tag:theconversation.com,2011:/uk/topics/valium-5038/articlesValium – The Conversation2021-10-20T17:19:06Ztag:theconversation.com,2011:article/1673392021-10-20T17:19:06Z2021-10-20T17:19:06ZShort-sleepers are more likely to suffer from irregular and heavy periods<figure><img src="https://images.theconversation.com/files/424587/original/file-20211004-15-3dam4r.jpg?ixlib=rb-1.1.0&rect=60%2C41%2C2995%2C2144&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Menstrual periods can disturb sleep, but sleep troubles can worsen menstrual symptoms.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/african-american-woman-experiences-stomach-pain-royalty-free-image/1208951173?adppopup=true">Catherine McQueen/Getty Images</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em></p>
<h2>The big idea</h2>
<p>Menstruating women who sleep less than six hours a night tend to suffer heavier and irregular periods. That is the conclusion from our study, which was published in 2021 in the <a href="https://doi.org/10.1111/jsr.13434">Journal of Sleep Research</a>. </p>
<p>We found that those who got less than six hours of sleep on average nightly were 44% more likely to have an irregular period and 70% more likely to have heavy bleeding during a period than healthy sleepers who got seven to nine hours. </p>
<p>Many people understand the importance of a good night’s rest, but even myriad new therapeutics, treatments and tracking apps are leaving women behind. We analyzed survey data from 574 menstruating females from age 24 to 40. They were asked about menstrual bleeding and regularity, sleep and how well they functioned during the day. We found that those who experienced heavy or irregular periods were more likely to suffer from short and poor-quality sleep, fatigue, stress and depression.</p>
<p>One might ask: Which comes first, the chicken or the egg? When females experience mood swings, cramps, irritability and fatigue before or during periods, they can suffer from <a href="https://doi.org/10.1016/j.jsmc.2019.01.002">disturbed sleep</a>. These symptoms are all characteristic of premenstrual syndrome – widely known as PMS – or premenstrual dysphoric disorder, which can cause severe depression or anxiety in the lead-up to a period. </p>
<p>On the other hand, sleep loss itself can <a href="https://doi.org/10.1016/j.smrv.2005.08.001">lead to worse pain</a>, which can intensify PMS and premenstrual dysphoric disorder symptoms. Females are also <a href="https://doi.org/10.1162/jocn_a_01225">more likely to suffer from anxiety</a> when they lose sleep, making it even more difficult to fall asleep.</p>
<h2>Why it matters</h2>
<p>Females are <a href="https://doi.org/10.1093/sleep/29.1.85">40% more likely</a> than males to suffer from insomnia. The leading treatments, however, rarely consider menstrual health. Cognitive behavioral therapy for insomnia is recognized by the American College of Physicians as the first-line treatment for insomnia. While this behavioral therapy is effective for those living with <a href="https://doi.org/10.1016/j.jsmc.2014.02.007">chronic pain</a> and <a href="https://doi.org/10.1093/sleep/zsx019">depression</a>, it hasn’t yet been tested for menstrual symptoms that ebb and flow each month.</p>
<p>Doctors sometimes prescribe drugs such as Valium and Ambien to help with sleep disorders, but these can lead to <a href="https://doi.org/10.3109/10826084.2014.980952">dependency</a>, <a href="https://doi.org/10.2165/00023210-200418010-00004">withdrawal syndrome</a> and other <a href="https://doi.org/10.1080/13803395.2014.928268">cognitive dysfunctions</a>.</p>
<p>Oral contraceptive pills are frequently given for problematic periods, but these come with some risks and tradeoffs: They have been linked to <a href="https://doi.org/10.1001/jamapsychiatry.2016.2387">depression</a>, <a href="https://doi.org/10.1176/appi.ajp.2017.17060616">suicide</a>, <a href="https://doi.org/10.1136/bmj.d6423">blood clots</a> and <a href="https://www.nejm.org/doi/10.1056/NEJMc1800054">breast cancer</a>. </p>
<h2>What’s still not known</h2>
<p>Researchers like us who study women’s health don’t yet fully understand the intricacies of the relationship between menstruation and sleep. Menstrual complaints are often not taken seriously; for instance, it can sometimes take years to receive a diagnosis of endometriosis – a condition in which uterine tissue grows outside of the uterus in places such as the fallopian tubes, characterized by heavy periods and pain. <a href="https://dx.doi.org/10.1007%2Fs10815-010-9436-1">For about 25% of women</a>, this condition appears asymptomatically at first, making it harder to identify.</p>
<p>However, we believe menstrual complaints could be improved with better education about how to effectively diagnose these conditions. There must also be better awareness about implicit bias among medical providers against those with menstrual health complaints.</p>
<h2>What’s next</h2>
<p>Medical providers and patients could also communicate better. For example, doctors might take a broader look at menstrual symptoms and consider how important life transitions – puberty and stressors like the elusive work-life balance or starting a family – can worsen mental health, pain and sleep problems. This holistic approach could better serve patients and lead to more sustainable long-term solutions. </p>
<p>Women can also take an active role in their menstrual health by practicing mindfulness techniques such as meditation and relaxation. Every woman is different. The root causes of pain vary from person to person, and so do strategies to improve sleep.</p>
<p>A Band-Aid approach to solving menstrual and sleep problems is unsustainable and can cause more serious problems. By adopting a more holistic mind-body model to treating these complaints, doctors could improve what is otherwise a monthly struggle for many women, thereby boosting quality of life and overall health.</p><img src="https://counter.theconversation.com/content/167339/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Menstruating women who sleep less than six hours a night suffer worse periods. But leading treatments for insomnia rarely look at menstrual health.Kat Kennedy, PhD Student, Physiology, University of ArizonaSara Nowakowski, Associate Professor of Medicine, Baylor College of Medicine Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1023432018-09-18T20:34:28Z2018-09-18T20:34:28ZI can’t sleep. What drugs can I (safely) take?<figure><img src="https://images.theconversation.com/files/236593/original/file-20180917-177935-1k5b32x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There are many pharmacological options available for insomnia. But they will mostly make you reliant upon them for sleep. </span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p>If you’re having trouble sleeping, <a href="https://theconversation.com/some-reasons-why-you-should-avoid-sleeping-pills-10054">medicines</a> shouldn’t be your first option. Exercise regularly, cut back on coffee (and other caffeinated drinks) after midday, eat less in the evening, ease up on “screen time” before, and in, bed, practise meditation and try to have a quiet, dark bedroom dedicated mostly to sleep.</p>
<p>But what if you’ve tried everything and are still struggling with sleep? Many people will want to turn to a medicine for help. Navigating the various options for effectiveness, safety and the potential to become habit-forming can be difficult.</p>
<p>Long-term regular use of medicines to promote sleep should be avoided, as initial effectiveness declines rapidly over a few weeks and dependence and adverse effects become <a href="https://www.nejm.org/doi/full/10.1056/NEJMra1611832">problematic</a>. But in the short <a href="https://www.nps.org.au/australian-prescriber/articles/the-management-of-insomnia-an-update">short term</a>, sleep medications do have their place. Unfortunately they are often <a href="https://link.springer.com/content/pdf/10.1007%2Fs40271-016-0182-z.pdf">over-used, especially in older</a> people.</p>
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<strong>
Read more:
<a href="https://theconversation.com/why-getting-enough-sleep-should-be-on-your-list-of-new-years-resolutions-88007">Why getting enough sleep should be on your list of New Year's resolutions</a>
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<h2>Benzodiazepines</h2>
<p>Benzodiazepines are drugs such as <a href="https://theconversation.com/weekly-dose-valium-the-safer-choice-that-led-to-dependence-and-addiction-59824">Valium</a>, also used to treat anxiety. They are the most commonly prescribed <a href="https://www.nps.org.au/australian-prescriber/articles/management-of-benzodiazepine-misuse-and-dependence-5">sleeping pills</a>.</p>
<p>Their effects, which include some muscle relaxing properties, are achieved by enhancing the effect of <a href="https://www.wikiwand.com/en/Gamma-Aminobutyric_acid">GABA</a>, an inhibitory neurotransmitter operating throughout the brain. Rarely, some people experience the opposite and become over-excited and more anxious. </p>
<p>As benzodiazepines depress brain function (they depress the central nervous system), their effects add to other central nervous system depressants including alcohol, sedating antihistamines and opioid analgesics such as oxycodone (<a href="https://www.healthdirect.gov.au/endone">Endone</a>). This can be very dangerous, and when combined can lead to respiratory failure, coma and even death.</p>
<p>Physiological and psychological dependence on the drug can develop after only a few days in some people, or weeks in most. Unfortunately, far too many people are <a href="https://www.nps.org.au/news/benzodiazepine-dependence-reduce-the-risk">dependent</a>. </p>
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<strong>
Read more:
<a href="https://theconversation.com/weekly-dose-valium-the-safer-choice-that-led-to-dependence-and-addiction-59824">Weekly Dose: Valium, the 'safer choice' that led to dependence and addiction</a>
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<p>Importantly, the effectiveness for inducing sleep wears off after a few weeks. It can be very hard to stop taking benzodiazepines as insomnia and often anxiety returns. The duration of “<a href="https://theconversation.com/weekly-dose-valium-the-safer-choice-that-led-to-dependence-and-addiction-59824">withdrawal</a>” is related to the length of time these are taken.</p>
<p>Stopping suddenly after long-term use can be dangerous, with violent withdrawal reactions possible, including epileptic seizures. <a href="https://theconversation.com/weekly-dose-valium-the-safer-choice-that-led-to-dependence-and-addiction-59824">Ceasing</a> these medicines needs to be managed by your doctor. Essentially, a gradual reduction in dose is needed with support and counselling to assist with the temporary increase in insomnia and perhaps anxiety.</p>
<p>Side effects include a “dulling” of cognitive function, memory impairment and the increased risk for accidents, especially unsteadiness and falls in older people. </p>
<p>Benzodiazepines should only be used for two to four weeks, or intermittently, and only in addition to <a href="https://www.nps.org.au/medical-info/consumer-info/how-to-sleep-right">good sleep hygiene</a> (that is, practising the measures listed in the first paragraph).</p>
<p>Temazepam (brand names Normison, Temaze, Temtabs) and lorazepam (brand name Ativan) are reasonable choices from the many benzodiazepines available. That’s because they have a faster onset and short duration of effect so as to avoid a “hangover” the next day.</p>
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<p>
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<strong>
Read more:
<a href="https://theconversation.com/health-check-how-to-soothe-yourself-to-sleep-83154">Health Check: how to soothe yourself to sleep</a>
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<h2>Z-drugs (hypnotics)</h2>
<p>Zopiclone (brand names Imovane and Imrest) and zolpidem (brand name Stilnox) are similar in their pharmacology and effects to the benzodiazepines. These prescription-only medicines also enhance the actions of GABA to depress brain activity and have the same hazards related to excessive sedation and dependence. </p>
<p><a href="https://www.tga.gov.au/alert/zolpidem-stilnox">Bizarre</a> behaviours and symptoms, for example hallucinations and sleep-walking that can be dangerous, are more likely than with benzodiazepines.</p>
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<a href="https://images.theconversation.com/files/236595/original/file-20180917-177947-18nirlm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/236595/original/file-20180917-177947-18nirlm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/236595/original/file-20180917-177947-18nirlm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/236595/original/file-20180917-177947-18nirlm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/236595/original/file-20180917-177947-18nirlm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/236595/original/file-20180917-177947-18nirlm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/236595/original/file-20180917-177947-18nirlm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/236595/original/file-20180917-177947-18nirlm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Medications for sleep can’t be used long term.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
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<h2>Antihistamines</h2>
<p>Older antihistamine medicines, now known as sedating antihistamines, induce drowsiness through their central nervous system-depressing properties. These are available over the counter from pharmacies. Common examples include diphenhydramine (brand name Unisom Sleep Gels), doxylamine (brand name Restavit) and promethazine (branded Phenergan). </p>
<p>Especially in those with allergies such as hay fever disturbing their sleep, these may be a reasonable short-term option. Dependence on these medications to sleep is a hazard. </p>
<p>These medicines have <a href="https://www.veteransmates.net.au/VeteransMATES/documents/module_materials/M39_TherBrief.pdf">side effects</a> including dry mouth, blurred vision, constipation, confusion, dizziness and urinary retention in men with prostrate problems. All side-effects are worse in older people.</p>
<p>By contrast, over-the-counter antihistamines commonly used to treat hay fever (such as brand names Telfast, Zyrtec and Claratyne) are non-sedating, and therefore not likely to make you drowsy.</p>
<h2>Analgesics</h2>
<p>Any opioid-containing medicine, all now requiring a prescription, will induce drowsiness (depending on the dose) because they also depress our central nervous system. Codeine (in Panadeine, Panadeine Forte or Nurofen Plus), tramadol, tapentadol, morphine or oxycodone will make us sleepy, but they’re not recommended to treat insomnia. </p>
<p>These powerful medicines are best reserved for judicious use in pain relief, given the severe <a href="https://www.mja.com.au/journal/2011/195/5/prescription-opioid-analgesics-and-related-harms-australia">hazards of dependence and overdose</a>. Older people are more sensitive to the central nervous system-depressing effects and also to constipation.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-five-ways-to-get-a-better-nights-sleep-43700">Health Check: five ways to get a better night's sleep</a>
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<h2>Melatonin</h2>
<p>Our sleep-wake cycle is dependent on the hormone melatonin released cyclically from a gland in our brain. <a href="https://www.nps.org.au/radar/articles/melatonin-prolonged-release-tablets-circadin-for-primary-insomnia-in-older-people">Melatonin</a> administered orally helps induce sleep in some people, but is <a href="https://www.nps.org.au/australian-prescriber/articles/melatonin">not as effective as other sedatives</a>.</p>
<p>However, a <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002587">recent Australian study</a> tested melatonin in people with sleep problems caused by delayed melatonin release in their brains. These people have trouble falling asleep and waking at times appropriate for proper functioning.</p>
<p>Taken one hour prior to bed time, melatonin (0.5mg) accompanied by a behavioural intervention (such as learning how to meditate) helped the participants get to sleep and improved common accompanying impairments such as low mood, anxiety and difficulty concentrating. </p>
<p>You need a <a href="https://tga-search.clients.funnelback.com/s/search.html?query=melatonin&collection=tga-artg&start_rank=1">prescription for melatonin</a> in Australia. It’s best to avoid alcohol as it interferes with sleep, thereby reducing any effect of melatonin. It is worth trying as it is generally well tolerated, although some people experience back pain. It may work in other types of sleep disturbances, not due to delayed release of melatonin. A dose of 2mg, controlled release one to two hours before bedtime is <a href="https://www.nps.org.au/radar/articles/melatonin-prolonged-release-tablets-circadin-for-primary-insomnia-in-older-people">most commonly</a> used.</p>
<h2>Antipsychotics</h2>
<p><a href="https://www.nps.org.au/australian-prescriber/articles/concerns-about-quetiapine-3">Antipsychotic medicines</a> (such as quetiapine) have been increasingly used to treat insomnia. </p>
<p>Typically used at a lower dose, quetiapine can induce sleep but carries a significant burden of possible harmful effects. These include a fast heart rate, agitation, <a href="https://www.nps.org.au/australian-prescriber/articles/concerns-about-quetiapine-3">low blood pressure and unsteadiness</a>. These make quetiapine not appropriate for treating common sleep problems.</p>
<h2>Antidepressants</h2>
<p>Antidepressants are typically prescribed at a low dose for insomnia, but the supporting <a href="https://www.ncbi.nlm.nih.gov/pubmed/29761479">evidence</a> of efficacy (despite the wide use) is low quality and there is the <a href="https://www.nps.org.au/medical-info/consumer-info/antidepressant-medicines-explained?c=antidepressant-medicine-side-effects-a38bd490">risk of adverse effects</a> such as confusion, dry mouth and blurred vision.</p>
<h2>Herbal and complementary medicines</h2>
<p>Herbal remedies such as valerian, lavender, passiflora, chamomile, hops and catnip are widely promoted to promote “sleep health”. Research to support their efficacy is <a href="https://www.ncbi.nlm.nih.gov/pubmed/20965131">limited</a>.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/is-it-possible-to-catch-up-on-sleep-we-asked-five-experts-98699">Is it possible to catch up on sleep? We asked five experts</a>
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<p>Many <a href="https://www.ncbi.nlm.nih.gov/pubmed/29487083">newer and emerging medicines</a> are being tested for insomnia, so in the future more options should be available. </p>
<p>For now it’s important to remember none of the options listed above is without side effects, and most will cause dependence if used long term, meaning falling asleep without them will be even harder than it was before. </p>
<p>Improve your sleep hygiene, and if that hasn’t worked for you, speak with your doctor about what’s keeping you up at night. She’ll be able to prescribe the best type of medication for you to use in the short term.</p><img src="https://counter.theconversation.com/content/102343/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>With so many different types out there, it’s hard to know what sleep medications are safe to use. Here’s a guide.Ric Day, Professor of Clinical Pharmacology, UNSW SydneyAndrew McLachlan, Head of School and Dean of Pharmacy, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/982622018-06-13T14:52:09Z2018-06-13T14:52:09ZHow organised crime affects the most vulnerable communities<figure><img src="https://images.theconversation.com/files/222995/original/file-20180613-32307-1uwjxjm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-homeless-boy-sleeping-on-bridge-403125922">Shutterstock</a></span></figcaption></figure><p>Despite the lurid coverage of organised crime in the UK, the public often appears relatively <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/116623/horr16-report.pdf">sanguine about it</a> in studies, preferring police to focus on more everyday crime such as antisocial behaviour, burglary and property damage. Other surveys such as the Police Foundation’s <a href="http://www.police-foundation.org.uk/2017/wp-content/uploads/2017/10/oc_in_local_communities_final.pdf">recent study</a> of the impact of organised crime on communities in England have attempted through creative (but speculative) analysis of local crime figures, to determine what proportion is down to organised crime.</p>
<p>Our <a href="http://www.gov.scot/Publications/2018/06/8630">own study</a> of communities in Scotland focuses more on the stories and experiences of local people in trying to understand how organised crime not only affects community life, but how it has come to “sell” and sustain itself in particular areas.</p>
<h2>The mafia effect</h2>
<p>For most law-abiding people, organised crime is a hidden presence that actually poses little direct threat in their daily life. <a href="https://www.dailyrecord.co.uk/news/scottish-news/public-risk-crime-agency-reveals-12532999">High-profile media coverage</a> of gangland violence obscures the fact that current shootings in Scotland are clinically targeted at other gangland figures.</p>
<p>This contrasts with the more chaotic violence sometimes associated with drug gang-related incidents elsewhere in the UK, such as the recent <a href="https://www.bbc.co.uk/news/uk-wales-north-east-wales-44194611">murder of teenager Mathew Cassidy</a> in rural North Wales, and the occasional <a href="https://www.independent.co.uk/news/uk/crime/london-shooting-harrow-latest-updates-boy-shot-child-high-street-a8339796.html">shooting of innocent bystanders</a> in gang-related violence in London.</p>
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<p>In our Scottish case studies many people were certainly fearful of crossing – or even talking about – prominent criminals, giving organised crime a sense of protection and license. The widespread glamourisation of organised crime, whether in the news or in fiction, arguably strengthens these criminals, bolstering their cachet and their ability to command silence and consent. </p>
<p>But like the Wizard of Oz booming from behind the curtain, much of this is just smoke and mirrors – amplified bluster. <a href="https://www.thenation.com/article/ungood-fellas/">Popular portrayals</a> of mafia-style crime depict prominent villains as powerful figures within communities, who in the absence of effective policing, exert alternative forms of control, commanding authority and loyalty.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/222984/original/file-20180613-32327-1jz44p5.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/222984/original/file-20180613-32327-1jz44p5.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/222984/original/file-20180613-32327-1jz44p5.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/222984/original/file-20180613-32327-1jz44p5.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/222984/original/file-20180613-32327-1jz44p5.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/222984/original/file-20180613-32327-1jz44p5.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/222984/original/file-20180613-32327-1jz44p5.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Popular portrayals of the mafia, such as The Sopranos, lend organised crime groups glamour and cachet.</span>
<span class="attribution"><span class="source">HBO</span></span>
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<h2>The reality</h2>
<p>This is in stark contrast to our own findings. While Scottish villains may periodically pay for funerals of their henchmen and families, or look after their foot soldiers in prison, these displays of patronage are largely just propaganda, playing up to the mafia image, rather than representing a more substantial role in protecting, controlling or providing for communities.</p>
<p>In fact, our study found that organised crime flourishes in communities that remain vulnerable, disadvantaged and fractured. These areas of Scotland are not power bases for organised crime, they are feeding grounds. Mental health, drug addiction, debt, family dysfunction and troubled childhoods are all vulnerabilities to be milked for profit.</p>
<p>Mr or Mrs Big may lend Joe Soap some cash to tide him over after cuts to his housing benefit, but these favours come with strings attached (grow these plants, hold on to this package, deliver this to here). Granny Soap may get a loan at a diabolical rate of interest, but the loan is to pay off grandson Soap’s drug debts – debts in turn owed to the same crime clan. </p>
<p>Arguably the only order that crime gangs bring to some communities is of the chemically induced variety – cheap handfuls of street Valium anaesthetising the lost, depressed and hopeless from Friday night to Monday morning.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/-3CjOD4R5Yk?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
</figure>
<h2>Problems to fix</h2>
<p>In Scotland there is certainly the <a href="http://www.gov.scot/Publications/2015/06/3426">political will and drive</a> to try and break these forms of exploitation. But three big challenges loom:</p>
<ol>
<li><p>Economic austerity: this continues to restrict public finances and the services needed to turn communities around. Our study revealed how remote many of these services have become in the most affected communities, with office closures and the combining of services (often far from some of the neediest communities).</p></li>
<li><p>Cybercrime: established organised crime groups have successfully co-opted technology, commanding access to regional distribution networks and local markets, while using it to frustrate law enforcement through counter-surveillance and the ability to hide their criminal transactions.</p></li>
<li><p>Brexit: the notion that Brexit will facilitate more effective sovereignty and governance, at least through building up borders seems doubtful when cyber-technology has made such borders redundant, connecting local criminals directly (and more cheaply) to international producers, wholesalers and distributors. In Scotland there are substantial economic sectors that rely on hard-working, low-paid, and currently legal migrant populations. Some, such as fishing, agriculture and hospitality, have already been <a href="https://www.bbc.co.uk/news/uk-scotland-glasgow-west-33653553">troubled</a> with instances of exploitation and human trafficking. Disruption to regulation, security co-operation, legislation, and taxation can’t be precisely anticipated in terms of Brexit, but it is likely to be significant. </p></li>
</ol>
<p>Any situation where the hand of good governance is weak, or where the state appears to falter, criminal entrepreneurs will be quick to extract profit. The added reach and flexibility afforded through increasingly connected (and handily insulated) global networks makes their job even easier.</p>
<p>Our research makes clear that we should be under no illusions that organised crime offers any sort of patronage or protection to the desperate or dispossessed in difficult times. The poor and vulnerable will not be fed, they will be eaten.</p><img src="https://counter.theconversation.com/content/98262/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>NIall Hamilton-Smith received funding from the Scottish Government to undertake research looking at the community impact of organised crime. </span></em></p>Mental distress, addiction, debt, family dysfunction and abuse are all problems to be milked for profit.NIall Hamilton-Smith, Senior Lecturer, University of StirlingLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/945942018-04-11T13:15:12Z2018-04-11T13:15:12ZXanax: how does it work and what are the side effects?<figure><img src="https://images.theconversation.com/files/214290/original/file-20180411-592-17j2le2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/deanslife/1270344046/sizes/l">Dean812/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>More teenagers and young people use drugs than any other age group: <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/642738/drug-misuse-2017-hosb1117.pdf">in 2017</a>, 16.5% of 16- to 19-year-olds and 21.2% of 20- to 24-year-olds across England and Wales said they had taken drugs in the past year. And although drug use has declined over the past decade, new and potentially life-threatening trends continue to appear. Most recently, doctors <a href="https://www.theguardian.com/society/2018/feb/05/xanax-misuse-uk-dark-web-sales-health">have warned</a> of an “emerging crisis” relating to Xanax use among young people. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/214285/original/file-20180411-587-1gs5wa3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/214285/original/file-20180411-587-1gs5wa3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/214285/original/file-20180411-587-1gs5wa3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=514&fit=crop&dpr=1 600w, https://images.theconversation.com/files/214285/original/file-20180411-587-1gs5wa3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=514&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/214285/original/file-20180411-587-1gs5wa3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=514&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/214285/original/file-20180411-587-1gs5wa3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=646&fit=crop&dpr=1 754w, https://images.theconversation.com/files/214285/original/file-20180411-587-1gs5wa3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=646&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/214285/original/file-20180411-587-1gs5wa3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=646&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Alprazolam (Xanax) is a short-acting anxiolytic of the benzodiazepine class of psychoactive drugs.</span>
<span class="attribution"><span class="source">Igor Petrushenko / www.shutterstock.com</span></span>
</figcaption>
</figure>
<p>Xanax is a brand of alprazolam – a <a href="https://www.mind.org.uk/information-support/drugs-and-treatments/sleeping-pills-and-minor-tranquillisers/about-benzodiazepines/#.Ws3ks9PwalM">benzodiazepine</a> drug, or “benzo” – which is marketed as an alternative to Valium (diazepam) and used to treat anxiety, panic attacks and problems associated with depression. It works by affecting the way that the brain functions, to increase feelings of pleasure and reduce stress and anxiety. </p>
<p>Doses range from 0.25mg to a maximum of 3mg per day (by comparison, a teaspoon of sugar is about 1,300 times this amount). A dose can take up to an hour to have an effect, which then typically lasts for between five and 12 hours, depending on the formulation of the drug. It can take four or five days to clear the drug from the body. </p>
<h2>Here to stay</h2>
<p>While it is the most frequently prescribed benzodiazepine in the US, Xanax is not available in the UK, but it can be obtained on private prescriptions and online. Recent data suggests that <a href="https://www.theguardian.com/society/2018/feb/05/xanax-misuse-uk-dark-web-sales-health">the UK is the second largest market for Xanax on the dark web</a>, after the US. Its widespread availability on the internet has made the situation around this drug especially perilous. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/214282/original/file-20180411-540-wtry47.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/214282/original/file-20180411-540-wtry47.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/214282/original/file-20180411-540-wtry47.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/214282/original/file-20180411-540-wtry47.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/214282/original/file-20180411-540-wtry47.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/214282/original/file-20180411-540-wtry47.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/214282/original/file-20180411-540-wtry47.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/214282/original/file-20180411-540-wtry47.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A bottle of prescription alprazolam pills.</span>
<span class="attribution"><span class="source">PureRadiancePhoto/Shutterstock</span></span>
</figcaption>
</figure>
<p>To be clear, there is no such thing as a “safe” drug. A drug – whether swallowed, smoked, inhaled, injected – is going to have an effect on the physiology and, potentially, the mental state of the person who takes it. Every person is different, and will react differently to different drugs, doses and ingredients. It is never clear exactly what is actually in the recreational drugs that people take which is why we should be so concerned about the effects that they might have. </p>
<p>But we can’t pretend that recreational drugs are going to go away. People have used drugs for thousands of years; whether for religions reasons, as a way of life, due to peer pressure, to experiment, or to escape from reality. Some are legal, while others carry severe fines, prison sentences or penalties as harsh as the death sentence in some parts of the world. People will use drugs such as Xanax regardless of legal controls, so it’s best to be clear how it works, and why it presents a health risk.</p>
<p>When people use Xanax regularly, they build up a tolerance to the drug, which means they need to take larger and more frequent doses for the drug to have the desired effect. Eventually, this results in a physical dependence – where the brain needs the drug to function “normally”. People can also develop a psychological dependence – they feel like they “need” the drug. Together, these effects lead to what we understand as addiction. </p>
<h2>Know the risks</h2>
<p>If someone becomes addicted to prescription drugs, including Xanax, then the effect of the drugs has to be reversed - normal functioning of the brain cells must be restored and this is a long, slow and often painful process. Under the influence of the drug, there are <a href="https://drugabuse.com/library/the-effects-of-xanax-use/">side effects</a> – apathy, sleepiness, decreased cognitive functioning, as well as the possibility of slurred speech or violent outbursts. </p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/214288/original/file-20180411-566-y0h123.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/214288/original/file-20180411-566-y0h123.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/214288/original/file-20180411-566-y0h123.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/214288/original/file-20180411-566-y0h123.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/214288/original/file-20180411-566-y0h123.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/214288/original/file-20180411-566-y0h123.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/214288/original/file-20180411-566-y0h123.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/214288/original/file-20180411-566-y0h123.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Unhealthy combination.</span>
<span class="attribution"><span class="source">Burlingham/Shutterstock</span></span>
</figcaption>
</figure>
<p>Like any other benzodiazepine drugs, Xanax should not be taken with alcohol. This can increase the drug’s effects, potentially leading to loss of consciousness and coma. What’s more, Xanax levels could build up in the body, which increases the chance of an overdose the next time the drug is taken. All of these effects present risks to the user’s health, or to their livelihood and future aspirations. </p>
<p>The drug market contains products manufactured legally and illegally. Some drugs are diverted onto the black market from legal pharmaceutical sources, while others are powders imported from overseas and pressed into tablet form. In our work as forensic chemists, we have seen this with many other drug types over the years through our <a href="http://pubs.rsc.org/en/content/articlelanding/2014/ay/c3ay41020j#!divAbstract">casework and research</a> on MDMA, piperazines and cathinones. There is always a risk that the drug in the powder is not what it seems – even if the pill looks legitimate. </p>
<p>Drugs which are legally manufactured and sold undergo quality control procedures - for example controlling the amount of drug in each pill and its purity. On the black market, these processes are completely missing. Most users can’t determine the materials and processes used to make illegal drugs, so there is no way of knowing the toxicity of the drugs or of the chemicals made from the side reactions of the drug making process. </p>
<p>Drug testing kits are available on the internet, but at best, these will only tell you the group of drugs that a pill may contain - not which of the many possible drugs are present. They won’t accurately tell you how much drug is present, or how the drug was made or what impurities the pill might contain. Some employers use drug testing in the workplace: these tests are accurate, and employees who test positive for drugs often face dismissal. The best way to avoid the risks associated with recreational drugs is to avoid taking them altogether.</p><img src="https://counter.theconversation.com/content/94594/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Cole has received funding from the EPSRC, EU (Framework V), EU AGIS programme, Botswanan Government and South African Police Service for carrying out research on the analysis and profiling of controlled substances.</span></em></p><p class="fine-print"><em><span>Agatha Grela and Lata Gautam do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>More young people are using Xanax – but overdose, addiction and side effects present serious risks.Michael Cole, Professor of Forensic Science, Anglia Ruskin UniversityAgatha Grela, Postdoctoral researcher, Anglia Ruskin UniversityLata Gautam, Senior Lecturer in Forensic Science, Anglia Ruskin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/725712017-03-21T20:28:22Z2017-03-21T20:28:22ZHow to reduce dependency on drugs like Valium with alternative therapies<figure><img src="https://images.theconversation.com/files/160124/original/image-20170309-21026-4k6vx7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Benzodiazepines are prescribed for anxiety, but can cause more problems than they solve. </span> <span class="attribution"><span class="source">Pavel Kubarkov/Shutterstock</span></span></figcaption></figure><p>Benzodiazepines (such as Valium and Xanax) are <a href="http://adf.org.au/drug-facts/benzodiazepine/">depressant prescription drugs</a> used most commonly for anxiety. But evidence suggests dependence on these medications is increasing and side effects are common, so we increasingly need to look to alternative therapies.</p>
<p>Benzodiazepines <a href="http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD002798.pub2/full">cause sedation</a> by slowing down nerve activity in the central nervous system and the messages <a href="http://adf.org.au/drug-facts/benzodiazepine/">travelling between the brain and the body</a>. They became a popular prescription drug for treating anxiety in the US, and many Western countries, after their creation in 1955. </p>
<p>They’re <a href="http://www.racgp.org.au/afp/201111/44792">prescribed for</a> managing panic attacks, excessive worry or fear and other signs of stress and anxiety, and to help with sleep. Other conditions treated with benzodiazepines include <a href="http://www.cochrane.org/CD005063/ADDICTN_benzodiazepines-for-alcohol-withdrawal">alcohol withdrawal</a>, relief from muscle stiffness and tightness <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3684331/">caused by central nervous system pathology</a>, and epilepsy.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4919169/">Concern about risks and problems</a> associated with benzodiazepines has increased in recent years. Around seven million scripts for benzodiazepines <a href="http://www.racgp.org.au/your-practice/guidelines/drugs-of-dependence-b">have been written each year</a> in Australia since 2002. <a href="http://www.coronerscourt.vic.gov.au/home/coroners+written+findings/finding+-+finding+without+inquest+into+the+death+of+frank+edward+frood">Benzodiazepines contributed to over half</a> of all pharmaceutical drug overdose deaths in Victoria in 2015.</p>
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Read more:
<a href="https://theconversation.com/weekly-dose-valium-the-safer-choice-that-led-to-dependence-and-addiction-59824">Weekly Dose: Valium, the 'safer choice' that led to dependence and addiction</a>
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<p>Evidence also suggests people are <a href="http://www.nps.org.au/publications/health-professional/health-news-evidence/2015/reduce-benzodiazepine-dependence-risk">using benzodiazepines in the long term</a>, for which they’re generally <a href="http://www.racgp.org.au/your-practice/guidelines/drugs-of-dependence-b">not recommended</a>. And benzodiazepines were the pharmaceutical drug associated with the <a href="https://www.ncbi.nlm.nih.gov/pubmed/21545557">highest rates of ambulance attendances in Melbourne</a> between 2000 and 2009.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/160126/original/image-20170309-21022-v1mb2s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/160126/original/image-20170309-21022-v1mb2s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=565&fit=crop&dpr=1 600w, https://images.theconversation.com/files/160126/original/image-20170309-21022-v1mb2s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=565&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/160126/original/image-20170309-21022-v1mb2s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=565&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/160126/original/image-20170309-21022-v1mb2s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=710&fit=crop&dpr=1 754w, https://images.theconversation.com/files/160126/original/image-20170309-21022-v1mb2s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=710&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/160126/original/image-20170309-21022-v1mb2s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=710&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Advertisement for Librium® (chlordiazepoxide) from the early 1960s.</span>
<span class="attribution"><span class="source">Francisco López-Mu˜noz, Cecilio Álamo and Pilar García-García</span></span>
</figcaption>
</figure>
<h2>What are the health risks?</h2>
<p>Many risks and harms are associated with taking benzodiazepines. The risk of <a href="http://adf.org.au/wp-content/uploads/2017/02/ADF-PreventionResearch-Nov16.pdf">developing dependence on benzodiazepines</a> is higher the longer the drug is used. <a href="https://adf.org.au/family/supporting-a-loved-one/withdrawal/">Dependence</a> can occur quickly and be difficult to treat. <a href="http://nceta.flinders.edu.au/files/6113/2823/3742/EN448_Nicholas_2011.pdf">Withdrawal from benzodiazepines</a> is challenging, too.</p>
<p>More <a href="http://nceta.flinders.edu.au/files/6113/2823/3742/EN448_Nicholas_2011.pdf">research is needed</a> to determine how many people are dependent on benzodiazepines in Australia. However, evidence of prescriptions written for benzodiazepines and ambulance attendances and overdose deaths associated with their use suggest more people need to know benzodiazepine use carries a risk of side effects, including dependency.</p>
<p>Other <a href="http://adf.org.au/drug-facts/benzodiazepine/">side effects include</a> drowsiness, depression, headaches, tiredness but difficulty sleeping, irritability, personality changes, impaired thinking, paranoia, reduced sex drive and fertility problems.</p>
<p>While <a href="http://www.racgp.org.au/afp/201111/44792">violence and aggression associated with benzodiazepines</a> is rare, it can be of a high severity. Mixing benzodiazepines with alcohol and other drugs <a href="https://www.ncbi.nlm.nih.gov/pubmed/21545557">can lead to overdose and death</a>. In the US, for instance, <a href="http://www.bmj.com/content/356/bmj.j760">nearly 30% of fatal overdoses</a> from opioids (such as codeine) involve benzodiazepines.</p>
<h2>What treatments can be used instead?</h2>
<p>The <a href="http://www.racgp.org.au/your-practice/guidelines/drugs-of-dependence-b">Royal Australian College of GPs recommends</a> benzodiazepines be used only in the short term and after a comprehensive medical assessment. The assessment should include consideration of risks and benefits from using the drug, as well as alternative approaches. More work could be done during assessments by both patients and doctors to consider alternative approaches given recent evidence of harms associated with benzodiazepine use.</p>
<p>Non-drug-based alternatives are recommended as the first option for treating stress, anxiety <a href="http://www.racgp.org.au/your-practice/guidelines/drugs-of-dependence-b">and trouble sleeping</a>. Having a well-balanced diet, exercising regularly and using cognitive behaviour therapy are proven to be more effective at treating <a href="http://www.nps.org.au/publications/health-professional/health-news-evidence/2015/reduce-benzodiazepine-dependence-risk">stress, anxiety and difficulty sleeping than benzodiazepines</a>. Non-drug-based alternatives don’t have the negative side effects of benzodiazepines, either.</p>
<p>For some people, use of benzodiazepines with supervision by a doctor could better meet their health needs. Some mental health conditions are severe and likely to be short-term.</p>
<p>Alternatives are best explored when a person reviews their need for help managing stress, anxiety or insomnia with a health professional. This discussion should also consider ways of handling the health condition in the long term.</p>
<p><strong>Cognitive behaviour therapy</strong></p>
<p>Cognitive behaviour therapy (CBT) is very effective for helping people to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3584580/">manage anxiety and stress and to sleep better</a>. People use the therapy to develop practical skills for more <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/cognitive-behaviour-therapy">helpful ways of thinking, feeling and behaving</a>. Dealing differently with sources of stress and anxiety helps to reduce worry and improve wellbeing.</p>
<p>Cognitive behaviour therapy for insomnia (CBT-i) was <a href="https://www.ncbi.nlm.nih.gov/pubmed/24138364">developed specifically for helping people sleep</a>. CBT-i uses stimulus control (stopping things like watching television and use of computers in bed), sleep restriction, relaxation techniques, cognitive therapy and sleep hygiene education.</p>
<p>In sleep hygiene education, people learn about habits and behaviours that help with better sleep. These include avoiding long naps in the day time, exercising regularly, having a regular wake-up time throughout the week and limiting alcohol consumption.</p>
<p>People can try CBT through sessions with a counsellor, group education <a href="https://www.ncbi.nlm.nih.gov/pubmed/23459093">and self-help materials</a>. Normally, consultation with a GP is the <a href="https://www.beyondblue.org.au/get-support/who-can-assist/getting-support-how-much-does-it-cost">first step for a referral to a counsellor or mental health specialist</a>.</p>
<p>Online platforms <a href="http://focus.psychiatryonline.org/doi/abs/10.1176/appi.focus.12.3.299">are promising for reaching and supporting people with anxiety and depression</a> who might not otherwise receive help.</p>
<p><strong>Exercise</strong></p>
<p>Regular physical activity can help improve <a href="https://www.beyondblue.org.au/get-support/recovery-and-staying-well/staying-well">energy levels, sleep and moods</a>.</p>
<p><a href="https://www.beyondblue.org.au/get-support/online-forums">Beyondblue forums</a> offer suggestions for people experiencing anxiety and depression who may find it difficult to start exercising and stay motivated.</p>
<p><strong>Dietary changes</strong></p>
<p>Magnesium relaxes muscles. When vitamin B and calcium are at low levels in the body, increasing magnesium can help to relax tight muscles and <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/anxiety-treatment-options">reduce the risk of anxiety and difficulty sleeping</a>. Green vegetables, such as spinach and broccoli, and nuts, seeds and unprocessed cereals are <a href="https://www.ncbi.nlm.nih.gov/pubmed/26404370">foods rich in magnesium</a>.</p>
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<img alt="" src="https://images.theconversation.com/files/160129/original/image-20170309-21050-izro8q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/160129/original/image-20170309-21050-izro8q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=337&fit=crop&dpr=1 600w, https://images.theconversation.com/files/160129/original/image-20170309-21050-izro8q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=337&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/160129/original/image-20170309-21050-izro8q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=337&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/160129/original/image-20170309-21050-izro8q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/160129/original/image-20170309-21050-izro8q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/160129/original/image-20170309-21050-izro8q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Examples of food in a balanced diet.</span>
<span class="attribution"><span class="source">margouillat/Shutterstock</span></span>
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<p>Consuming less nicotine, caffeine and stimulant drugs also <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/anxiety-treatment-options">helps reduce stress</a> as these trigger the adrenal gland. (The adrenal gland releases hormones that can help the body react rapidly and move fast away from danger.)</p>
<p>A <a href="http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(14)00051-0/abstract">well-balanced diet</a> with plenty of vegetables, fruits, legumes, lean proteins like fish, and whole grains is important for good mental health. Kimchi, sauerkraut, pickles and similar foods may also have a <a href="http://www.health.harvard.edu/blog/nutritional-psychiatry-your-brain-on-food-201511168626">positive impact on mood and energy levels</a>. These foods are fermented and therefore contain bacteria that can affect mood and energy levels.</p>
<hr>
<p><em>Dr Shauna Sherker from the Alcohol and Drug Foundation co-authored this article.</em></p><img src="https://counter.theconversation.com/content/72571/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ben O'Mara is affiliated with the Alcohol and Drug Foundation where he works as a science writer.</span></em></p>Benzodiazepines are used by many people despite their associated risks and harms.Ben O'Mara, Adjunct Research Fellow, Swinburne University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/598242016-07-13T05:20:03Z2016-07-13T05:20:03ZWeekly Dose: Valium, the ‘safer choice’ that led to dependence and addiction<figure><img src="https://images.theconversation.com/files/130301/original/image-20160712-9307-usxl64.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Long-term use is not recommended because of the known side effects. But it took two decades, after its release in the 1960s, to recognise this.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/-dear-diary/4852660461/">3 0 d a g a r m e d a n a l h u s Follow/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p>Valium is a brand name for diazepam, which belongs to a group of drugs called <a href="http://www.nps.org.au/medicines/brain-and-nervous-system/anxiety-medicines/diazepam/valium-tablets">benzodiazepines</a>. Also included in this class are temazepam, oxazepam, nitrazepam, clonazepam, alprazolam, midazolam and flunitrazepam.</p>
<p>Benzodiazepines remain among the <a href="http://www.nps.org.au/medicines/brain-and-nervous-system/anxiety-medicines/diazepam/valium-tablets">most widely prescribed psychotropic medications</a> – that is, drugs that affect brain function. <a href="http://www.racgp.org.au/yourracgp/news/media-releases/benzodiazepines-guide/">Nearly 7 million prescriptions</a> are issued for benzodiazepines in Australia each year, with diazepam the <a href="http://onlinelibrary.wiley.com/doi/10.1111/imj.12315/abstract">most common</a>.</p>
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<a href="https://images.theconversation.com/files/130350/original/image-20160713-12353-8429qv.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/130350/original/image-20160713-12353-8429qv.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/130350/original/image-20160713-12353-8429qv.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=703&fit=crop&dpr=1 600w, https://images.theconversation.com/files/130350/original/image-20160713-12353-8429qv.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=703&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/130350/original/image-20160713-12353-8429qv.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=703&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/130350/original/image-20160713-12353-8429qv.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=884&fit=crop&dpr=1 754w, https://images.theconversation.com/files/130350/original/image-20160713-12353-8429qv.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=884&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/130350/original/image-20160713-12353-8429qv.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=884&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<h2>How does it work?</h2>
<p>Benzodiazepines <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.1994.tb03743.x/abstract">bind to specific receptors</a> to strengthen the effect of an amino acid called Gamma-aminobutyric acid (GABA) in nerve cells. This reduces the turnover of other neurotransmitters, therefore depressing the central nervous system.</p>
<p>The dampening of the nervous system reduces anxiety and causes muscles to relax. This leads to sedation, reduced cognition and motor function, and sleep. </p>
<p>Benzodiazepines, like alcohol, are depressant drugs. These are sometimes referred to as “downers” as they make people feel relaxed, sleepy, less coordinated and generally slowed down.</p>
<h2>How is it used?</h2>
<p>Benzodiazepines have been used for insomnia, anxiety, reducing muscle tension and other situations where there is a need to calm the central nervous system. </p>
<p>There is little controversy about using benzodiazepines in acute psychiatric emergencies, anaesthesia, intensive care, palliative care at the end of life, and in the treatment of seizures and alcohol withdrawal. But its use in long-term situations has been <a href="http://www.racgp.org.au/afp/200711/21023">increasingly questioned</a>. </p>
<p>Diazepam is an effective and low-cost drug – at <a href="http://www.pbs.gov.au/medicine/item/3162K-5072Y-5356X">A$11.67 to $17.19</a> for a pack of 50 in Australia – and therefore remains on the <a href="http://www.who.int/medicines/publications/essentialmedicines/en/">World Health Organisation List of Essential Medications</a>.</p>
<h2>Side effects</h2>
<p><a href="http://www.australianprescriber.com/magazine/38/5/152/5">Benzodiazepines can cause</a> confusion, cognitive impairment and falls, resulting in considerable disruption and socioeconomic costs. This is particularly problematic given that use is more common among older age groups.</p>
<p>Benzodiazepines are also sold as street drugs, can impair driving and are associated with overdose. </p>
<p>Continued use even at low dose for a few weeks can lead to physiological dependence (tolerance and withdrawal). Tolerance means that, over time, the effect of the drug wears off and a higher dose is needed for the same effect. <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.1994.tb03743.x/abstract">When the drug is stopped</a>, users can experience severe withdrawal symptoms such as insomnia, irritability, tension, panic attacks, tremor, sweating, poor concentration, nausea, palpitations, headache, muscle aches and sometimes even seizures and psychotic reactions. </p>
<p><a href="http://www.nps.org.au/publications/health-professional/health-news-evidence/2015/reduce-benzodiazepine-dependence-risk">Long-term use is generally not recommended</a> because of the known side effects. </p>
<p>But withdrawal can be difficult since the initial symptoms for which the drug was prescribed might return, made worse by the symptoms from the withdrawal itself. Some people are therefore reluctant to stop the drug. For these reasons, <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2011.03563.x/abstract">withdrawal should be gradual</a> and guided by clinicians, who can help patients cope with any symptoms. </p>
<h2>History</h2>
<p>Up to the mid-1950s, barbiturates were widely used to treat insomnia and anxiety. But the incidence of dependence, severe withdrawal reactions, overdose and death had become a great concern. </p>
<p>In the <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2011.03563.x/abstract">quest for a safer alternative</a>, American chemist Leo Sternbach created the first compound in the benzodiazepines class of drugs, methaminodiazepoxide. </p>
<p>This led to the release of diazepam (Valium) in 1963, considered to be <a href="http://www.bmj.com/content/309/6946/3">safer</a> than barbiturates. Over the next decade, it became the <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2011.03563.x/abstract">most prescribed drug in the United States</a>. </p>
<p>Negative effects were <a href="http://www.nejm.org/doi/full/10.1056/NEJM199305133281907">slow to be recognised</a> and widely acknowledged. This took nearly two decades after the description of the withdrawal syndrome. Only then did prescription rates begin to fall. </p>
<p>The good news is there is now <a href="https://hal.archives-ouvertes.fr/hal-00571435/document">greater caution</a> and questioning about the potential unintended effects of new drugs.</p>
<h2>Current use</h2>
<p>Despite the clear evidence and widespread acceptance that benzodiazepines cause harm, they have a <a href="http://www.racgp.org.au/afp/200711/21023">legitimate place in therapeutics</a>, such as in acute emergencies. </p>
<p>Yet despite international and national guidelines recommending that the use of benzodiazepines should be <a href="http://www.nps.org.au/publications/health-professional/health-news-evidence/2015/reduce-benzodiazepine-dependence-risk">limited to two to four weeks</a>, these drugs continue to be prescribed beyond these time frames. </p>
<p>The reasons for this are complex. As the largest medical workforce, GPs have the greatest contact with patients and therefore prescribe the most medications. They are often seen as responsible for the benzodiazepine problem. </p>
<p>But GPs may <a href="https://hal.archives-ouvertes.fr/hal-00571435/document">not always be the initiator</a>. They often take over the care of patients who have been started on benzodiazepines by psychiatrists or during hospital admissions. Psychiatrists <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2011.03563.x/abstract">commonly prescribe</a> these medications as an add-on to antidepressant treatment to reduce anxiety and to increase the likelihood that patients will adhere to treatments and respond early. </p>
<p>In Australia, the modest <a href="http://onlinelibrary.wiley.com/doi/10.1111/imj.12315/abstract">decline in the amount of benzodiazepines prescribed</a> between 1992 and 2011 reflects an awareness of risks and GPs’ reluctance to prescribe the drugs, especially to those who have not previously had them. </p>
<p>Today there is a <a href="http://nceta.flinders.edu.au/files/6113/2823/3742/EN448_Nicholas_2011.pdf">broad spectrum of people and contexts</a> where benzodiazepines are used, from the clearly legitimate short-term situations in known patients to deliberate drug misuse and sale in people with chaotic and sometimes aggressive behaviour. </p>
<p>GPs are aware that benzodiazepines may be obtained through <a href="https://ama.com.au/ausmed/national-system-urgently-needed-counter-doctor-shopping-drug-deaths">deliberate “doctor shopping”</a> to obtain medications from multiple medical practitioners under false pretences. </p>
<p>Further, with an increasingly internationally networked world, benzodiazepines can now be <a href="http://thecircular.org/ireland-asleep-in-the-dangers-of-benzodiazepine/">purchased on the internet</a> without a prescription. </p>
<p>The promotion of the <a href="http://www.healthdirect.gov.au/healthy-sleep-habits">dangers of inadequate sleep</a> also results in people seeking medications to reach the goal of seven to nine hours of sleep. In some cases, there are underlying causes that can be treated or healthy sleep habits can improve sleep. In other cases, a person may feel well and simply need less sleep. </p>
<p>New guidelines now recognise individual variations with a broader range of <a href="http://www.sleephealthjournal.org/pb/assets/raw/Health%20Advance/journals/sleh/NSF_press_release_on_new_sleep_durations_2-2-15.pdf">possible appropriate sleep</a> durations of six to ten hours in adults aged 26-64 years, and five to nine hours in those aged 65 years and over.</p>
<p>Clinicians need to discuss the potential side effects of sedative drugs with patients, emphasising the risk of dependence and cognitive decline. They also need to promote non-drug approaches for managing stress, insomnia and anxiety, such as cognitive behavioural therapy, and reinforce that sedative drugs do not work in the long term.</p><img src="https://counter.theconversation.com/content/59824/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Moira Sim does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Benzodiazepines, like alcohol, are depressant drugs, sometimes referred to as “downers” as they make people feel relaxed, sleepy, less coordinated and generally slowed down.Moira Sim, Professor and Dean of School, Medical and Health Sciences, Edith Cowan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/128972013-03-19T03:52:17Z2013-03-19T03:52:17ZWhy the TGA should make it harder for people to get Xanax<figure><img src="https://images.theconversation.com/files/21410/original/9jnghy6d-1363657382.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">This class of drug poses significant risks of misuse and dependence, paradoxical reactions, disinhibition, amnesia and intoxication.</span> <span class="attribution"><span class="source">Jacek Becela</span></span></figcaption></figure><p>The body responsible for regulating drugs in Australia, the Therapeutic Goods Administration (TGA), is poised to decide whether to restrict access to benzodiazepines, such as Xanax, Valium and Normison. </p>
<p>The drugs are commonly – <a href="http://dx.doi.org/10.1111/j.1360-0443.2011.03563.x">but controversially</a> – used to treat anxiety and insomnia. However, there is a growing body of evidence that they’re increasingly being misused. </p>
<p>A TGA committee meeting on Wednesday will consider <a href="http://www.tga.gov.au/newsroom/consult-scheduling-acmcs-1303.htm">rescheduling benzodiazepines</a> to restrict their use. </p>
<p>More than 7.5 million benzodiazepine prescriptions were dispensed across Australia in 2010 - including more than 680,000 for alprazolam (AKA Xanax). The proposal is to move benzodiazepines from Schedule 4 to the more restrictive <a href="http://www.australianprescriber.com/magazine/20/1/12/3">Schedule 8</a>. Medicines on Schedule 8 are considered potentially addictive, and have an additional layer of monitoring and control to support quality prescribing, and reduce drug dependence and diversion. </p>
<p>Benzodiazepines are not <a href="http://jop.sagepub.com/content/19/6/567.short">first-line treatments</a> for anxiety and there’s limited medical evidence of their efficacy beyond two to four weeks. In fact, they’re only approved and recommended for short-term use. </p>
<p>There’s good evidence that, in most cases, non-pharmaceutical treatment of <a href="http://www.biomedcentral.com/1471-2296/13/40">insomnia</a> <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1440-1614.2004.01423.x/full">and</a> <a href="http://journals.lww.com/co-psychiatry/Abstract/2009/01000/Current_use_of_benzodiazepines_in_anxiety.16.aspx">anxiety</a> are as effective as these drugs. And that their benefits are more enduring, with less risk of adverse effects. </p>
<h2>What’s the harm?</h2>
<p>There’s been growing concern about the misuse and harms of <a href="http://www.health.vic.gov.au/aod/pubs/benzoresponse.htm">benzodiazepines</a> in recent years. The drug poses significant risks of misuse and dependence, paradoxical reactions, disinhibition, amnesia and intoxication. </p>
<p>There’s particular concern about <a href="http://www.mjainsight.com.au/view?post=alprazolam-linked-to-heroin-deaths&post_id=12343&cat=issue-7-4-march-2013">alprazolam</a>, a potent, fast-acting benzodiazepine that has been associated with <a href="http://au.news.yahoo.com/sunday-night/features/article/-/14207856/expressInstall/">serious</a> <a href="http://www.theage.com.au/national/experts-warn-xanax-usage-may-reach-epidemic-proportions-20120713-2223j.html">health risks</a>, such as misuse, dependence and crimes including <a href="http://www.theage.com.au/victoria/tranquilliser-use-causing-accidents-20121120-29o1j.html">traffic injuries</a>, <a href="http://ecite.utas.edu.au/74824">violence</a>, property damage, <a href="http://abcnews.go.com/US/xanax-defense-utah-woman-allegedly-mowed-husband-suv/story?id=16975190">blackouts</a>, theft and <a href="http://www.mjainsight.com.au/view?post=alprazolam-linked-to-heroin-deaths&post_id=12343&cat=issue-7-4-march-2013">overdoses</a>. Alprazolam has also been implicated in a number of celebrity drug-related deaths, including Heath Ledger’s.</p>
<p>Benzodiazepines were responsible for <a href="http://www.turningpoint.org.au/site/DefaultSite/filesystem/documents/Ambo%20Project%20Annual%20Trends%20Report%202010-11%20edit.pdf">3,135 ambulance attendances</a> in Victoria alone in 2010-11. In terms of all alcohol and drug related attendances, they were second only to alcohol, and there was a disproportionate increase in involvement of alprazolam compared to all benzodiazepines in ambulance attendances. </p>
<p>Health-care professionals, including general practitioners, needle syringe program workers and forensic workers, have experienced incidents of <a href="http://www.racgp.org.au/afp/2011/november/benzodiazepines/">extreme violence and aggression</a> resulting from Xanax misuse; this drug is often described as “angry pills”.</p>
<p>People who inject drugs or use opioids may take benzodiazepines for insomnia or anxiety, or to enhance the intoxicating effects of opioids. But benzodiazepine use causes particular problems for opioid dependent people. </p>
<p>One <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2005.01051.x/abstract">study</a> found people using a benzodiazepine within 12 hours of using heroin were at 28 times the risk of overdose compared with those who did not. Several studies have found that opioid users who also take benzodiazepines have poorer health and are at greater risk of contracting <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1465-3362.2012.00514.x/abstract">HIV</a>.</p>
<p>A <a href="https://www.mja.com.au/journal/2013/198/4/recent-increase-detection-alprazolam-victorian-heroin-related-deaths">study we recently published</a> investigated prescription rates of alprazolam and its detection in heroin-related deaths over the past 21 years. We found there was a disproportionate increase in the supply of the high-dose two milligram formulation of alprazolam (compared to other formulations). We also found a significant increase in the detection of alprazolam in heroin-related deaths since 2005. </p>
<p>The relationship between the increase in supply and increasing detection in deaths was linear. While we can’t definitively know whether alprazolam contributed directly to the deaths, we know that opioids and benzodiazepines (and alcohol) are central nervous system depressants, meaning that it’s easier to overdose if they’re taken together. That people who inject drugs are increasingly using this potent benzodiazepine is a huge concern.</p>
<h2>What’s the source?</h2>
<p>While some prescriptions are provided directly to opioid users, <a href="http://www.ncbi.nlm.nih.gov/pubmed/22141578">recent research</a> shows most (81%) people who inject drugs in Melbourne obtained alprazolam from illicit sources. Users pay between $3 and $5 for one tablet. A concessional prescription for 50 alprazolam tablets subsidised by the Pharmaceutical Benefits Scheme (PBS) costs $5.90, yielding a potential street value between $150 to $250. </p>
<p>This is a considerable profit for those on-selling their medication. And there’s been a considerable increase in reports of forged and altered prescriptions to obtain Xanax, which is the preferred brand name of alprazolam. </p>
<p>A 2012 Victorian review of reports of forged benzodiazepine prescriptions found 65% were for Xanax. This is the main reason why alprazolam should be rescheduled to S8. Before dispensing S8 drugs, pharmacists are required to recognise the prescriber’s handwriting or check whether she actually wrote the prescription.</p>
<p>Pharmacists report that it’s not uncommon for them to see prescriptions for 100 or 200 tablets. This is worrying for a product that has no proven benefit beyond short-term use.</p>
<h2>Would restrictions help?</h2>
<p>The proposed rescheduling of benzodiazepines could have significant infrastructure and workforce implications for already stretched addiction and <a href="http://www.agedcare.org.au/national-report/acsa-national-report-issue-297-24-january-2013/tga-proposal-to-reschedule-benzodiazepines">aged care</a> sectors. Still, many health professionals <a href="http://www.mjainsight.com.au/view?post=alprazolam-linked-to-heroin-deaths&post_id=12343&cat=issue-7-4-march-2013">support</a> a selective rescheduling of alprazolam because of the problems stemming from its higher potency.</p>
<p>The effectiveness of this kind of rescheduling is well demonstrated by the case of flunitrazepam (Rohypnol). This drug was rescheduled to S8 in 1998, leading to a significant drop its detection in heroin-related deaths. </p>
<p>Similarly, in May 2001, the PBS started to require authority for temazepam gel capsules, which became favoured for injection in the late 1990s (causing serious injection wounds and gangrene). This resulted in a <a href="https://www.mja.com.au/journal/2004/181/6/effects-restricting-publicly-subsidised-temazepam-capsules-benzodiazepine-use">reduction in its use</a> by people who inject drugs. And the product was eventually <a href="http://www.ncbi.nlm.nih.gov/pubmed/18264874">withdrawn</a> and remaining stocks destroyed by the manufacturer in 2004.</p>
<p>Given the success of the restrictions applied to flunitrazepam and temazepam, and the substantial harm resulting from the increased supply of alprazolam, we hope the TGA’s scheduling committee will acknowledge the evidence of its significant harms and make it more diffuclt for people to access alprazolam.</p><img src="https://counter.theconversation.com/content/12897/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Suzanne Nielsen does not work for, own shares, or consult for any company or organisation that would benefit from the article. She is the current recipient of an NHMRC Early Career Fellowship. </span></em></p><p class="fine-print"><em><span>Angela Rintoul and Louisa Degenhardt do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The body responsible for regulating drugs in Australia, the Therapeutic Goods Administration (TGA), is poised to decide whether to restrict access to benzodiazepines, such as Xanax, Valium and Normison…Angela Rintoul, Doctor of Public Health Candidate, Monash UniversityLouisa Degenhardt, Professor of Epidemiology, NDARC, UNSW SydneySuzanne Nielsen, NHMRC Early Career Research Fellow Addiction Medicine, University of SydneyLicensed as Creative Commons – attribution, no derivatives.