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Tranquillizers and Sleeping pills; Facts
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<h1> Tranquillizers and sleeping pills</h1>
Tranquillizers are depressant
drugs that slow down the central
nervous system (CNS), and thus are similar to such
other CNS
depressants as alcohol and barbiturates.
<p>
The term "major tranquillizer" was formerly applied to drugs used
to treat
severe mental illnesses, such as schizophrenia. However,
these drugs are now more
commonly called neuroleptics; their
action specifically relieves the symptoms of mental
illness, and
they are rarely misused for other purposes. This paper therefore
called
"minor" tranquillizers).
<p>
Anti-anxiety agents share
many similiarities with barbiturates;
both are classified as sedative/hypnotics. These
newer agents
were introduced under the term "tranquillizer" because, it
was
claimed, they provided a calming effect without sleepiness.
Today,
tranquillizers have largely replaced barbiturates in the
treatment of both anxiety and
insomnia because they are safer and
more effective. The degree of sleepiness induced
depends on the
dosage. Tranquillizers are also used as sedatives before some
medically during
alcohol withdrawal.
<p>
Although tranquillizers do not exhibit the
serious dependence
characteristics of barbiturates, they nevertheless can produce
tolerance and dependence. They may also be misused and abused.
<p>
The first drug to be labelled a tranquillizer was meprobamate -
under the
trade name Miltown - in 1954. Today, however, the most
popular anti-anxiety agents are
the benzodiazepines (e.g. Valium,
Halcion, and Ativan). (NOTE that where a drug name
is
capitalized, it is a registered trade name of the manufacturer.)
Since
the early 1960s, the benzodiazepines have accounted for
more than half the total world
sales of tranquillizers. They are
currently the most commonly prescribed class of
psychotropic
(mood-altering) drugs in Canada.
<p>
The
first benzodiazepine developed was chlordiazepoxide, which is
sold under such trade
names as Librium and Novopoxide. The next
was diazepam; it is marketed, among other
brand names, as Valium,
E-Pam, and Vivol. In the early 1970s diazepam was the most
widely
prescribed drug in North America. Now Halcion and Ativan - drugs
from the same family as diazepam but eliminated more rapidly from
the body - account
for most benzodiazepine prescriptions.
There are 14 different benzodiazepines
currently available in
Canada. Some are prescribed as anti-anxiety drugs (e.g.
Valium,
Librium); others are recommended as sleeping medications (e.g.
Dalmane, Somnol, Novoflupam, and Halcion).<p>
<h2>Effects</h2>
The effects of any drug depend on several factors
<ul>
<li>the amount taken at one time
<li>the user’s past drug experience
<li>the manner in which
the drug is taken
</ul>
he circumstances under which the drug is
taken (the place, the
user’s psychological and emotional stability, the presence of
other people, the simultaneous use of alcohol or other drugs,
etc.).<p>
With tranquillizers, a therapeutic dose (i.e. what is
medically
prescribed) relieves anxiety and may, in some people, induce a
loss of inhibition and a feeling of well-being. Responses vary,
however. Some people
report lethargy, drowsiness, or dizziness.
Tranquillizers, though, have very few side
effects.
<p>
As the dose of a tranquillizer is increased, so is
sedation and
impairment of mental acuity and physical coordination. Lower
doses are recommended for older people or for those with certain
chronic diseases,
since their bodies tend to metabolize these
drugs more slowly.<p>
Studies show that anti-anxiety agents, even at the usually
recommended
and prescribed doses, may disrupt the user’s ability
to perform certain physical,
intellectual, and perceptual
functions. For these reasons, users should not operate a
motor
vehicle or engage in tasks calling for concentration and
coordination. Such activities are particularly hazardous if
tranquillizers are used
together with alcohol and/or barbiturates
(i.e. other sedative/hypnotics) or
antihistamines (in cold,
cough, and allergy remedies). These effects occur early in
therapy, however, and wane over time with increased tolerance
(when more of
the drug is needed to produce the same effect).
<p>
Because some
tranquillizers (such as diazepam) are metabolized
quite slowly, residue can accumulate
in body tissues with long-
term use and can heighten such effects as lethargy and
<p>
sluggishness.
<h2>Toxic effects</h2>
Tranquillizer overdose, particularly with benzodiazepines, has
become increasingly
common since the 1960s. While these drugs are
usually safe even when an overdose is
taken (death rarely results
from benzodiazepine use alone), they can be fatal in
combination
with alcohol and other drugs that depress the central nervous
system.
<p>
In Canada, as elsewhere, tranquillizer-related
poisonings and
overdoses have kept pace with the drug’s availability. It is a
widely prescribed and
available. (The majority of these
drug-related suicide attempts are by women under
30.)
<p>
<h2>Tolerance and dependence</h2>
Because tolerance to the mood-altering effects of tranquillizers
can develop with
regular use, higher daily doses become necessary
to maintain the desired effects.
Tolerance may occur even at
prescribed doses.
<p>
Chronic users may become both psychologically and physically
dependent on
tranquillizers.
<p>
Psychological dependence exists when a drug is
so central to a
person’s thoughts, emotions, and activities that the need to
<p>
With
chronic use, especially at higher doses, physical dependence
can also occur. The user’s
body has adapted to the presence of
the drug and suffers withdrawal symptoms when use
is stopped. The
frequency and severity of the withdrawal syndrome depends on the
dose, duration of use, and whether use is stopped abruptly or
tapered off.
Symptoms range in intensity from progressive
anxiety, restlessness, insomnia, and
irritability in mild cases
to delirium and convulsions in severe cases.
<p>
Dependence may also occur following long-term therapeutic use,
but withdrawal symptoms in such cases are mild. Patients complain
of
gastrointestinal problems, loss of appetite, sleep
disturbances, sweating, trembling,
weakness, anxiety, and changes
in perception (e.g. increased sensitivity to light,
sound, and
smells).
<p>
Risk of dependency increases if
tranquillizers are taken
regularly for more than a few months, although problems have
been
reported within shorter periods. The onset and severity of
withdrawal
differ between the benzodiazepines that are rapidly
eliminated from the body (e.g.
Halcion) and those that are slowly
eliminated (e.g. Valium). In the former case,
symptoms appear
within a few hours after stopping the drug and may be more
severe. In the latter case, symptoms usually take a few days to
appear.
<p>
<h3>Tranquillizers and pregnancy</h3>
If a woman
uses tranquillizers regularly, the drug can affect the
baby for up to 10 days after
birth. Babies may exhibit the
withdrawal symptoms common to such other depressant drugs
as
alcohol and barbiturates. These symptoms include feeding
difficulties,
disturbed sleep, sweating, irritability, and fever.
Symptoms will be more severe if the
doses the mother took are
higher.<p>
Administration of
diazepam during labor has been linked to
decreased responsiveness and respiratory
problems in some
newborns.
<p>
<h3>Who uses
tranquillizers</h3>
A 1989 Addiction Research Foundation survey of Ontario adults
aged 18 years and over indicated that 6.5% had used
tranquillizers in the
previous 12 months - roughly half the
percentage of users reported in 1977.
<p>
The survey showed that women, as a group, use tranquillizers
most
frequently. A 1990 study done at the Foundation found that women
who
were abused as girls, or who saw their mothers abused by a
male partner, were more
likely, as adults, to use tranquillizers
and also illegal drugs. The study found too
that women who are
abused by their partners use more tranquillizers - as well as
more sedatives, sleeping pills, and alcohol - than other women.
<p>
Other frequent tranquillizer users are people over 50 (with those
over 65
being the highest users); those with only elementary
school education; people in the
lowest income group; and those
who marked their occupation category as
"other" (which included
people who are housewives and students, and those who
are
disabled, retired, or unemployed).
<p>
The study
also showed that tranquillizer use by people 50 years
and more remained at virtually a
constant level from 1977 to
1984, but declined in 1987. For those between 18 and 29,
use
decreased steadily from 1977 to 1987.
<p>
In a
separate Foundation study done in 1987, Ontario students in
grades 7 to 13 were polled.
The findings showed that 4.9%
reported using prescribed tranquillizers, and 3%
non-prescribed
tranquillizers, at least once in the preceding year. The self
students (6.3% for
prescribed tranquillizers, and 4.5% for
nonprescribed ones).
<p>
People dependent on alcohol or other drugs are at higher risk
than others for
tranquillizer abuse and dependence. Alcohol
treatment and methadone maintenance
programs report that their
clients often abuse or are dependent on tranquillizers.
<p>
<a href="amphetam.html">Amphetamine</a> and
<a href="cocaine.html">cocaine</a> users frequently take tranquillizers to
relax or sleep after over-stimulation by the former drugs.
Prescribing
tranquillizers to users of other drugs, or to people
undergoing withdrawal, carries a
risk of transferring their
dependence to tranquillizers. Dose and duration of treatment
should be closely monitored.
<p>
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