"Sky News and the Times are reporting today that Michael Jackson's death has been ruled to be a homicide and that the drugs found in his body included the anaesthetic Propofol but also the benzodiazepine tranquillisers Ativan (Lorazepam),Valium and Midazolam.
I would like to comment on the dangers of the benzodiazepine tranquillisers involved. In 2004 the Canadian Ativan data sheet contained the warning that "Use of benzodiazepines,including lorazepam may lead to potentially fatal respiratory depression." It also contained a seven day addiction warning and suicide warning ,for lorazepam.
Phil Woolas M.P. wrote to Sir Alastair Breckenbridge, Chair of the U.K. drug licensing authority the MHRA,in 2004 asking for similar warnings to be introduced into the U.K. product information.The warnings were never introduced and in fact no product information sheet for lorazepam tablets was published at all in the U.K. in 2009, despite the increased number of licenses issued.
Tranquilliser related deaths in the U.K. are running at some 300 per year,in some years they have exceeded the total number of deaths for all class A drugs added together ,according to Home Office figures.In answer to a Parliamentary question the Department of Health reported that in 2008 over 17 million tranquilliser prescriptions were issued in the U.K.,an increase on 2007. My question is how many people have died a Michael Jackson type death in the U.K.,and elsewhere, but with no homicide investigation or any other kind of investigation.
Tranquillisers are highly addictive yet the Department of Health provides no withdrawal treatment at all except for one worker in Belfast and two in Oldham. The All Party Parliamentary Group on Involuntary Tranquilliser Addiction (APPGITA) is campaigning for the introduction of specialized tranquilliser withdrawal services by the Department of Health.We are also campaigning for medical research into the damage caused by tranquillisers,a review of the benzodiazepine product licenses ,which were issued with no assessment of safety or efficacy and a no-fault drug compensation scheme for patients who suffer drug injuries.
In light of these recommendations, we should be aware of two interesting studies which involved Professor Heather Ashton (who spoke at APRIL’s 2008 conference) and discussed two effective approaches that also save money.
The cost-effectiveness of two brief interventions for helping people to withdraw from long-term benzodiazepine use are addressed in the following two papers by Nick Heather and colleagues in 2004 and Christine Godfrey and coworkers in 2008. These interventions consisted of a letter that was sent to patients advising a gradual withdrawal as well as a brief GP consultation.
The earlier paper reports that both interventions are effective in leading to a reduced intake of benzodiazepines.
The later study found that of the two interventions, overall the letter was the most cost-effective. The authors estimate that the savings for that particular authority in Newcastle and North Tyneside would be a minimum of £4.9 million.
It would be interesting to make an estimate of financial savings and reduction in human suffering and iatrogenic illness, that could be made nationally using these interventions.