Psy-Q: What 1966 rock song described the use and dangers of benzodiazepines?

Answer:

The Rolling Stones sang about housewives taking a “little yellow pill” to get through the day in their 1966 hit “Mother’s Little Helper.” Providing social commentary about the widespread use of benzodiazepines, diazepam (Valium) in particular, during that time period, the song’s final lyrics warn about overdose and death. Despite the rock band’s soft warning, it was years before any boxed warnings were added to the drug.

Sixty years after benzodiazepines first came on the market (chlordiazepoxide was approved in 1960), and four years after the FDA’s first boxed warning about mixing them with opioids, the agency cautioned clinicians and patients just this year – 2020 – about the serious risks of benzodiazepine addiction, misuse, dependence, and withdrawal. See the FDA’s September 2020 updated boxed warning in our News Roundup. Why not sooner?

Sumit Agarwal, MD, an instructor at Brigham and Women’s Hospital and Harvard Medical School, and lead author of the 2019 JAMA study “Patterns in Outpatient Benzodiazepine Prescribing in the United States,” shared his thoughts on the FDA’s announcement with Psycom Pro.

His view is that the FDA has looked at data within the past few years such as ER visits, poison control calls, abuse outside of prescriptions, and co-prescribing with other CNS depressants and realized that stronger warnings were needed. He speculates that the agency didn’t see prescribing trends decrease after its previous warning in 2016. “This is a little bit to my surprise because I think the awareness around the opioid epidemic should have spilled over to benzodiazepines, too, at least among prescribers,” he says.

Dr. Agarwal makes the point that the effectiveness and immediate relief of benzodiazepines is what makes them attractive options to prescribers and patients. But as for the current state of widespread benzo use, he says, “It was an over-appreciation of the benefits and an underappreciation of the risks that have led to long-term use beyond what the original FDA approval was for, which is intermittent use for up to 8, maybe 12 weeks.”

Data is still lacking on the dependence potential of these drugs because most rigorous studies only go out for about 2 to 3 months, and the information we have on the long-term effects comes from anecdotes and reports, adds Dr. Agarwal. While there are no official CDC or FDA guidelines for tapering benzodiazepines, he says that the Ashton Manual, a guide to withdrawal developed by a British psychopharmacologist, is often used as a starting point to the months-long, patient-specific process of safely stopping benzo use.

Looking forward, Dr. Agarwal says he is concerned about how the COVID-19 pandemic has raised anxiety levels, and whether people will turn to benzodiazepines as a way to get sleep and deal with their anxiety. “I worry about the implications if people start taking these drugs long-term,” he says.

 

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Last Updated: Apr 22, 2021