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Beyond opioids

America’s drug crisis now includes benzodiazepines, commonly prescribed for anxiety, and as the death toll grows, the underlying problems remain unaddressed

Beyond opioids

Seized packets of Xanax (Niall Carson/PA/AP)

A campus doctor first introduced Kristen Gunn to the drug Klonopin during her final semester of college at the University of Virginia.

She had a paper to write, about some Reformers’ views of Scripture, which sparked a personal crisis. She wanted to do well in it, but she had questions about her Christian faith. Once an aspiring missionary, now she didn’t know what she would do with her religion major after graduation.

“My views were becoming undone,” she recalled. “Personal, spiritual, emotional, professional, everything you can imagine was on unstable ground.”

Five days before the paper was due, Gunn was awake all night with anxiety. Then the anxiety about not sleeping built on top of her anxiety about her life. She didn’t sleep the second night. She went to student health, and someone talked her through some breathing exercises, but those didn’t work. She didn’t sleep for a third night.

After 72 hours without sleep, she stumbled back to the student health office, where the doctor prescribed a drug called Klonopin. It was a script for a couple of weeks, when she was supposed to come back and see a psychiatrist. She didn’t remember receiving any instructions or warnings; she does remember a glorious night of sleep.

“I felt like Superman taking this drug,” said Gunn. She had never done any hard drugs, but her roommates told her she seemed “high as a kite,” and they were worried. After a couple of weeks she went back to the psychiatrist and got another prescription, and began taking Klonopin every night. When spring break was approaching, she recalled the psychiatrist telling her to go easy on alcohol, without forbidding it—so she drank. Alcohol and benzodiazepines, the class of drugs to which Klonopin belongs, together can be deadly, but she only learned that later. 

Matthew Miller/Genesis

Kristen Gunn (Matthew Miller/Genesis)

Gunn continued to take Klonopin the rest of the semester. Those three months in her memory were fuzzy, a common side effect of the tranquilizing drug. She had a good memory, but she couldn’t remember vocabulary words in her Hebrew class. Klonopin also removes inhibitions, which was a wonderful feeling for Gunn, but her friends were bearing her uncharacteristically harsh comments. Gunn remembered apologizing to a few people, telling them she didn’t know why she was saying such things.

When classes ended, she went on a beach trip, where she received a panicked call from her dad, who had been talking to a doctor friend about the drug she was on. He warned that it was highly addictive and dangerous over a long period of use. When she returned home, she went to a different psychiatrist.

The doctor promised to help wean her off the drug but warned that withdrawal would be difficult.

THE UNITED STATES IS FACING  potentially the third year of decreased life expectancy at the end of 2018, a streak that hasn’t happened since record keeping began. A record 72,000 Americans died of drug overdoses last year, even as opioid prescriptions were down. The ongoing deaths show a general crisis of drug addiction, not just opioids.

Bob Cutillo—a doctor working in a clinic for the homeless in Denver, Colo., and who teaches at Denver Seminary—puts the responsibility for lower life expectancy on these rising “deaths of despair” like suicide, drug overdoses, and deaths from alcohol abuse.

“The Christian community has much to contribute, but I am not sure it is equipped to respond,” he said. American Christians are lacking concern for “how lost people are in our Western culture” while showing “limited dependence on the hope we have in Jesus Christ.”

What are the drugs of despair? They’re not just opioids or heroin. When I talked to addiction doctors this month about troubling trends they’re seeing, they pointed me to benzodiazepines (“benzos”), a class of prescription drug that typically treats anxiety. That class includes drugs like Xanax, Ativan, Valium, and Klonopin—the one that hooked Kristen Gunn.

While opioid prescriptions are down, benzo prescriptions are still rising and are among the most prescribed drugs in the United States. They’re very addictive, but patients often don’t understand the risks of long-term use and chemical dependence.

Because benzos depress breathing, they’re dangerous when combined with opioids or alcohol. In 2016 the CDC issued new guidelines urging doctors to avoid prescribing benzos alongside opioids. But prescribers told me that patients often hide their other drug or alcohol use when seeking benzos.

Users don’t typically abuse benzos by themselves but combine them with other substances to get a different high. Like fentanyl, some benzos are sold on the internet and shipped through the mail. Benzos are involved in more than 30 percent of overdose deaths.

This overdose epidemic has dominated the young career of emergency medical technician Sara Del Vecchio. Most of her emergency training is in overdoses.

She worked an ambulance in an affluent county outside of her native Philadelphia for a year, where she responded to suburban overdoses. The last two years she’s worked in an emergency department in Kensington, Philadelphia’s worst neighborhood for drug use and violence, and specifically in a part of Kensington called the Badlands.

On a given 12-hour shift, Del Vecchio estimates that overdose patients fill half of the beds in the Kensington emergency department. Once revived in the ER and observed for a few hours, those who overdose hear a list of options for next steps. They can talk to a psychiatrist at the hospital, do detox, and get referrals to rehab programs or local ministries. But they usually head back out to the street because they’ve tried everything and “it hasn’t worked,” said Del Vecchio.

One day, an overdose victim was brought into the ER, and Del Vecchio began doing chest compressions to try to revive the patient. As she was doing compressions, she looked up and saw that it was a guy she went to high school with. Del Vecchio helped the medical staff identify him—they couldn’t revive him.

“I just remember standing there,” she said, stunned. She knew he dabbled in drugs in high school, but had no idea about his pill and heroin problem. “He was a nice, sweet kid.”

Even before Del Vecchio became an EMT, she had lost friends to overdoses. She’s seen it in well-to-do suburbs and in the poverty-stricken Badlands, and knows no one is immune. About half of the users in Kensington die, she said, and she is shocked how many of her overdose patients feel helpless and have made peace with the idea of dying from drugs.

Kensington has several long-term ministries serving the addicted population, and those ministries are providing most of the outreach to addicts in the Badlands. But they have conflicting approaches to addiction, in Del Vecchio’s view. She volunteered with one ministry, but felt it was offering only “comfort care” to addicts.

“It’s an over-ministried area, which confuses me, because why is this still such a problem?” she asked. “Why are they still dying?”

BENZOS WERE ONE DRUG OF MANY for Kyle Walker, according to his mother, Bridget Crowley. When Walker was 17, he was in a bad car accident, and doctors prescribed opioids for about a year after as he recovered. Crowley didn’t realize Kyle was addicted. Her son seemed to be doing well, but then started a job with a railroad company where his co-workers were using pills recreationally. Soon he was on heroin and had to quit his job: A recent study estimated that 2 million Americans of prime working age are out of the workforce because of opioids.

For the last 15 years Crowley has supported her son through two stints in rehab. Crowley recalled that one time, when her son was asleep, she looked in his pockets and found an assortment of benzos and other pills. She said parents of addicts are “constantly waiting for them to fall asleep so you can snoop through their stuff, which is terrible.”

There have been victories, like happy family dinners after a successful rehab. But one time, when he was a month out of rehab and she was picking him up for church, he wasn’t coming out of his house. She decided to see what was taking so long—and found him unconscious on the floor of his closet. He had overdosed on heroin laced with fentanyl. Crowley called 911. Paramedics revived him with Narcan.

“That was something I never want to see again,” said Crowley, as tears crept into her voice. “I don’t think God wants us to stay in this spot forever. But you can’t make a person change.”

Crowley finds few people at church can relate to this close relationship with someone with a drug addiction: the shame mingled with love for her son, the walking on eggshells around him, the regular feeling of not knowing if she’ll see him alive again.

Now he is in a court-mandated boot camp to get clean, and about to graduate: “In his letters he goes, ‘Mom, I just want to be part of the family again.’” Crowley is planning to talk to her pastor at their Southern Baptist church about re-starting a prayer group for men with addictions that her son could join when he gets back from boot camp.

Sandy Dettmann, a Christian addiction doctor in Michigan, had her own experience of dependence on benzos. Previously she was a pediatric emergency specialist and saw enough horrible accidents with children that she began to feel intense anxiety about her own children. (She recalled putting helmets on her kids in the car.)

Her doctor prescribed Ativan, and she continued to take benzos regularly for seven years—as prescribed. In 2011, feeling the effects of the dependence, she went to a five-day medically supervised detox to get off of them. Withdrawals from benzos are more dangerous than from opioids, and can be deadly.

Now, as an addiction doctor, she is educated about them. Dettmann says benzos should only be for rare emergencies, and doctors shouldn’t prescribe them for regular use of more than two to four weeks: “They work very well for anxiety, until your whole life falls apart. Then the drug you used for anxiety in the first place actually causes anxiety, and people quickly get on escalated doses.”

Johnny Quirin

Sandy Dettmann (Johnny Quirin)

Thomas Paulus, a psychologist working in intensive outpatient addiction treatment in San Diego, Calif., also finds benzos to be a huge problem. Benzos aren’t always bad, he said, but “I’ve not encountered cases where I’m glad someone is on them.” Paulus says benzos mask the natural but unpleasant physiological symptoms of anxiety, and thus prevent addressing the mental illness underneath: “Many in our culture view painful experience as a problem to be solved rather than as a symptom to be understood.”

KRISTEN GUNN, the former University of Virginia student, knows her addiction was a symptom of a larger problem. Her psychiatrist’s prediction of difficult withdrawals from Klonopin proved to be true. As Gunn cut down the amount of Klonopin she was taking, she experienced her most intense anxiety ever. She remembered almost running out of Klonopin on her first day of work that summer, and not getting to the pharmacy for the refill before it closed.

She went to a different pharmacy and tried to get the prescription filled there, but the pharmacist declined because a different pharmacy had already filled it. Gunn broke down in tears there in the pharmacy, terrified not to have the drug. Through the summer as she took less and less of it, she had panic attacks and uncontrollable shaking. When a panic attack started, she took a walk.

“I wish I had never gotten involved in drugs to try to fix this,” Gunn said. “There were issues that needed deeper therapy, but I didn’t have the time to invest in that.” She knew she was putting her identity in the wrong places—in being the perfect student, in being a good writer—and wished she had instead sought spiritual resources. Seeing how her parents and friends had sounded the alarm about the drug, “I knew deep down that I would need a community to get off of this stuff,” she said.

At the end of her summer internship, she packed her bags and final bottle of Klonopin to go to the evangelical community L’Abri in Switzerland. She spoke about her dependence on the drug in a group prayer meeting, and one of the people there was a pharmacist who empathized with her.

After a month she resolved to be done with the drugs. She went to the bathroom with her pills, negotiating with herself—maybe she needed one more week? But with two friends cheering her on outside, she dumped her pills down the toilet.

Gunn retaught herself how to sleep, and described the wonder of standing in the kitchen chopping a tomato and feeling present. When she returned to the United States, she started seeing a psychotherapist to work through her anxiety. Three years later, anxiety remains but she feels she’s begun to find resolution through therapy and “spiritual resources.” She is hoping to re-create a slice of L’Abri in her living situation too.

“There’s something about all Christian communities that work—which is some degree of shared vulnerability and intimacy,” she said. She wished churches would offer more of what L’Abri offered her: She spoke about her anxiety once in a church setting and got uncomfortable silence.

“My church was probably the hardest place to talk about any of this.”

Emily Belz

Emily Belz

Emily reports for WORLD Magazine from New York City. Follow Emily on Twitter @emlybelz.

Comments

  • not silent
    Posted: Fri, 10/26/2018 11:29 am

    Thank you for your willingness to address difficult topics.  Addiction is a very serious issue, and I've seen it firsthand because there has lot of it in my family.  Most addicts in my family have had problems with alcohol and marijuana-I am personally a recovering alcoholic.  

    Someone close to me who is a doctor has said that the potential for addiction with opiods was downplayed when he was in medical school.  Some of my own doctors have offered to prescribe benzos without telling me about the addictive potential-even though they knew I was in recovery.  Because I also had crippling anxiety and would go for nights at a time without sleep, I tried Klonopin for a while; but it didn't seem to affect me at all, even when I stopped cold turkey. 

    I think my situation is unusual, and I'm grateful to God for his protection.  I spent a lot of time working through various issues and letting the Lord bring healing, but there was a period of time when my anxiety was so paralyzing I could not sleep.  (After not sleeping for days, a person can literally begin to lose touch with reality.)  Thankfully, there were doctors who prescribed non-addictive meds for me for a time, though not every doctor agreed because they were prescribed off-label.  With counseling and God's guidance, I have learned additional tools to cope with anxiety; and i know it won't kill me.  I don't take meds now, but I would not hesitate if I needed them-though I would not take any benzos.  

  • Narissara
    Posted: Fri, 10/26/2018 02:57 pm

    Thank you 

  • Narissara
    Posted: Sun, 10/28/2018 05:09 pm

    Thank you for this article.  I’ve been taken task for voicing concerns about benzodiazepines several times by someone wholly unqualified to speak who insists that they’re not addictive; they’re only dangerous when mixed with other drugs or alcohol; if a patient is on them, it must be for a reason, and they’re only problematic when he or she tries to quit without a doctor’s supervision.  This article doesn’t explicitly confirm my concerns, but it does lend support.  

    I hope a future piece will address how benzodiazepines are abused as chemical restraints for dementia patients with belligerent behaviors and how they’re over-prescribed for elderly patients, particularly women whose anxiety is caused by underlying medical causes such as sleep apnea/sleep deprivation, hormone imbalanc, etc.  

     

  • JerryM
    Posted: Sun, 10/28/2018 12:19 am

    “My church was probably the hardest place to talk about any of this.”

    This is obviously very sad.  Sad too are the increasing numbers of children, teenagers and adults dealing with mental heath issues but are not taking drugs.  I suppose many churches expect their congregants to be "well", even perfect? 

    Thanks for another good article about an issue of importance...

  • SGTahan
    Posted: Sun, 10/28/2018 04:08 pm

    Thank you for this timely article. I recently saw an ENT doctor about some issues in that area. He first recommended a sleep study and the results showed a mild case of sleep apnea along with restless leg syndrome.  He nonchalantly prescribed clonazepam to reduce the leg problem. Not knowing about this drug, I looked it up online and it seemed to be an extreme use for this type medicine. I decided to pass it up. This article only reinforces this decision. I plan to make comments about this in their offices after-appointment survey.  Thank you again and God Bless.

  • Bob C
    Posted: Tue, 10/30/2018 01:24 pm

    You did the right thing to investigate the recommended drug yourself. Corporate owners of Doctors practices these days are forcing Docs to push patients in and out too fast.  So one needs to be more responsibility for their own health care.  

  • VolunteerBB
    Posted: Tue, 10/30/2018 06:54 pm

    To Ms. Crowley and others.  It is really sad that we get stunned silence when opening up to our church people in Bible studies, etc., because they don't know what to say, and the judgement feels like a sledge hammer to the chest.  I would wager that there are 30% of congregants if not more in any give church that is struggling with addiction in their families.  Most of us don't want to tell others about our struggles, whether it be ourselves or a family member due to the fear of being judged and getting worthless advice.  If they haven't walked a mile in my shoes, I don't want to hear what they have to say; unless it is:  "How can I pray for you?"  Please, Christians out there, listen up.  People are scared, and feeling alone.  Don't judge, just offer a listening ear and a shoulder to cry on and prayer support, and don't offer advice or platitudes if you don't know what they are going through.  Just admit that and be supportive.  Addiction is overtaking our country, and the people sitting next to you in church could be hurting beyond belief!

  • Kiwi's picture
    Kiwi
    Posted: Tue, 11/06/2018 06:16 pm

    I would also add that benzodiazipines can have the opposite effect in patients with severe autism.  My son was given Ativan for his seizures, and after two days it caused him to weep and scream and leap about the house repetitively punching himself in the head - for 18 hours a day, for two weeks, till we managed to get the doctor to switch him to a different anti-seizure medicine. He had never hit himself before taking the Ativan.  Later he was prescribed Klonipin prn to reduce self-injurious behaviours, but it did nothing, so we took him off it.  Both Seroquel and Abilify  caused him to be extremely agitated and violent, and to not sleep.  If you have a child with severe autism, be very careful with these meds - let your doctor know you will only accept them on a trial basis, and be ready to quickly wean if they have the opposite effect.  Now my son has been successfully weaned off most of his medicines, (his epilepsy still requires medication), and his psychiatrist loves to show him off to her trainees as the success story that he is. He is no longer violent, and I am grateful to all of the people at church who lovingly helped us through those difficult years.  There were times when we were trying a new medicine that made him worse, that he really disrupted the whole church, but they never complained, they tried to help in any way they could.  Sometimes they drove him around and around in their cars during the service so I could have a break, the old ladies who were not strong enough to help with him sent me nice cards with encouraging verses.  Some just smiled at him and greeted him normally - even when he was screaming and thrashing about, some took my other children out for fun events.  It all helped.