is dr. drew too risky for prime time?

This arti­cle gives a good cri­tique on the dan­gers and quack­ery of the “tough-​love” approach to treat­ing drug addic­tion, and relates evidence-​based treat­ments for drug addiction.

With the news last week of coun­try star Mindy McCready’s sui­cide by gun, the death toll among Dr. Drew’s Celebrity Rehab patients now stands at five, giv­ing the show an unusu­ally high mor­tal­ity rate of nearly 13%. But what’s even more dis­turb­ing is that most of those deaths — pos­si­bly even McCready’s — might have been pre­vented if the pro­gram had uti­lized treat­ment prac­tices proven to be most effective.

I would like to use a per­sonal expe­ri­ence to point out that “side effects” of pre­scrip­tion drugs are effects of the drugs and that with­drawal is an effect of the drugs. Though with­drawal is caused by the taper­ing off and ces­sa­tion of a drug’s use, with­drawal is a drug-​induced state. Until the body/​brain has recov­ered from the effects of a drug (which could take as much as a year for the brain to achieve nor­mal func­tion­ing (relapses are usu­ally phys­i­o­log­i­cal, not psy­cho­log­i­cal in nature)) then a per­son free­ing them­selves from addic­tion is still under the influ­ence of a drug.

Accord­ing to this article

…“ben­zo­di­aza­penes “can cause with­drawal seizures if patients aren’t ade­quately med­icated dur­ing detox. Indeed, with­drawal from ben­zo­di­azepines and alco­hol — unlike methadone or heroin with­drawal — can be fatal because these seizures can progress into a con­di­tion called sta­tus epilepticus…the death rate from such seizures can be as high as 10%.“

I had a grand mal seizure dis­con­tin­u­ing a low dose of pre­scrip­tion clon­azepam that I was pre­scribed to help with the sleep prob­lems that were being caused by ritalin. I took and dis­con­tin­ued the drug exactly as directed. Fol­low­ing the seizure I expe­ri­enced automa­tism— I was straight­en­ing and re-​straightening items on my desk in a repet­i­tive and mechan­i­cal man­ner and did not stop until I was inter­rupted by a para­medic. I asked if he was there for my care-​giving client that I sud­denly feared might be hav­ing a med­ical cri­sis. The para­medic said that he was there for me. I said, “Me?!” He and my friend walked me into the ambu­lance. The para­medic asked me if I could tell him my name. I thought about it, drew a blank, and said, “Nooo.” Sud­denly I under­stood why they looked so wor­ried about me, but to me it was just inter­est­ing the way find­ing a con­tainer with left­over lasagna in the refrig­er­a­tor would be inter­est­ing if I couldn’t remem­ber hav­ing made it recently off the top of my head. What was really inter­est­ing was the equip­ment in the ambu­lance. He grabbed my atten­tion, asked me if I could tell him my par­ents’ names. Nope. The town where I went to high school? Uh uh.

So off we went. First ambu­lance ride. Emer­gency room. First I.V. First cat scan. Some­where along the line my mem­ory came back, but it did so with­out fan­fare. You’d think that some­thing like that would make an impres­sion, but it was just there when the doc­tor inter­viewed me again after the tests. For­tu­nately, the V.A. cov­ered my bill. Had I had no cov­er­age, I would have payed that bill for years.

I blanche to think of what might have hap­pened to me in that con­di­tion had I not been in a safe place with a trust-​worthy per­son who looked out for me.

I had no idea that ben­zo­di­aza­pene with­drawal could cause seizures, though I had done research on it when I started tak­ing it. All that hap­pened in 2001. There is much bet­ter infor­ma­tion avail­able now on the risks of taking/​discontinuing drugs that are com­monly pre­scribed. Since then, doc­tors and pre­scrib­ing nurses have been using longer and slower dis­con­tin­u­a­tion sched­ules. Because the drug man­u­fac­tur­ers don’t make these drugs in small enough doses to make the sched­ule gen­tle enough, there are elab­o­rate sched­ules for cut­ting doses in a way that will min­i­mize the bio­log­i­cal may­hem of drug withdrawal.

If you’re think­ing about using ben­zos, please con­sider their addic­tive nature, whether or not you could han­dle the cost of cat­a­strophic effects, whether or not you can be sure that you won’t run out and can rea­son­ably expect to have the pre­scrip­tion refilled with­out delay. Whether other slower and more con­scious efforts to change your lifestyle so that you can get ade­quate sleep or man­age stress would be much bet­ter for you. And whether of not your prob­lem with sleep­less­ness may be caused by a drug that you’re taking.

If you’re tak­ing ben­zos illic­itly, you might seri­ously want to recon­sider because if it does cause a prob­lem that requires emer­gency treat­ment, you may find your­self iden­ti­fied as a drug user in the med­ical sys­tem and, like those labeled with men­tal ill­ness, you may find your­self being treated as if your med­ical prob­lems are per­sonal prob­lems, be deprived of some of the ben­e­fits of sci­ence, and be at the mercy of folk psy­chol­ogy being exer­cised by med­ical staff. Most of them should know bet­ter, but we all have our biases.

Pre­scrip­tion drugs are respon­si­ble for more over­doses and deaths than heroin or cocaine com­bined now, so emer­gency med­ical per­son­nel can rea­son­ably bet that an over­dose is caused by a pre­scrip­tion drug, though they shouldn’t bet on it. One rea­son why it is so com­mon for peo­ple to over­dose on pre­scrip­tion drugs is that they are being over-​prescribed and are being given too many refills with­out ade­quate warn­ing of the risks. Many peo­ple make the mis­take of think­ing that a pre­scrip­tion drug can’t be as dan­ger­ous as a street drug. Don’t make that mis­take, please.