America's Most Dangerous Pill?
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You could argue that the deadliest “drug” in the world is the venom from a jellyfish known as the Sea Wasp, whose sting can kill a human being in four minutes—up to 100 humans at a time. Potassium chloride, which is used to trigger cardiac arrest and death in the 38 states of the U.S. that enforce the death penalty is also pretty deadly . But when it comes to prescription drugs that are not only able to kill you but can drag out the final reckoning for years on end, with worsening misery at every step of the way, it is hard to top the benzodiazepines. And no "benzo" has been more lethal to millions of Americans than a popular prescription drug called Klonopin.
Klonopin is the brand name for the pill known as clonazepam, which was originally brought to market in 1975 as a medication for epileptic seizures. Since then, Klonopin, along with the other drugs in this class, has become a prescription of choice for drug abusers from Hollywood to Wall Street. In the process, these Schedule III and IV substances have also earned the dubious distinction of being second only to opioid painkillers like OxyContin as our nation's most widely abused class of drug.
Seventies-era rock star Stevie Nicks is the poster girl for the perils of Klonopin addiction. In almost every interview, the former lead singer of Fleetwood Mac makes a point of mentioning the toll her abuse of the drug has taken on her life. This month, while promoting her new solo album, In Your Dreams, she told Fox that she blamed Klonopin for the fact that she never had children. “The only thing I’d change [in my life] is walking into the office of that psychiatrist who prescribed me Klonopin. That ruined my life for eight years,” she said. “God knows, maybe I would have met someone, maybe I would have had a baby.”
Nicks checked herself into the Betty Ford Clinic in 1986 to overcome a cocaine addiction. After her release, the psychiatrist in question prescribed a series of benzos—first Valium, then Xanax, and finally Klonopin—supposedly to support her sobriety. “[Klonopin] turned me into a zombie,” she told US Weekly in 2001, according to the website Benzo.org, one of many patient-run sites on the Internet offering information about benzodiazepine addiction, withdrawal and recovery. Nicks has described the drug as a “horrible, dangerous drug,” and said that her eventual 45-day hospital detox and rehab from the drug felt like “somebody opened up a door and pushed me into hell.” Others have described Klonopin’s effects as beginning with an energized sense of euphoria but ending up with horrifying sense of anxiety and paralysis, akin to sticking your tongue into an electric outlet, or suddenly feeling that your brain is on fire.
When benzodiazepines first came to market in the 1950s and 1960s, they were prescribed for a range of neurological disorders such as epilepsy as well as anxiety related disorders such as insomnia. But over time, a loophole in federal drug-control laws known as the “practice of medicine exception” has permitted psychiatrists and other physicians to prescribe the drugs for any perceived disorder or symptom imaginable, from panic attacks to weight control problems. Much in the same way, Valium became infamous as "mother's little helper," a sedative used to pacify a generation of bored and frustrated suburban housewives.
Alcoholics and drug addicts are most likely to run into Klonopin during detox, when it is used to prevent seizures and control the symptoms of acute withdrawal. Klonopin takes longer to metabolize and passes through your system more slowly than other benzos, so in theory you don’t need to take it so frequently. But if you like the high it gives you, and keep increasing your dosage, the addictive effects of the drug accumulate quickly and can often be devastating. The drug's label clearly specifies that it is "recommended" only for short-term use—say, seven to 10 days—but once exposed to the pill's seductive side-effects, many patients come back for more. And not surprisingly, many doctors are happy to refill prescriptions to meet this consumer demand. In the process, countless numbers of people swap one addiction for another, often worse than the initial addiction they were trying to treat. Although benzodiazepines are rarely reported to be the cause of single-drug overdoses, they show up with great frequency in deaths from so-called combined drug intoxication, or CDI. In recent years there have been thousands of deaths caused by this lethal combination. The drug has also help hasten the death of a wide list of otherwise healthy celebrities. :
In 1996, Actress Margaux Hemingway committed suicide by overdosing on a barbiturate-benzodiazepine cocktail. Weeks later, Hollywood movie producer Don Simpson (Beverly Hills Cop) also died from an unintentional benzo-based overdose. Klonopin was one of 11 different prescription drugs—all written by the same doctor—found in the body of Playboy centerfold model Anna Nicole Smith, who OD’d in 2007. Thereafter, the well-known Los Angeles author, David Foster Wallace, who was suffering from a profound depression when a doctor prescribed him Klonopin, went into his backyard on a September evening and hanged himself with a leather belt he had nailed to an overhead beam on his patio. Klonopin has been striking down more than just troubled celebrities, however. In 2008, reports began to surface of soldiers returning from Iraq with post-traumatic stress disorder who were dying in their sleep, the victims of a psych-med cocktail of Klonopin, Paxil (an antidepressant), and Seroquel, an antipsychotic that is routinely prescribed by VA hospitals.
Hospital emergency room visits for benzodiazepine abuse now dwarf those for illegal street drugs by a more than a three-to-one margin. This trend has been increasing for at least the last five years. In 2006, the U.S. government’s Substance Abuse and Mental Health Services Administration published data showing that prescription drugs that year were the number two reason for ER admissions to hospitals for drug abuse, slightly behind illicit substances like heroin and cocaine. But a survey released by the agency earlier this year claims that benzos, opioids and other prescriptions meds are now responsible for the majority of drug-related hospital visits.
Scientists can't say for sure what Klonopin does when ingested, except that it dramatically affects the functioning of the brain. This much we know: If your brain is on fire with electrical signals—like, say, you’re having an epileptic seizure—a dose of clonazepam will help put out the flames. It does so by lowering the electrical activity of the brain, specifically which electrical activities it suppresses is something that no one really seems to know for sure. And therein lies the reason why clonazepam, like nearly the entire class of benzos, causes such unpredictable reactions in people. Put simply, the brain is just too complex a structure for its owners to understand—and when you start monkeying around with the way it functions, it’s anybody’s guess what is going to happen next.
Here's how the respected neurosurgeon Frank Vertosick, Jr., describes the brain in his book When The Air Hits Your Brain: Parables of Neurosurgery: “The human brain: a trillion nerve cells storing electrical patterns more numerous than the water molecules of the world’s oceans.” So, if clonazepam is given to a patient with a history of epileptic seizures, it is likely to bring the symptoms under control. But give the same drug to a person suffering from a completely different problem (an eating or sleeping disorder, for example), and it might actually cause an epileptic seizure.
Clonazepam has wreaked such havoc on people partly because it is so highly addictive; anyone who takes it for more than a few weeks may well develop a dependence on it. As a result, you can be prescribed Klonopin as a short-term treatment for, say, insomnia, and wind up so hooked on it that you’ll begin frantically “doctor shopping” for new prescriptions if the first physician who gave it for you refuses to renew the prescription. As with all benzos, use of Klonopin for more than a month can lead to a dangerous condition known as “benzodiazepine withdrawal syndrome,” featuring elevation of a user’s heart rate and blood pressure along with insomnia, nightmares, hallucinations, anxiety, panic, weight loss, muscular spasms or cramps, and seizures.
Along with Klonopin, here are the three other benzos that, by general agreement, have made it into the top ranks of the world’s worst and most widely abused drugs: temazepam, alprazolam, and lorazepam.
Temazepam: Sold in the U.S. under the brand name Restoril, this benzo was developed and approved in the 1960s as a short-term treatment for insomnia. It is basically what is commonly called a “knockout drop.” Taken even in relatively modest dosages, temazepam can produce a powerfully hypnotic effect that numbs users and makes them extremely compliant and susceptible to control. But thanks to the “practice of medicine exception” physicians can prescribe it for anything they want.
During the Cold War, the Soviet Union reportedly used temazepam extensively to keep political dissidents in a drugged-out state in government-run psychiatric hospitals. Both the CIA and the KGB are also said to have also used the sleeping pill in prisoner interrogations and in research into mind-control, brainwashing and social engineering.
Temazepam is sometimes referred to as a “date rape” drug, and it figures frequently in drug-related crimes of violence. In the drug world underground, where it is often sold as an alternative to heroin and crack cocaine, it goes by such street names as “tams,” “Vitamin T,” “terminators,” “big T,” “mind eraser” and “Mommy’s Big Helper.” Common side-effects include confusion, clumsiness, chronic drowsiness, impaired learning, memory and motor functions, as well as extreme euphoria, dizziness and amnesia.
Alprazolam: Brand name Xanax, this benzo now accounts for as many as 60% of all hospital admissions for drug addiction, according to some research. What’s more, violent and psychotic responses to Xanax are not limited to humans. In May 2009, a 200-lb chimpanzee being kept as a house pet by a Stamford, Conn., woman went on a rampage after being dosed with Xanax, escaping into the neighborhood and ripping off the face of a friend of its owner.
Lorazepam: Brand name Ativan, this drug has figured in an array of well-publicized homicides and suicides by those using it. Ativan surfaced in the 2000 divorce case between Washington, D.C., socialite Patricia Duff and her husband, Wall Street billionaire Ronald Perelman. In deposition testimony, Perelman acknowledged taking Ativan as an anti-anxiety drug during his separation from Duff and the commencement of divorce proceedings. The period was marked by numerous outbursts by Perelman and at least two physical assaults on Duff. In 2008, news reports revealed that Ativan was being used by the U.S. Customs Service to keep suspected terrorists sedated while deporting them to detention facilities abroad.
You can buy any of these "feel-good" drugs without a doctor's signature by simply typing the name into any Internet search engine. Instantly, you’ll be presented with dozens of websites, both foreign and domestic, where you can make your purchase, no prescription required. (Most of the websites accept all major credit cards.)
Why has all this happened? In large measure you can thank the 47,000 members of the American psychiatric profession for this dreadful state of affairs. Neither the pharmaceutical industry nor the psychiatric profession would be anywhere near as lucrative as they are today without their mutual support system. Together they have created a marketing juggernaut that over the last 20 years has spawned a seemingly nonstop gusher of profits that is only now beginning to slow—and probably only temporarily.
The scholarly journals of the psychiatric profession were filled with early warnings, beginning almost 50 years ago, from those who could see where the encroaching influence of the drug companies was destined to lead the profession. Now, even the medical journals themselves have been corrupted by the hidden hand of Big Pharma. In 2008, the New York Times reported that a survey of the six top medical journals showed that on average almost 8% of the bylined articles published in their pages were ghostwritten by freelance writers, then published under the names of cooperating doctors and researchers to give the pro-drug messages contained in the articles the appearance of impartiality. The scheme is bankrolled, of course, by the company that makes the drug.
Consider Dr. Joseph Biederman, the world-renowned Harvard University psychiatrist and father of modern psychopharmacology for children, who, it now turns out, has been taking secret “consulting fees” from drug companies for years. Biederman is widely credited with legitimizing the concept of “bipolar disorder” as a chemical imbalance in the brain that can be corrected with psychiatric drugs. But documents uncovered by Senate investigators probing ties between the psychiatric profession and the drug industry, which have resulted in an explosion in medically approved uses for psychiatric drugs for children, show that Biederman received more than $1.6 million in undisclosed payments since 2000 from the pharmaceutical companies manufacturing the drugs he was encouraging parents to give to their children if they appeared to be “bipolar.”
No surveys that I am aware of have ever been conducted regarding the public’s impression of what psychiatrists actually do. But from pop culture media characters such as the fictional female psychiatrist Dr. Jennifer Melfi in the HBO series The Sopranos, the general belief seems to be that psychiatrists are learned and humane professionals who counsel their patients through hour-long “talk therapy” sessions in their offices once a week, and more frequently than that if necessary to help them resolve their conflicts.
In fact, many do nothing of the sort. It may be only a patient’s first session with a psychiatrist that lasts any meaningful amount of time. In this initial consultation the psychiatrist relies on the DSM manual as the diagnostic tool to decide precisely what the patient suffers from. Once that is established, the psychiatrist can begin prescribing psych meds as therapy, free of fear about the danger of a medical malpractice suit lurking down the road.
The follow-up sessions (weekly, monthly, etc.) that come after the initial consultations—that is, the sessions that are portrayed on The Sopranos as the occasions when Mafia killer Tony Soprano sits down in Dr. Melfi’s darkened office and pours out his guts about his troubled childhood—usually last as little as 15 minutes. During these so-called “med checks,” a psychiatrist typically charges $100 or more for asking the patient little more than how he or she is responding to the prescribed medication—a question that can usually be answered by a quick glance at the patient’s demeanor.
At the end of such a med-check, the psychiatrist may decide to renew the patient’s current prescription, substitute or add a new one—or even offer the patient a free sample of some new psych-med, courtesy of a sales rep from a pharmaceutical company. At four med-checks per hour, a psychiatrist with enough patients to fill up his workdays can easily make $120,000 annually from his med-check practice alone and still take a month-long summer vacation.
It's obvious that this system incentivizes doctors financially to keep prescribing drugs in order to keep patients returning for med-checks. But Big Pharma offers a whole host of additional income opportunities. Last year, ProPublica, the Pulitzer Prize–winning public-interest investigative website, did an extensive report on the financial compensation drug companies shower on physicians. Well-titled “Dollars for Docs,” this series included a database of more than 17,000 doctors who accepted “speaker fees” and other money from eight drug companies in 2009 and 2010 totaling $320 million.
That accounting is only the tip of the iceberg, however, as most pharmaceutical companies have refused to disclose their physician payments. Not surprisingly, most doctors interviewed by ProPublica denied that their medical decisions and prescribing habits were influenced by drug company payments. The new healthcare reform bill calls for greater transparency, requiring all drug-makers to disclose all fees paid to all doctors by 2014. Until then, you can type your doctor’s name into the database to find out if he or she is on the pharma take, and for how much.