V is for Valium

The wonderdrug of the Seventies became one of the most notorious in history. Thousands still grapple with its crippling side-effects, and its makers have quietly dropped its brand name. But as mother's little helper celebrates its 40th birthday, Elizabeth Heathcote discovers that V may yet stand for Vindication
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The Independent Online

Valium was launched 40 years ago. These are some of the withdrawal symptoms that have been reported by people who have become addicted to it since.

Anxiety and panic attacks; excitability; jumpiness; insomnia; nightmares; agoraphobia; hallucinations; obsession; depression; paranoia; aggression; poor memory and concentration; headaches; pains; stiffness; fatigue; tics; electric shocks; dizziness; tinnitus; nausea; weight change; loss of libido; epileptic fits.

"I had all of those," says Barry Haslam.

In 1976, Haslam was working and studying 90 hours a week to become an accountant. He passed his exams but at a price: he had a nervous breakdown. He was prescribed tranquillizers, which helped for a while, and when they stopped working his prescription was increased. Soon anti-depressants were added to the mix, and then stronger drugs from Valium's family, the benzodiazepines. By 1985, he was taking the equivalent of 300mg a day of Valium (the standard starting dose is 6mg) and had, he says, "turned from a quiet accountant into a monster".

"I can't remember anything really of that 10 years but by the end I was a Jekyll and Hyde - violent, punching the wall." In a rare lucid moment, he decided enough was enough. He weaned himself off all the drugs over a period of 15 months. "I lost 7 stone. It was hell. But I woke up one morning and saw my wife for the first time in 10 years."

Fifteen years later he still has health problems that he attributes to the drugs. He has to take thyroid hormones, has constant pains in his legs and chronic breathing difficulties. He can't work but devotes himself when he feels well enough to Beat the Benzos, a support and campaigning group. He estimates he takes 200 calls a month from men and women still addicted or suffering the consequences, including many who have been housebound for years through agoraphobia. This is, he says, the tip of the iceberg. No one knows how many long-term benzodiazepine users there are in Britain, but estimates start at 500,000.

His and other groups are lobbying for new legislation on these drugs. The Home Office is studying a proposal to reclassify them from schedule 4 to schedule 2, which would mean tighter controls on a GP's ability to prescribe, especially repeat prescriptions. (Haslam is optimistic: when in opposition, the Home Secretary David Blunkett described Britain's benzo addiction problem as a national scandal".)

There is also a proposal to reclassify the group's legality from class C to class A, which means dealing in them would carry the same sentence as heroin or cocaine. Abuse of benzodiazepines is rife: most heroin users also abuse benzos, often intravenously, and it is a popular "comedown" from other drugs. In combination (and particularly with opiates), they are the second most commonly implicated drug group in emergency-room admissions from overdose (Valium was found in Elvis's blood after his death). Perhaps most sinisterly, they are central to the date rape phenomenon. In a police spot-check at a nightclub in Essex earlier this month, eight women's drinks were found to have been spiked, seven with benzodiazepines.

This is the unhappy story of Valium that most of us have been reading for the past 20 years. Which might explain why, when the patent expired early last year, Roche, the creator and manufacturer, quietly decided to stop production of the drug that had propelled it into the super-league. It is still available under its generic name diazepam but Roche's decision was unusual - drug companies generally continue to trade on the brand, even after patent has expired and few names are as well-known as Valium. The problem is that it is famous for all the wrong reasons.

But is it possible those little blue, yellow and white pills have been done an injustice?

Not everyone hates Valium. Emily Green for one would like to wish it a very happy birthday.

In her late teens, Emily started to suffer from anxiety attacks. She thought she was going mad. "I know now it is very common in young women but at the time I was petrified. I was too scared to leave the house, let alone get a job, and spent my days doing crossword puzzles and going off my head. It just got worse and worse - a spiral of fear. Eventually I went to my doctor who explained what was happening and gave me a small prescription of diazepam."

She discovered that if she took a pill the panic dispelled. But she rarely needed to after that first time. The reassurance of having an escape route was enough to keep the anxiety at bay. Valium freed her to engage with the world again and build a normal life, which in turn made her better. "It was the early Eighties and everyone was talking about how potentially addictive these drugs were and I used them accordingly. I made the first prescription - for 10 tablets - last nearly a year. But by that time my life had been transformed."

Now 36 and a lawyer in London, she still likes to know she has a pill to hand for occasional use. "Over the years I've had some therapy and done some yoga and they did their bit, but I have also accepted that I was born with an anxious disposition and nothing is going to change that. Diazepam is part of my armoury."

When Nigel Griffiths's wife suffered a brain haemorrhage while they were on holiday in Italy, he spent two days trying and failing to deal with the situation. When doctors at the hospital pressed a bottle of pills into his hand he didn't even look at the label - he just took the prescribed dose, and suddenly things became manageable. "I started coping for the first time - I slept for the first time - and I got us back to Britain." It was only then that he discovered the tablets were Valium. "It saved me really. I can't see any way I'd have got through it otherwise."

Virginia Ironside, 59, The Independent's agony aunt, has taken diazepam on and off for 30 years, at some points in high doses and for lengthy periods. Nowadays she keeps one in her handbag "for emergencies". Like many people, she takes a milligram now and again if tormented thoughts are keeping her awake. "It saves an enormous amount of grief. I meet people looking haggard and they say they have been so worried and can't sleep, and I think, you stupid wallies - take a Valium and it'll all look different in the morning. And you'll stop a pattern developing where you wake up at four in the morning day after day."

Millions of Britons have stories like these but most don't choose to tell them because of the stigma attached to Valium. No one would wish to downplay the suffering of people like Barry Haslam, whose lives have been ravaged by an unwitting benzodiazepine addiction, but the truth is that their numbers are small in comparison to those who have been quietly helped along their way by these drugs.

In 1963, when Valium was first prescribed, it was hailed as a wonderdrug. Its main application was in treating anxiety and anxious insomnia, two of the most common causes of visits to GPs. Valium was amazing because it worked and yet seemed to have no side-effects. It was also impossible for people to overdose from it, accidentally or intentionally. Barbiturates, the only previous alternative, were fraught in both respects (both Jimi Hendrix and Marilyn Monroe died of barbiturate overdoses).

"These drugs were like magic," says Dr Ross Taylor, a GP for nearly 40 years and now leader of the prescribing advisory group for the Royal College of General Practitioners. "After barbiturates, everyone was focused on finding drugs that could deal with the huge problem of minor anxiety disorders but were less dangerous in terms of overdose. With benzos you could take bucketloads."

Which everybody proceeded to do, including GPs, who frequently wrote out prescriptions for themselves. This wasn't, after all, the pill-phobic generation of today: many of those faithfully popping their three a day had been born before the NHS, and prescription drugs came coated with a holy-water gloss.

"I was taking three 10mg doses a day," says Virginia Ironside. "All my friends were chucking them back. Lots would have bottles in their handbags and just hand them round. We were all worried about something or other and doctors would just hand them out."

Ninety per cent of Valium was prescribed by GPs, gynaecologists and (disturbingly) paediatricians rather than mental health professionals, which extended its reach. By 1976, one in 20 prescriptions written in Britain was for Valium, the majority for women. The stereotypes of the lonely ageing housewife in her suburban home, or the struggling young mum in a housing estate were already well-established. "The drug that tames tigers - what will it do for nervous women?" was how one newspaper heralded its launch. The Rolling Stones dubbed Valium "mother's little helper" in 1966.

There is no doubt the drug was mis-prescribed during these years. Valium was given to too many people and for too long. It was also too often seen as a psychological cure-all and diagnosed for conditions that it couldn't help and might make worse. Depression, for example - tranquillizers, which calm and numb, are by definition depressants. In anxiety relating to personality disorders or psychosis, diazepam can exacerbate symptoms, including violence. People with compulsive conditions or a history of addictive behaviour should also avoid it.

In defence of GPs, these have been described as the "dark years" of benzos, not because of their extravagant use but because so little was known about them. No one understood how they worked. There were whispers about possible addiction problems, but they were muted. In 1975 US Vogue ran an article on how "the pill you love can turn on you", and there are reports of doctors experiencing withdrawal problems from the drugs they'd self-prescribed. But Dr Taylor quotes from the British National Formulae 1976, the British standard on prescribing, which has little to say about negatives. Instead it points out that habituation problems associated with barbiturates mean that for long-term use, "they are becoming replaced by benzodiazepines".

Valium's peak came in 1979: 30 million prescriptions for benzos were written. A year earlier, Professor Malcolm Lader of the Institute of Psychiatry expressed concern about the "zombifying" effects on patients in an article in Neuroscience. But it was Esther Rantzen who really started the backlash.

That's Life, her campaigning programme, ran a piece on the plight of a patient struggling to come off benzodiazepines. The response was overwhelming. A campaign was launched and it was picked up by the national media. In 1988 the UK Committee on Safety of Medicines issued guidelines saying benzos should not be prescribed for more than four weeks, including a tapering off period, and that the risks could outweigh the benefits. Between 1981 and 1989, sales in Britain declined by 50 per cent.

In the wings, meanwhile, a new generation of antidepressants - Prozac and the other SSRIs - were being hailed as the latest wonderdrug. Antidepressants and tranquillizers are designed to treat discrete conditions (depression and anxiety) but the line between them is often hazy. Whether it was the most appropriate drug in every case or not, Prozac was poised to sweep up the market. Despite scares of its own since, including a heightened risk of suicide and withdrawal problems (spot a pattern yet?), 20 million prescriptions for SSRIs were written last year.

But benzos didn't go away. Seventeen million prescriptions were written for benzodiazepines in 2002, a little over half the 1979 peak, which is staggering when you think how far the drugs have been pushed into the cold. Some of them go to those struggling with addiction - the people Barry Haslam talks to; some to other long-term users who have no desire to stop taking the pills (one woman in her seventies I spoke to had fought her GP tooth and nail for the right to continue taking diazepam, the drug she considers has saved her life for more than 30 years). The rest go where they most probably should: to be used in short-term bursts, sometimes repeatedly, to help people with defined anxiety disorders (the World Health Organisation estimates this includes 450 million people worldwide). Or to relieve the suffering of painful life events that for some provoke unmanageable anxiety.

Many Britons who think nothing of getting sloshed night in and night out to help them through a bad time would never dream of "going down the road" of diazepam, even though alcohol is an addictive depressant. Other countries take a more pragmatic approach. In France right now, one in four adults is under the influence of a "mood-altering" prescription drug, including tranquillizers. As use of benzodiazepines declined in Britain in the Eighties, it increased by 18 per cent worldwide.

'Sometimes I think the tables will turn once again," says Dr Taylor. "These drugs are very effective. They have proved themselves extremely safe in terms of overdose as long as they are not mixed with other drugs or alcohol, and they have fewer side-effects than SSRIs. Their position needs to be reviewed."

In the years since the height of the controversy, our understanding has moved on. We have known for 25 years how diazepam works (by enhancing the body's GABA neurotransmitter system, responsible for regulating and "damping down" reactions to stimulation and excitement) but the Nineties brought increased insight into the biochemical and genetic origins of many psychological disorders. As a result the emphasis has shifted slightly away from talking cures as the ultimate elixir and back, once again, towards chemical management.

The authors of a revisionist book, Good Chemistry: The Life and Legacy of Valium Inventor Leo Sternbach (McGraw Hill, £19.99, out this month), including three professors of psychiatry, suggest that GPs in Britain may now under-prescribe these drugs. They quote a psychiatrist saying "We are referred patients time and time again from GPs who are frightened to prescribe any benzodiazepines. Sometimes we may restrict our patients lives unwittingly by not providing them with the best treatment."

While they acknowledge potential addiction problems exist for some patients, they assert that with short-term use and a tapering off period, there should be no ill-effects. In around 10 per cent of cases, they say, longer term use is appropriate. Addiction is not, after all, a given. Virginia Ironside came off without incident after lengthy periods of using it, as did all her friends.

We live in stressful, existentially challenging times. We have never existed further from our natural rhythms, or been less at one with human realities such as death and loss. Our stress system was devised to cope with occasional attacks by sabre tooth tigers: more and more people find it stretched to snapping point by daily encounters with long hours, gridlock and loneliness. There is only so far you can go in bucking the ways of the world you live in: for some diazepam is an acceptable helpmate. As Virginia Ironside says, "You just have to stay in control of it."

Beat the Benzos can be contacted on 01457 876355

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