Overprescription of sedatives and tranquillizers

Rauwolfia root was used as a tranquillizer in India as early as 1000 BC. Bromide (potassium and sodium salts), then paraldehyde barbiturate sedatives were introduced for medical purposes between 1857 and 1903 AD.  Barbiturates, such as phenobarbital, also have long use as anxiolytics and hypnotics.

The first benzodiazepine was created in 1955 and marketed by drug company Hoffmann-La Roche as Librium. This and related drugs were supposed to help people engage in psychotherapy.  Polish-American chemist Leo Sternbach and his research group chemically altered Librium in 1959, producing a much more powerful drug. This was diazepam, marketed from 1963 as Valium. Valium paved the way for modern antidepressants. It was more difficult (but not impossible) to overdose on these newer drugs, and they had fewer side effects. The first SSRI, or selective serotonin reuptake inhibitor, was fluoxetine, marketed from 1987 as Prozac.
 

Cheap, easily available anti-anxiety drugs had a huge impact. From 1969 until 1982, Valium was the top-selling pharmaceutical in the United States. These drugs created a culture of managing stress and anxiety with medication.

More women than men are using tranquillizers or sleeping pills. When men and women report similar psychological or psychosomatic symptoms, men are more likely to be given physical and laboratory tests, and women are more likely to be given drugs. Women are also more likely to be given a repeat prescription once they have been prescribed a minor tranquillizer.

Benzodiazepines, are sedative hypnotic anxiolytics (“depressants” that reduce anxiety). They significantly reduce brain activity but have been associated with a 35% increase in developing cancer and patients receiving hypnotics are more than four times likely to die than people who are not on the drugs. It appears that the dosage plays a key role. In addition, benzodiazepines are highly addictive and interact with neurotransmitters like GABA. It takes several months of regular use for a person to develop addiction, tolerance and significant withdrawal symptoms. Benzodiazepines are being grossly over-prescribed according to data published in 2018 by the Journal of the American Medical Association:

• More than 5% of US adults aged 18 to 80 years take benzodiazepines
• The percentage who use benzodiazepines increases with age from 2.6% (18-35 years) to 5.4% (36-50 years) to 7.4% (51-64 years) to 8.7% (65-80 years)
• The prevalence of women users is nearly twice as much as men
• Long-term use categorized by age is; 14.7% (18-35 years) to 31.4% (65-80 years)
• Interestingly, the number of prescriptions from a psychiatrist decreases with age – 15.0% (18-35 years) to 5.7% (65-80 years)
• In all age groups, roughly one-quarter of individuals receiving benzodiazepine involved long-acting benzodiazepine use.
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• Barbiturates, derivatives of barbituric acid, are still one of the most important of the group of depressants, hypnotics, sedatives and tranquillizers. Drugs of this kind "damp down" the activity of the brain so that the effect of naturally calming substances is increased and naturally arousing substances is stopped. Although they may be considered 'safe' if used as sleeping pills or sedatives in small doses or in large doses under medical supervision, as in anaesthesia, after regular and prolonged use there is great danger of dependence. In the long run the brain's own mechanisms for controlling anxiety and tension can no longer function. They are addictive to the extent that after using them for three months, there is a 50% probability of becoming dependent on them. It is claimed that withdrawal is then even more difficult as from hard drugs such as heroin. Distinct from the morphine-type withdrawal syndrome, these symptoms of barbiturate withdrawal reach maximum intensity a few days after the onset and subside slowly.

  Barbiturates are commonly used in conjunction with other substances, the most widespread and dangerous use being with heroin, alcohol and stimulants. 'Street drugs' (for example, marijuana, mescaline) are sometimes doctored with animal tranquillizers (for example, PCP). Since large quantities are used for therapy it is much more difficult to evaluate the extent of abuse of barbiturates and other hypnotics and sedatives than that of narcotic drugs or other psychotropic substances. In a number of countries they account for about 10% of prescriptions. The general picture is complicated by the fact that the majority of people who are addicted to barbiturates are also dependent on other substances. 'Chasing the dragon' with a mixture of heroin barbiturate is fairly widespread in Asia. Barbiturates are the most commonly used group of addictive drugs.

  Although the behavioural effects of tranquillizer intoxication closely resemble alcoholic intoxication, abuse is far more dangerous with a high possibility of unintentional overdose. With chronic abuse a rapid tolerance develops and both physical and psychic dependence occur. Abrupt withdrawal is dangerous and the convulsions which follow can be fatal. A period of mental confusion, delirium, hallucination and temporary psychotic, often paranoid reactions, may follow. Pharmacological dangers are increased by the character of those who use the drug. Social, emotional and personality deterioration are associated with chronic abuse. If the drugs are injected large ulcers may develop at the site.