When Audrey Kellestine was prescribed a common drug to treat insomnia, she believed she could stop using it at any time.
However, after taking the medication for just a month, she said she suffered severe physical dependency that uprooted her life for more than a year.
"It's like hell," Kellestine, 46, said of the ordeal of being in the grip of withdrawal from lorazepam, a medication that falls under the anti-anxiety group of drugs called benzodiazepines.
The family of author and psychologist Jordan Peterson recently revealed he was near death from the effects of withdrawing from a type of benzodiazepine he was prescribed for anxiety.
His daughter Mikhaila Peterson said in a YouTube video posted last week that his family took him to Russia for an emergency medical detox.
"It's awful and I feel really poorly for him," Kellestine said of Peterson, who has an international following, but is also criticized for his controversial views on gender.
She hopes the news surrounding Peterson's experience could shed light on the need for public awareness about the physical-dependence characteristic of benzodiazepines.
"I know he wasn't necessarily well respected, and I don't know him. But I think coming from somebody of his prestige some truth will come out into the medical world, that people are not just making up their symptoms and their realities and how long it really takes to go through a benzodiazepine withdrawal."
So-called benzos are a class of prescription drugs typically used to treat anxiety and sleep disorders. They also include diazepam, sold under the brand name Valium and alprazolam, with the brand name Xanax.
Health Canada lists dizziness, confusion, and memory loss as common side-effects, while long-term effects can include physical dependence and substance use disorder.
Kellestine, who lives in Woodstock, Ont., was given a prescription for lorazepam, sold under the brand name Ativan, with five repeats and instructions from her family doctor to take one milligram of the medication in the morning and another milligram at night to deal with ongoing insomnia.
But her pharmacist warned her to take only one pill in the evening, saying she would be too sedated if she also took the morning dose.
Kellestine followed that advice for four weeks in 2014 but was concerned about becoming dependent on the drug, even after her doctor assured her that would not happen.
"Looking back, I realize that I was probably physically dependent on it after seven days because I could not get to sleep at all without it."
She decided to quit "cold turkey" because her doctor told her she could stop using it any time, said Kellestine.
That's when the panic attacks and anxiety began, requiring her mother to help care for her and her two daughters, who were then nine and 11.
"She moved into my home for 15 months, from Monday to Friday, while my husband worked. The acute withdrawal symptoms were so bad I couldn't make it to the bathroom without her help. It gets pretty ugly."
"Lots of not being able to move, not being able to eat, dizzy. I was pretty much bedridden for a long period of time," said Kellestine, who ended up in hospital.
She went to another physician to help her taper off the drug over two years "because my family doctor still thought I was crazy for not being able to get off it," said Kellestine, who eventually found ongoing support through an online community of former and current benzodiazepine patients trying to withdraw from the drug they felt trapped by.
Dr. Keith Ahamad, an addictions specialist at St. Paul's Hospital in Vancouver, said two important side-effects of benzodiazepines are physical dependence and tolerance, meaning patients need more of the medication to get the same effect, similar to alcohol.
"The same thing happens with benzodiazepines, where if you're taking them regularly for anxiety and sleep you get to the point where they no longer work but if you stop them you actually get worsening of your symptoms," he said, adding withdrawal from benzos can be life-threatening.
"It's really difficult for us to know who will get tolerance and who will suffer really debilitating withdrawal based on how long they take the medication and the dose they're taking. And it can happen in as little as four weeks for sure."
Dr. James Wright, a specialist in internal medicine and clinical pharmacology in Vancouver, treats patients trying to withdraw from benzodiazepines, sometimes after using them for years.
He said the medication works effectively for short-term "rescue therapy" and should be used "once or twice a month," not on a regular basis, to prevent withdrawal symptoms that can include akathisia, which is characterized by an inability to sit still.
"I specifically tell people not to take it more than two nights in a row. And if they came back and used it all I wouldn't give them another prescription," Wright said.
"I think where the medical professionals got it wrong is they have this idea that to put patients on a regular dose it continues to work. The reality is it doesn't. They should never be used for anxiety on a long-term basis," he said, adding physical dependence can occur in a week.
"If you're prescribing it appropriately you give them only a small number of pills and you tell them not to take it more than two nights in a row. And you explain to them what will happen is, if they take it regularly, it won't work and they'll become tolerant and they could get themselves into trouble trying to get off."
For those patients, the "brain has changed as a result of the drug," he said. "When you take it away completely they experience all these terrible effects and feel really severely anxious."
Some patients taper themselves off benzodiazepines by using a method called liquid titration, and Wright said they mostly use Valium in part because it is the longest-acting benzodiazepine.
The method, which Wright monitors for his patients, involves dissolving the drug in water and precisely measuring the dose to decrease the amount by 10 per cent.
"They take off 10 per cent and discard that and swallow the rest of it," he said, adding the amount is slowly reduced further over time and that patients experience some withdrawal effects, which are manageable.
"It just means your brain is trying to heal and re-adapt," he said of his assurance to patients.
Data published in 2018 by the Canadian Institute for Health Information indicates the number of benzodiazepines dispensed declined by 5.9% between 2016 and 2017. The stats did not include non-prescription sources of drugs.
In recent years, benzodiazepines have been popularized in music — in Travis Scott's smash hit "Sicko Mode," for instance, Drake raps: "I did half a Xan, 13 hours 'til I land, had me out like a light."
Lynne Laramee, whose son Matthew Koeck started using Xanax he bought from friends and then the black market to deal with his anxiety stemming from attention deficit hyperactivity disorder, said such casual references to potentially dangerous drugs in music that appeals to millions of youth are disturbing.
"We talked about that exact song," she said, adding her son told her "so many people do it" and he needed Xanax to relax.
Koeck was doing well in a welding program and had two jobs but was still using the medication, Laramee said, adding she spoke to him about her concerns regarding his use of the benzodiazepine that wasn't prescribed to him.
"He didn't think it was a big deal because they're prescribed for people, saying: 'So what's wrong with pills that are prescribed for so-and-so's mother?'"
However, taking Xanax caused more anxiety for her son.
"He told me he was anxious before but he was now even more anxious. One pill one day calmed him down and then he needed more and more," she said.
Laramee, who lived with her son in Aylmer, Que., at the time, chatted with him as usual before he went to bed on the evening of Dec. 5, 2018, when he took one Xanax pill.
She found him dead the next morning and later learned the Xanax he'd bought on the street contained the opioid fentanyl, which killed him. He was 20.
It's important for parents to keep benzodiazepines and all their prescription medications locked away, Laramee said.
"This is an issue, and I think if you hear about it in popular songs and you see it in a friend's mother's medicine cabinet you think it can't be that bad."
This report by The Canadian Press was first published Feb. 16, 2020.
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