There's a problem with Victoria Ratliff, the wife of a wealthy financial operator in Season 3 of HBO's “The White Lotus.”
And her drug of choice, the anti-anxiety drug Lorazepam, left her with a bit of a loopy loopy.
In the show that follows guests on vacation at a fictional resort, Victoria is paired with her medicine and wine, and nods at the dinner table. Sometimes she kills her words.
When she notices that her medication supply is mysteriously diminishing, she asks if the children are stealing them.
“Do you have enough Lorazepam to spend a week at the wellness spa?” asks her daughter, Piper.
“The White Lotus” is not the only show to show these drugs recently. The new Max series “The Pitt” in the emergency department includes a storyline about benzodiazepines called the Librium.
This is not the time for Hollywood to deprive you of dramatic freedom. Benzodiazepines such as Lorzepam and Chlordiazepoxide are notoriously highly addictive. It can also be accompanied by difficult and sometimes fatal symptoms.
Dr. Ian C. Neil, a geriatric doctor at UC San Diego Health, said that misuse of the character benzodiazepine drugs is not uncommon. “We definitely see a lot in real life.”
And in recent years he added that research has shown that it is a bigger problem than initially recognized.
Widely misused collection of drugs
Drugs often called benzos and downers are commonly used to treat sleep disorders such as anxiety, panic attacks and restless leg syndrome. However, it can also be used for other reasons, such as helping people manage alcohol withdrawal.
Other common benzodiazepines include diazepam (barium), clonazepam (clonopine), and alprazolam (Xanax).
Unlike antidepressants, which can take weeks to get started, most benzodiazepines can provide relief within minutes. However, if taken for a long period of time, patients can develop resistance within weeks of starting the drug. This, even when used as prescribed, says Dr. Ludmira de Faria, chairman of the Women's Mental Health Council of the Women's Psychiatry Association.
“That's where people get into trouble,” she added, and began taking more medications. “The same dose will no longer eliminate symptoms.”
Furthermore, drugs such as clonazepam and diazepam last longer than short-acting drugs such as alprazolam. “People don't realize that,” she said. “So they take multiple doses and it accumulates,” and it could lead to people “wandering around like they have some drinks.”
All of these factors have led to the widespread misuse of the drug. According to the US Food and Drug Administration, the latest available data, available in 2019, dispensed an estimated 92 million benzodiazepine prescriptions. Studies suggest that the drug is most frequently prescribed in adults aged 50 to 64 years old.
Delirium, falls, and other risks
In 2020, the FDA updated the information given to all benzodiazepine prescribers and patients, warning about the risk of physical dependence, withdrawal response, misuse, abuse and addiction.
Ideally, these risks will be explained to the patient before taking the first medication. But that doesn't always happen. And even if the patient receives proper counseling, “It's one thing to say, and then another thing to experience it,” Dr. Neal said.
He said he has been looking closely at patients who are already taking cocktails of other medications and does not understand the risks of combining the depressant benzodiazepine.
And if you're going to drink alcohol or use cannabis, it's best not to have benzodiazepines in your system. When people combine substances that have depressive effects, they can even interfere with breathing.
The elderly population that Dr. Neil handles is particularly vulnerable as benzodiazepines are metabolized in different ways with age, he adds, and remains in the body for a long time. As a result, older people who take them can be more likely to fall or cause a car accident. Drugs can also cause delirium in patients with dementia.
However, drugs can be dangerous for people of all ages. So it is usually prescribed for a short period of time (usually less than four weeks) and is considered a last resort to treating chronic conditions, Dr. Neal said.
The delicate withdrawal process
A 2019 survey found that nearly 20% of people taking benzodiazepines misuse them. If someone develops addiction, it is difficult to quit due to severe withdrawal symptoms.
These symptoms include stomach problems such as sleep disorders, irritation, sweating, heart movement pits, increased blood pressure, and dry swelling.
Tapering the drug should ideally be done in a gentle manner, under the supervision of a doctor.
“We've seen a lot of trouble with our customers,” said Dr. John Taurus, a psychiatrist at Beth Israel Deacones Medical Center in Boston.
While this is happening, patients can try different methods to get more sleep and talk to the therapist about strategies to manage their anxiety.
Plus, there are other drugs like clonidine. Clonidine can be used to treat anxiety and is also useful for withdrawal symptoms.
Ultimately, it is always better to identify and try to address the root cause of anxiety, Dr. Tours added. “Benzo is giving you a rapid relief of your brain, but then it will disappear someday. That rapid relief is gone.”
