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Anxiety pills that promise so much leave behind a hidden ‘epidemic’

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Two weeks after her mother died, Rhonda Assoun-Gritten was looking around the 63-year-old woman’s Dartmouth, N.S., apartment, opened the drawer of the night table and discovered receipts for three recent prescriptions. Assoun-Gritten didn’t recognize the names of the medications, but stuffed the papers in her back pocket.

The death of Sharon Assoun on Feb. 24, 2016, had been shocking not only in its suddenness, but in its unusual nature. While babysitting that night at her son’s home, she had gone down to the fridge, her daughter says, and drank a bottle of his illicitly purchased methadone.

When the toxicology report came back six months later, it pointed to the obvious. The amount of methadone, which is used to treat opioid addiction, had been within the lethal range. But the medical examiner’s report also listed two sedatives in the cause of death. A third was found during toxicology tests.

It turned out that Sharon Assoun had for years been prescribed a class of drugs called benzodiazepines for insomnia and anxiety. On a hunch, her daughter showed the prescription receipts she had retrieved from her mother’s home to her own family doctor.

“She put her hands on her head and put her head on the desk,” says Assoun-Gritten. “‘Rhonda,’ she said, ‘Your mother was so overmedicated she wouldn’t have known, awake or asleep, if she was drinking the methadone.”

Sharon Assoun, right, had filled prescriptions for three different benzodiazepines leading up to her death. (Submitted by Rhonda Assoun-Gritten)

Benzodiazepines have been used for nearly six decades to treat seizures, anxiety and insomnia. In 2017, more than 26 million prescriptions for benzodiazepines and related drugs were written in Canada. They include diazepam, lorazepam, alprazolam and clonazepam, and go under brand names including Valium, Ativan and Xanax.

But addiction experts have long worried about what they view as the widespread misuse and overprescribing of benzodiazepines. There is a growing push to come to grips with a problem that crosses generations, from seniors hooked for decades to the alarming emergence of Xanax abuse among teens in places like Nova Scotia.

Some are now even drawing parallels to the opioid addiction problem.

“As we start to treat the opioid epidemic and peel back that layer, the extent of the benzodiazepine epidemic that is gripping North America is going to be shown,” says Dr. Selene Etches, manager of the concurrent disorder program at the IWK Health Centre, the Atlantic region’s largest children’s hospital.

This advertisement for the benzodiazepine oxazepam appeared in a 1967 publication of the Journal of the American Medical Association. (Journal of the American Medical Association)

Benzodiazepines were created in 1955 by chemist Leo Sternbach. Hoffmann-La Roche marketed its first version of the drug in 1960 and launched Valium three years later.

The drugs have a number of advantages. They’re effective. They also appeared to be safer than barbiturates, a predecessor used to treat anxiety and insomnia with higher risks for overdose.

But they could still be addictive.

The 1966 Rolling Stones song Mother’s Little Helper described “running for the shelter” of a “little yellow pill.” By the 1970s, some doctors were raising the alarm. Deep concerns about benzodiazepine-prescribing practices remain today.

“I’m as concerned about this as I am about the prescribing of opioids for chronic pain,” says Dr. Samuel Hickcox, the physician lead for addictions at the Nova Scotia Health Authority. “I think we’re really contributing to a problem, to be frank.”

One of the patients he has treated for addiction, he says, has been on benzodiazepines for 58 years, and was prescribed the first one to ever hit the market: Librium.

In Nova Scotia, the prescribing of benzodiazepine and related drugs remains stubbornly above the Canadian average, despite some modest decreases since 2012, according to data from the Canadian Institute for Health Information. Other Atlantic provinces fare even worse. Newfoundland and Labrador is double the national average. New Brunswick’s numbers are even higher.

From 2011 to October 2018, benzodiazepines contributed to 313 “acute toxicity deaths” in Nova Scotia. Nearly 80 per cent involved a deadly mix with opioids.

Doctors say benzodiazepines do have a useful role. They can prevent seizures and are an effective treatment for severe alcohol withdrawal. They offer rapid relief for acute anxiety, and can calm a person before surgery or help someone terrified of flying.

But doctors say in most cases, they should only be prescribed for short periods. Long-term use can lead to dependency and addiction. While some patients function just fine for years, for others, the side-effects include cognitive decline, dizziness and drowsiness.

“We know that in the elderly, the chance of falling or having an injury from a fall goes way up when they’re on benzodiazepines,” says Dr. Connie Leblanc, an emergency doctor in Halifax who is part of a campaign called Choosing Wisely, which aims to curb unnecessary tests and prescribing.

Too often, Hickcox says, benzodiazepines are so effective early on that patients lose the incentive to build resilience against their anxiety. He calls the drugs “alcohol in pill form” because they work on some of the same parts of the nervous system as booze. It’s almost akin, he says, to prescribing a beer.

As tolerance to benzodiazepines grows, anxiety can return. One pharmacist told CBC News she has made “grown men cry” by refusing early refills.

Worse yet, getting off them after long-term use is hard. Cold turkey is never recommended and potentially fatal due to seizures. It is more dangerous than opioid withdrawal, experts say.

“It gets me really nervous, as a physician who works in addictions,” says Hickcox.

Steve Sepulchre and his wife, Heather Holm, on a walk near their home in Martins Point, N.S. (Alex Lynch/CBC)

For Steve Sepulchre, that moment of reckoning came as he writhed on the floor of his psychiatrist’s office, begging for diazepam. He had lost his prescription and no one would give him more pills. Afterwards, his wife, Heather Holm, gave him an ultimatum: If he went back on benzodiazepines, their marriage would be over.

“It wasn’t even a threat to leave. It was a statement of reality,” she says in an interview at the couple’s home in Martins Point, N.S. “Because there was no marriage with those drugs. The intimacy of marriage was not complete with those drugs.”

Sepulchre’s decade-long slide had started in 2001 when he visited his doctor for insomnia. At the time, he was holding down two jobs, as an aviation regulations consultant for Transport Canada, and teaching French at Acadia University in Wolfville, N.S. He was also being gnawed at by unresolved trauma from childhood.

Different drugs were tried. Later, a psychiatrist prescribed lorazepam, and eventually diazepam.

“The immediate feeling is relief,” says Sepulchre, who is now 65. “That’s the immediate feeling is welcome relief. It’s like, now I can sleep. Huh. Now my problems don’t seem so big anymore. Huh. Now I’m getting along easier with the world, the constraints of the world.”

Sepulchre says he’s found new tranquillity through meditation. (Alex Lynch/CBC)

But as time wore on, the symptoms of anxiety would return. The dosage would rise. The pattern would repeat. His lock on reality was changing. Technical aspects of his contracts became too hard. It was like the people around him were at the bottom of a swimming pool, their voices distorted by the water.

He was becoming apathetic and withdrawn. His spark was gone. Friends noticed. He would write crazy things to relatives. When it all became too much, he would “freak out,” sometimes breaking electronics.

After his psychiatrist died, his file was sent to a family doctor in nearby Bridgewater who issued him a blunt assessment. His dosage of benzodiazepines would eventually kill him. A new psychiatrist put him on a tapering program, one of the primary ways to get someone off benzodiazepines.

Two years in, he lost his prescription. It was as if a decade of building tension was uncorked. Images flitted through his mind like banners trailing an airplane: details of meaningless work meetings long forgotten, obsessions from childhood. His heart rate shot up.

Today, he is off all the drugs, including an antidepressant he had also been prescribed. He only takes a small dose of marijuana oil at night to help him sleep. He credits meditation and the support of his wife with saving him. Slowly, incrementally, at times imperceptibly, he says, he’s found enough tranquillity to bring himself back in touch with reality.

Oxazepam is one of the benzodiazepines listed in Sharon Assoun’s cause of death. (Alex Lynch/CBC)

Concerns about benzodiazepines may date back at least to the Rolling Stones’ early days, but the pop culture references hardly end there. The Guardian newspaper in the U.K. called Xanax, also known as alprazolam, “perhaps the most fashionable drug in 2017’s rap scene.”

This came after American rapper Lil Peep, who had rapped about using Xanax and posted a video saying he had popped six pills, died of an overdose.

Grammy-nominated singer-songwriter and rapper Post Malone spelled out his drug problems in the lyrics of Better Now, released last year: “I did not believe that it would end, no. Everything came second to the benzo.” The California rapper Diego Leanos is even known by the stage name Lil Xan.

It was also in 2017 that Etches, the IWK addictions doctor, stepped back and realized something startling. The number of youth she was seeing who were abusing opioids was dropping. Xanax had now become her chief concern.

Many of the young people she treats are snorting and injecting the benzodiazepine in amounts far beyond what would be prescribed. They are self-medicating for anxiety and depression, to relax, sleep, escape trauma in their lives. Others want to get high, but then continue to use to deal with the withdrawal.

Dr. Selene Etches is the manager of the concurrent disorder program at the IWK Health Centre in Halifax. (Richard Cuthbertson/CBC)

Tutorials on the internet outline how to lie to a doctor to get a prescription. Many young people, Etches says, are simply raiding the medicine cabinets at the homes of families and friends. What is even more worrisome, she says, is  counterfeit Xanax is being sold over the internet.

Youth who come to the IWK for addictions treatment have their urine tested. The results reveal fakes are being laced with ecstasy, amphetamines, and deadly opioids like fentanyl and carfentanil.

“We tested one youth’s urine and the only benzodiazepine that wasn’t present was the one that he thought he was using,” she says. Some teens have even obtained take-home kits to test their drugs.

One of things that makes Etches the most nervous is the withdrawal. So significant is the danger of seizures and delirium that she hospitalizes youth going through the process.

“The cravings can last years, especially in adolescence, because the brain is developing so much.”

Xanax has been called ‘perhaps the most fashionable drug in 2017’s rap scene.’ (Alex Lynch/CBC)

In October, benzodiazepines were added to Nova Scotia’s prescription monitoring program, which can help flag worrisome prescribing patterns or identify patients doctor shopping for drugs.

A hotline staffed by specialists to give advice to doctors and nurse practitioners worried about patients with “problematic relationships to their medications,” such as opioids and benzodiazepines, could be up and running by April.

An addictions education mentorship for health-care professionals now has 300 members in Atlantic Canada. And a program launched by two Dalhousie University experts aims to help insomniacs sleep without taking pills.

The death of Sharon Assoun led to investigations by the College of Physicians and Surgeons of Nova Scotia and Nova Scotia College of Pharmacists. (Submitted by Rhonda Assoun-Gritten)

At her family doctor’s urging, Rhonda Assoun-Gritten launched a complaint with the College of Physicians and Surgeons of Nova Scotia against the physician who had been prescribing benzodiazepines to her mother.

An investigation showed Sharon Assoun had long been on oxazepam for anxiety and temazepam to help her sleep. But in the months leading up to her death, she had switched from oxazepam to a similar sedative, clonazepam, and then back again as she dealt with “distress” related to family issues.

Her doctor would later tell the college he instructed Assoun not to take the clonazepam once she returned to her old medication. He said he had counselled her and suggested mental-health treatment to help her deal with her issues. She declined. He reported she was coherent, clear and alert, and didn’t appear overmedicated.

But not long before her death, Assoun managed to fill prescriptions for all three benzodiazepines. She told the pharmacist she needed that much. He never called her doctor to clarify.

The college of physicians concluded Assoun’s family doctor had not been overprescribing. The Nova Scotia College of Pharmacists, which reprimanded two pharmacists involved, saw it somewhat differently. It noted that even using two benzodiazepines at the same time is “not a preferred treatment plan, however, it is not an uncommon prescribing practice.”

“I feel really let down by the whole system,” says Assoun-Gritten. “It’s really sad that one phone call, just one phone call, and my mom would still be here.”

If you have a story about benzodiazepines you want to share, contact richard.cuthbertson@cbc.ca  

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Health Ranger posts new microscopy photos of covid swabs, covid masks and mysterious red and blue fibers

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(Natural News) What follows is a series of microscopy photos of covid swabs (a synthetic swab, then a cotton swab), a covid mask and some zoomed-in photos of mysterious red and blue fibers found in the masks.

The magnification range for these photos is 50X to 200X. Most were taken with white light, but several (as indicated) were taken with UV light.

The images shown here are 600 pixels wide. We have higher resolution images available to researchers and indy media journalists; contact us for those hi-res images.

More microscopy investigations are under way, and new images will be posted as they are finalized.

First, this series shows the carbon fiber layer of a covid mask, illuminated with UV light:

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5,800 test positive, 74 die of coronavirus at least 14 days after getting fully vaccinated

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(Natural News) The Centers for Disease Control and Prevention (CDC) on Thursday, April 15, confirmed some 5,800 breakthrough coronavirus (COVID-19) cases in the U.S.

A breakthrough COVID-19 case is defined as someone who has detectable levels of SARS-CoV-2 – the virus that causes COVID-19 – at least 14 days after getting fully vaccinated against the disease.

Nearly 400 breakthrough cases required treatment at hospitals and 74 died. A little over 40 percent of the infections were in people 60 years and above and 65 percent were female. About 29 percent of the vaccine breakthrough infections were reportedly asymptomatic. The figures were for cases through April 13.

CDC Director Rochelle Walensky told a congressional hearing on Thursday that the causes of the breakthrough cases are being probed. “Some of these breakthroughs are, of course, failure of an immune response in the host. And then some of them we worry might be related to a variant that is circulating. So we’re looking at both,” she said.

The CDC is monitoring reported cases “for clustering by patient demographics, geographic location, time since vaccination, vaccine type or lot number, and SARS-CoV-2 lineage.” It has created a national COVID-19 vaccine breakthrough database, where state health departments can enter, store and manage data for cases in their region.

Where available, respiratory specimens that tested positive for COVID-19 will be collected for genomic sequencing “to identify the virus lineage that caused the infection.”

Positive test less than two weeks after getting fully vaccinated is not a breakthrough case

The number of cases the CDC has identified does not include people who contracted COVID-19 less than two weeks after their final dose. The two-week marker is important, said infectious disease expert Dr. Amesh Adalja, senior scholar at the Johns Hopkins Center for Health Security.

A human body should have enough time to develop antibodies to SARS-CoV-2 after that timeframe. Before then, a person won’t necessarily have the built-up immunity needed to fight off an infection. According to Dr. Adalja, cases that occur before the two-week mark are not considered breakthrough cases.

Dr. Adalja also noted that more research is needed to determine if highly infectious variants of the virus are behind the breakthrough cases. “It is crucial to study breakthrough cases to understand their severity, their contagiousness and what role variants may be playing,” Dr. Adalja said.

More than 78 million people have been fully vaccinated against COVID-19 in the U.S. as of April 15.

“To date, no unexpected patterns have been identified in case demographics or vaccine characteristics,” the CDC said in a statement. “COVID-19 vaccines are effective and are a critical tool to bring the pandemic under control.”

But the CDC conceded that “thousands of vaccine breakthrough cases will occur even though the vaccine is working as expected.”

Dr. William Schaffner, an infectious disease specialist and professor at the Vanderbilt University School of Medicine, agreed with the CDC. “These vaccines that we’re using are fabulous but they’re not perfect,” he said. “At best, they’re 95 percent effective in preventing serious illness, but minor illnesses can occur.”

According to U.S. drug regulators, Pfizer’s COVID-19 vaccine is 95 percent effective in preventing infection. Moderna’s was shown in a clinical trial to be 94.1 percent effective while Johnson & Johnson’s was 66.9 percent effective. Only Johnson & Johnson vaccine, which received its emergency use authorization from the Food and Drug Administration (FDA) on Feb. 27, was tested when variants were circulating.

The percentages are based on results from vaccine recipients two weeks after the final vaccination.

Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, stated in a briefing last week that the breakthrough cases are not a cause for concern.

“I think the important thing is to look at what the denominator of vaccinated people is. Because it is very likely that the number of breakthrough cases is not at all incompatible with the 90-plus percent vaccine efficacy,” he said. “So I don’t think that there needs to be concern about any shift or change in the efficacy of the vaccine.”

More info needed before drawing conclusions from breakthrough cases

The percentage of vaccine breakthroughs in a population depends on multiple factors, including vaccine efficacy, the amount of virus circulating and the length of time since vaccination, according to Natalie Dean, an assistant professor of biostatistics at the University of Florida.

“I love to see small numbers as much as anyone, but know that numbers like this cannot be directly interpreted as a measure of vaccine efficacy (although I have a feeling they will be). We can only interpret them against a background rate in unvaccinated people,” Dean wrote on Twitter.

“Similarly, ‘most breakthroughs have been in elderly adults’ should not be read as the vaccine is less effective in elderly adults. The majority of vaccinations (and the longest amount of follow-up time) have been in elderly adults. Again, we need more info to interpret.”

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More people died from fentanyl overdose than coronavirus in San Francisco last year

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(Natural News) More people died from fentanyl overdose than coronavirus (COVID-19) in San Francisco last year, a microcosm of a larger nationwide problem coinciding with the pandemic.

Data from San Francisco’s Office of the Chief Medical Examiner shows that 708 people were killed by fentanyl in 2020, an astonishing 118 times more since the introduction of the drug in the city just five years earlier.

That figure nearly tripled the 254 COVID-19 deaths recorded in the city for the whole of last year. More than 8 in 10 deaths were male, and just under half were white. People aged 55 to 64 made up nearly a quarter of the fatalities. Nearly 40 percent of the deaths occurred in open-air drug markets such as the Tenderloin and South of Market.

The number of overdose deaths in the city could have been far worse as more than 3,000 addicts suffering from an overdose were administered with naloxone, the lifesaving medication that reverses overdoses.

San Francisco’s death rate from fentanyl overdose continues to rise this year as 135 died by overdose in January and February, putting the city on pace for more than 800 deaths by the end of the year.

The city has become a significant part of a larger trend. The Centers for Disease Control and Prevention (CDC) released data on Wednesday, April 14, showing that more than 87,000 Americans died from drug overdose over the 12-month period that ended in September last year – the highest since the opioid epidemic began in the 1990s.

Lockdowns lead to more cases of drug overdose

The surge represents an increasingly urgent public health crisis that may be correlated to the government’s monotonous battle plan against the COVID-19 pandemic.

On March 19 last year, California became the first state in the U.S. to implement a stay-at-home order. It subsequently endured the longest lockdown of any state in the country.

The pandemic and accompanying lockdowns are believed to be partly responsible for the soaring number of drug deaths for obvious reasons. Lockdowns have badly disrupted the social services in the city, including drug addiction treatment. Drug experts say the isolation of the past 12 months is causing vulnerable residents to turn to opioids.

“We see the death and devastation getting worse right in front of us,” said Matt Haney, San Francisco Board of Supervisors member. “It’s an unprecedented spiraling, directly connected to the introduction of fentanyl in our city.”

Fentanyl first appeared on the streets of San Francisco in 2015. There were just six deaths from the synthetic opioid that year, 12 deaths in 2016 and 37 deaths in 2017. The figure skyrocketed when the drugs became widely available in the city in 2018.

Kristen Marshall, manager of the national drug harm reduction DOPE Project, noted the grim irony that while social isolation could save lives from COVID-19, it had undoubtedly contributed to the number of overdose deaths.

“Isolation is also the thing that puts people at the absolute highest risk of overdose death,” she said.

Pandemic exacerbates rise in deaths from drug overdose

The number of deaths from drug overdose started rising in the months leading up to the coronavirus pandemic, making it hard to gauge how closely the two phenomena are linked. But the pandemic unquestionably exacerbated the trend. The biggest jump in overdose deaths took place in April and May when fear and stress were rampant, job losses were multiplying and the strictest lockdown measures were in effect.

Many treatment programs closed during that time while drop-in centers, which provide support, clean syringes and naloxone, cut back services.

The data released by the CDC shows a 29 percent rise in overdose deaths from October 2019 through September 2020 compared with the previous 12-month period. Illicitly manufactured fentanyl and other synthetic opioids were the primary drivers, although many fatal overdoses have also involved stimulant drugs like methamphetamine.

Unlike in the early years of the opioid epidemic, when deaths were largely among white Americans in rural and suburban areas, the current crisis is affecting Black Americans disproportionately.

“The highest increase in mortality from opioids, predominantly driven by fentanyl, is now among Black Americans,” Dr. Nora Volkow, the director of the National Institute on Drug Abuse, said at a national addiction conference last week.

“And when you look at mortality from methamphetamine, it’s chilling to realize that the risk of dying from methamphetamine overdose is 12-fold higher among American Indians and Alaskan Natives than other groups.”

Dr. Volkow added that more deaths than ever involved drug combinations, typically of fentanyl or heroin with stimulants.

“Dealers are lacing these non-opioid drugs with cheaper, yet potent, opioids to make a larger profit,” she said. “Someone who’s addicted to a stimulant drug like cocaine or methamphetamine is not tolerant to opioids, which means they are going to be at high risk of overdose if they get a stimulant drug that’s laced with an opioid like fentanyl.”

The Drug Enforcement Administration (DEA) supported Dr. Volkow’s claim, saying that transnational criminal organizations cause a spike in overdoses by mixing fentanyl into illicit narcotics.

According to the DEA, Mexican cartels often purchase the drug components in China and use human mules to smuggle the narcotics to lucrative drug markets north of the border.

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