijuana/the traditional psychedelics.

Just another data point demonstrating the utter absurdity of US drug legislation and regulation.

I take 1mg xanax up to once a day (typically every other day) and it has completely changed my life for the better. In conjunction with propranolol taken regularly (20mg twice a day, roughly), my anxiety is finally in a fairly well-controlled state. Unfortunately, getting benzo prescriptions -- even for the low dosage and frequency I'm on -- is hard and getting harder. Ordering it online is possible but rife with scams and risks. I understand that some people abuse these medications but for me they're life-saving; in cracking down on benzo prescriptions, my anxiety medication is becoming a source of anxiety in itself.

According to my psychiatrist (whom I turned to when I realised that I had an addiction problem I had to deal with) were it not for some highly unusual metabolic pathways my sixteen-year benzodiazepine habit would have had a chance to end my life multiple times (as it is I just ended up in ER once after inadvertently combining a hefty dose of Valium in the morning with a few celebratory margaritas at midday).

Said pathways have also given me the privilege of being able to quit cold turkey (in the se se that I suffered no crippling withdrawal symptoms or rebound effects, but man is it difficult to break the habit).

I count myself amongst the very lucky.

I’m pleased to see this getting more attention. I find the memory-erasing drug of these effects to be unpleasant, and duration disturbing. If you take three of them, the next day 24 hours later or you may still have blood plasma like one pill or more, depending on which benzo it is. Most people don’t understand drug half life and are unaware of that. Then if you mix in cannabis or alcohol, things start to get really dangerous memory-wise. These drugs are prescribed fairly casually to people who don’t have any serious medical or psychological conditions, and in my observation are treated equally casually by consumers.

For anyone looking to quit benzodiazepines, the Ashton Manual is the canonical resource: https://www.benzo.org.uk/manual/

My mother had insomnia and her doctor prescribed some benzo (can't remember which) 3 times per day. She would take one in the morning and spend the rest of the day sleeping or calling random people with super weird conversations. I went back to the doctor with her demanding why he prescribed such a strong medicine 3 times per day when her problem was having difficulties falling asleep, and he says "oh she looked like she has anxiety". I wanted to punch him in the face. These doctors prescribe whatever the pharma marketeers pay them to prescribe.

I feel for the patients that actually need a benzo to lead a normal, functioning lifestyle. Due to the actions of abusers it seems the public is starting to distrust medication.

Dirt cheap, "synergizes" with alcohol, street presses being incredibly overdosed, it is weird seeing the writing on the wall then watch it be inked into existence.

I've found Hemp-based CBD flower a viable alternative to benzos. There are a few farm-to-customer websites where you can order it for a much more reasonable price than full-spectrum cannabis. If anyone out there wants to rid a benzo dependency, try CBD flower. The effects are rather immediate (due to inhalation).

A friend of mine got hooked on heroin and ended up on methadone maintence. He’s since managed to get off that and is clean, but he had horror stories of people on methadone abusing benzodiazepines like crazy. Apparently mixing methadone and high doses of drugs like Xanax produce effects similar to heroin, but benzos are really hard to get off. He talked about a woman who couldn’t get her Xanax fix, and she started having seizures. Benzodiazepines take months to titrate off safely, and higher doses associated with abuse do unpleasant things to your seizure threshold and memory.

Bad stuff unless you must have it.

> And of course, my Lorazepam was prescribed legally, by a responsible, well regarded psychiatrist, with very little warning regarding how quickly one builds both tolerance and physiological dependence on this chemical.

Sorry to hear that. Mine told me to take at most 1mg no more than once a week for that reason. Seeing what that quantity does to me, I can't imagine dosing at that quantity or frequency (obviously you acquire a tolerance, but still).

I really think most Psychiatrists know how addictive Benzodiazepines are, but Americans are very stressed out.

In my case, I busted a gasket in my twenties. I went from the most capable person in the room, to the trembling guy who could barely leave his room. I can honestly say it ruined my life.

I was given a benzo with a long half life. It worked a bit, but I never fully recovered. I think we all know the drug. 40 hour half life.

I tried all kinds of medications over the years, and nothing worked except benzodiazepines , and alcohol. Yes--alcohol hits so many different parts of the brain, but is horrid on the body. I really tried to avoid alcohol, but some days the anxiety susptoms we just unbearable.

I've been on the long half life benzodiazepine for decades. I take the same dose low dose, and try not to drink.

I've never even asked my doctor, but he knows my low dose isn't going to cause physical problems. They are better than alcohol, if you're self-medicating. I belive his thinking is I need the drug. I've been on it forever. Why put him through a misserable detox, at this stage of the game?

There are a few big studies done on patients whom were on opiates, and benzodiazepines for long periods of time. They didn't necessarily need to increase their dosages. I believe the studies were done on rest home geriatric patients.

I feel at my age, what's the point of a long withdrawal. It's easy to say for myself because my doctor has reasonable rates. He is getting close to retirement, and that has me very worried. The last thing I want is a long misserable detox.

I don't like the way this drug problem is playing out. I don't like blaming doctors. All their patients are very different.

My wish is we let, especially Psychiatrists, make these hard calls concerning what's best for their patients. That's what they went to school for.

I don't know why we are even discussing it here.

I don't want to live in a world where doctors send their patients home a mess because they are afaird of being accused of some sinister reason for keeping a patient on a addictive drug.

In all reality, so many doctors just don't prescribe certain drugs. Probally, one of the main reasons why former patients go to the streets, or liquor stores.

(I would further like to see a governmental bill that would allow patients, whom have been on addictive drugs for years, the ability to authorize their own scripts. The Same dose, and any increase would require a doctor's visit. At this point my office visits are pointless. There is a bill that is in congress now I believe, but it's for drugs that aren't addictive. I doubt the AMA will ever let it pass though.)

For benzos: There really is no drug alternative to benzos other than maybe SSRIs but most people perscribed them probably tried SSRIs in the past to no effect. Your other alternative is extensive psychotherapy, which your insurance is unlikely to cover. Perhaps in the future marijuana, MDMA or ketamine might prove useful.

Benzos generally require you to taper off them, as I believe the withdrawal side-effects include seizures. You cannot safely "cold turkey" them.... so I hope they don't get all heavy-handed with them like they are for people who rely on opiods to treat chronic pain.

Cannabis in both cases works well for a great many people.

Benzodiazepines are a useful option for the short-term management of acute anxiety crises, but there's very little evidence that they're useful in the long-term. Clinical guidance in the UK says that they shouldn't be prescribed for more than two weeks, because the harms rapidly outweigh the benefits. There is good evidence for the efficacy of SSRIs and CBT in the treatment of anxiety disorders.

Opioids are a more difficult problem. Some patients do need opioids, but we're not sure which. There is some evidence to suggest that opioids may worsen the long-term prognosis for many chronic pain patients. We need more research and better availability of psychosocial interventions and physiotherapy.

There are newer benzos (and analogs) that have less negative effects than Valium or Xanax, but they don't seem to be popular in the developed world for whatever reason.

Etizolam is one such drug. It's prescribed in Japan and India, but not really anywhere else as far as I can tell. It has a lower potential for dependance than classical benzodiazepines and tolerance builds up a lot slower. Anecdotally from people I know who've taken it, its acute effects feel much more mild than Xanax or Valium. In my limited experience, Valium feels like you've been lobotomised, and Etizolam feels like you've been given a big hug.

> what are the alternatives for people with chronic pain or chronic anxiety?

If you look around the world, what is the solution there? The US is unique in the prescription of these drugs, but also unique in its reluctance to look around and say "what's everyone else doing that's working"?

I think here the answer is that it's fundamentally a different view on chronic pain (Acute pain is a different story- you don't prescribe a ton of opiates to someone who needs to keep it for emergencies).

I don't know about pain, but for anxiety there are other drugs that are intended for long term use. The ones I'm aware of (mirtazapine and venlafaxine) are also used as anti-depressants.

> have become aware of many people who use opiods on a long-term, occasional basis to manage their pain

This is the correct way to use opioids for long term pain, but it's only useful for a small number of people.

https://www.rcoa.ac.uk/faculty-of-pain-medicine/opioids-awar...

"A small proportion of patients may obtain good pain relief with opioids in the long term if the dose can be kept low and especially if their use is intermittent (however it is difficult to identify these people at the point of opioid initiation".

This "small proportion" is in the UK context, where we are already prescribing much less opioids.

The mistake people make is to think that opioids are effective to treat long term pain. For most people they do not work to treat long term pain. The patient develops tolerance, needs increasing doses, and eventually they're taking dangerously high doses and also not getting pain relief.

We need to understand that there are limited treatments for chronic pain. Some people will need to lose weight and exercise. Some people may find a psychological treatment useful to either treat the pain or come to terms to live with the pain.

https://www.rcoa.ac.uk/node/21134

"Chronic pain can cause low mood, irritability, poor sleep and reduced ability to move around. Unlike acute pain, chronic pain is difficult to treat with most types of treatment helping less than a third of patients. Most treatments aim to help you self-manage your pain and improve what you can do. Different treatments work for different people. Medicines generally and opioids in particular are often not very effective for chronic pain. Other non-medicine treatments may be used such as electrical stimulating techniques (TENS machine), acupuncture, advice about activity and increasing physical fitness, and psychological treatments such as Cognitive Behaviour Therapy and meditation techniques such as mindfulness. Helping you understand about chronic pain is important and in particular helping you understand that physical activity does not usually cause further injury and is therefore safe. It is important that you understand that treatments tend not to be very effective and that the aim is to support you in functioning as well as possible."

"Neuropathic pain is a type of chronic pain associated with injury to nerves or the nervous system. Types of neuropathic pain include, sciatica following disc prolapse, nerve injury following spinal surgery, pain after infection such as shingles or HIV/AIDS, pain associated with diabetes, pain after amputation (phantom limb pain or stump pain) and pain associated with multiple sclerosis or stroke. Neuropathic pain is usually severe and unpleasant. Medicines may be used to treat neuropathic pain but are usually not very effective and work for a small proportion of people. You may not benefit from the first drug tried so you may need to try more than one drug to try and improve symptoms."

I get the feeling that you're not aware of the scale of over-prescribing in the US. The US prescribes hugely more opioids than other countries. For example, for a while the US was using 99% of the world supply of hydrocodone.

The US could correctly treat the small number of people who'd get benefit from occasionaly tightly controlled opioid prescribing while also massively reducing the total number of opioidprescriptions.

And for anxiety the story is similar. The evidence for efficacy of benzos isn't great.

https://www.nice.org.uk/guidance/cg113/chapter/Key-prioritie...

You need a stepped approach:

individual non-facilited self help

individual guided self help

psycho-educational groups (for one example see Recovery Colleges https://www.health.org.uk/recovery-college

If these don't work you offer a high intensity psychological intervention, or a medication.

Notice that for medication they say "Do not offer a benzodiazepine for the treatment of GAD in primary or secondary care except as a short-term measure during crises. Follow the advice in the 'British national formulary' on the use of a benzodiazepine in this context."

Every time the patient collects their benzos from the pharmacy there will be a patient information leaflet. Here's an example for diazepam: https://www.medicines.org.uk/emc/medicine/18061

I get the feeling that benzos are far more readily prescribed in the US, and for long times.

The DEA drug schedule is a hot mess.

https://www.dea.gov/drug-scheduling

There's no planet where Ritalin has a higher potential for abuse and addiction than Xanax. Not to mention all the lower-risk drugs that have been categorized schedule I for political reasons.

Under the current system rohypnol is schedule IV but has special date rape laws passed to make possession of it punishable like a schedule I drug as a workaround.

You have your schedules mixed up. All controlled substances have a potential for abuse. Schedule IV drugs only have a 'low' potential for abuse 'relative to the drugs or other substances in schedule III', not low overall. You could argue that it should be schedule III, but all controlled substances, regardless of their schedule, are more tightly controlled than any other unscheduled prescription-only drug.

Omeprazole is not a controlled substance and is OTC in the United States.

iodine is a schedule I substance.

You mean GABAergenic, right?

It is incredibly, incredibly dangerous to mix benzodiazepines (Xanax, Ativan, etc.) with Methadone. This is common knowledge amongst opiate addicts, at least everywhere I ever went in the US back in my wilder days. I have 3 close friends whom I grew up with that all died before age 30 from abusing that exact combination of narcotics, and know of countless more just in my home state alone.

Benzos are a respiratory depressant, and when combined with Methadone it amplifies it to the point where you stop breathing in your sleep and never wake up from respiratory failure, lack of oxygen to the brain, or your body freaks out and has a coronary episode, etc. it's really really risky -- no joke & no exaggeration. If alcohol is in the mix too then it's even worse.

And I'm not going to pretend like it's not enjoyable -- because it is. It's a great fuckin' buzz if downers are your thing. IMO it's better than heroin (no 'rush' to it, but the effects hit you like a ton of bricks and it lasts all night long. And it's a cheap buzz too), but it's also asking for your life to end.

methadone clinics know this and every one that I've ever seen, heard of, or been to personally Benzos are their one big 'no-no' [as in: if we find it in your Whiz Quiz we kick you out, some won't even give you a second chance and most clinics have mandatory urine screening twice a month, some every week]. You can test positive for damn near anything else -- and they expect you to test positive for opiates -- but if you have benzos in there then you kick rocks.

There is a pretty large community on Reddit just dedicated to recovery just from Benzo's.

https://www.reddit.com/r/benzorecovery/

Benzo withdrawal can, in some cases be even riskier than opiate withdrawal. You also build a tolerance to them very quickly, which makes addiction even worse.