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What are sleeping pills?

Sleeping pills belong to a class of medicines called benzodiazepines. What are benzodiazepines? Well, they include such household names as Calmpose, Valium, Alprax, Neurocalm, and Restyl. Despite the fact that benzodiazepines are only recommended for short-term use, majority of people who attend our pain clinic for the first time have been on it for years. They were prescribed either as the “little helper” to aid sleep or as a muscle relaxant. Muscle spasms, particularly ones in the neck and lower back, make people desperate. They even try Cupping to “increase circulation and release energy and toxins” resulting in their backs looking like a pepperoni pizza. The fact that muscle spasms and sleep disturbance are present in a high proportion of pain sufferers meant there were liberal prescription regimes by doctors and quacks alike.

Side-effects of sleeping pills

Now, benzodiazepines influence almost every aspect of brain and other bodily functions. We have seen physical and mental suffering in our clinic. Some were depressed, some were anxious; some had “irritable bowel”, heart or nervous system complaints with full gastrointestinal, cardiological and neurological screens. Memory impairment, paradoxical stimulant effects, emotional blunting, suicidal tendencies, domestic disharmony are some if not all symptoms noticed in these patients. We do not even understand their effect on the immunity and hormone levels of the user.

Addiction and sleeping pills

Some on benzodiazepines start to “require” larger doses. If the doctor would not prescribe, they would source it from quacks or even better walk across the road to the pharmacy, where they would be handed out like smarties. Because of widespread prescribing and easy availability, benzodiazepines have now entered the “drug scene”. They are taken illicitly in high doses, unleashing new and dangerous effects such as AIDS & hepatitis, and illegally.

What happens when sleeping pills are stopped?

We all need stress-coping skills to get on with life. Such skills are blocked for years during which benzodiazepines are taken. Withdrawing it leaves the ex-user in a vulnerable state with reduced ability to deal with stressful situations. They become anxious due to the uncovering of a learning defect. The widow, prescribed benzodiazepines following the death of her husband, may go through the grieving process following withdrawal, for a bereavement that occurred years before. A constant ringing or hissing in the ears (tinnitus) and other unpleasant bodily sensations like “pins and needles”, numbness, burning pain or aches, muscle tension, weakness, cramps, jerks, spasms and shakes persist for years following benzodiazepine withdrawal.

It is more difficult to withdraw people from benzodiazepines than it is from heroin The suppression of such evidence about benzodiazepine side effects has deservedly been national news in Britain. According to the Independent, “the Medical Research Council (MRC) in Britain agreed in 1982 that there should be large-scale studies to examine the long-term impact of benzodiazepines after research by leading psychiatrist showed brain shrinkage in some patients similar to the effects of long-term alcohol abuse”. Malcolm Lader, the psychiatrist mentioned in the report and an expert on benzos at London’s Institute of Psychiatry, called them “the opium of the masses” because of Britain’s very high prescribing rates. Professor Lader declared, in a 1999 interview on BBC Radio 4, “It is more difficult to withdraw people from benzodiazepines than it is from heroin”. Britain’s All-Party Parliamentary Group for Involuntary Tranquiliser Addiction estimated 1.5 million addicts in UK alone. Out of a population of 60 million, 11.5 million prescriptions were dished out in the UK in 2008.

Theoretically, airplanes can perform any manoeuvre from loops to barrels. Whether it’s a good idea is another matter. Their components are not designed for aerobatics, and the cleaners would be kept busy scrubbing out coffee stains and vomit. Ditto, human bodies and benzodiazepines. It may be prescribed for anxiety, stress, insomnia and muscle spasms, but the difficult job of cleaning up after the party belongs to the doctors. The ones who actually started it. In Britain, members of Parliament and lawyers described the MRC documents as a scandal, and predicted they could lead the way to a class action costing millions. One shouldn’t hold his or her breath for such a thing to happen in India.

Sleeping pills in India

Most Indian doctors think they know what the problem is. Majority of Indian doctors speak in hushed tones about it. Only a few point their finger at where the problem is. The International Narcotic Control Bureau’s report on India, reminds me of a particularly wonderful moment in The Simpsons Movie, where Homer leafs frantically through the Bible at a moment of crisis, crying ‘This book has no answers!’

What can doctors do?

Just like one could never run out of twitter followers, there are ample ways to treat muscle spasm, anxiety and sleeplessness. Benzodiazepines are just a short-term solution. Indian doctors may be adept at treating twenty- year-olds who have swallowed an unwise mix of vodka, Sprite, proxyvan, cattle-feed and laxatives, but they should also stop playing Tweedle Dee to the drug company’s Tweedle Dum. If it tantamount to gift horse dentistry, they should remind themselves of Bertrand Russel’s quote “Aristotle could have avoided the mistake of thinking that women have fewer teeth than men, by the simple device of asking Mrs. Aristotle to keep her mouth open while he counted.” The solution is as simple. So next time when there is a newer benzodiazepine in the market, the medics should start viewing them with the same sort of suspicion that veteran boozers eye teenage teetotallers.

Caution: Benzodiazepines should not be stopped abruptly. The doses have to be gradually tapered over several months.