In New York City crack and heroin aren't the only drugs of abuse. The street price for Xanax zoomed from $1.50 in December 1988 to $8 this fall. During the same time Valium went from $2 to $6 per pill. The sudden jump in black market pricing is attributed to a new New York state law that is cutting supplies drastically. To comply with the new regulation doctors must fill out all prescriptions for benzodiazepines in triplicate. In addition to triple forms, patients can obtain only one month's supply at a time, and refills are limited.
Benzodiazepines are primarily anti-anxiety agents and sleeping pills such as Ativan, Dalmane, Halcion, Librium, Restoril, Serax, Tranxene, Valium and Xanax. They are among the most popular and controversial drugs on pharmacy shelves.
For decades doctors assumed these tranquilizers were harmless and prescribed them freely for nervous or sleepless patients. It was assumed that anyone who complained of withdrawal symptoms when they stopped such a drug had been abusing it by taking too much.
But in recent years new research has shown that some people become physically dependent on these drugs at normal doses and suffer unpleasant symptoms when they stop suddenly. One of our readers wrote of her difficulties in getting off Xanax. Her doctor prescribed this drug for a nervous stomach. When she realized a year later that she was addicted, he sent her to a drug treatment clinic.
Ten weeks later she wrote, "I am still experiencing physical complications of severe stomach discomfort, heart palpitations and terrible shakiness. I have been unable to find any doctor who knows how to treat these aftereffects. The one thing they all agreed on at the clinic is that Xanax is incredibly difficult to stop taking because it is so addicting."
An insomniac wrote to us to describe her difficulties with sleeping pills. "I took Dalmane for five years until my doctor phased me off several months ago. I was so nervous, suffering from depression, sweating, insomnia and shakiness inside, that he prescribed Ativan at bedtime. Now I can sleep, but I am still suffering during the day."
The New York regulation should help eliminate open-ended refillable prescriptions that allow patients to stay on Dalmane, Halcion or Xanax for years without careful supervision. But it may lead to problems for some patients who have taken benzodiazepines for a long time and no longer need them. If they have a difficult time getting off, their doctors can get advice for assisting them by writing for "Techniques of Benzodiazepine Withdrawal" (Bruce H. Medd, M.D., Director Professional Services, Roche Laboratories, Nutley N.J. 07110).
Other states are considering whether controls like New York's would reduce the problems associated with benzodiazepine use, especially in the elderly.
It is too early to see the impact in New York, but officials hope that by curtailing overprescribing of benzodiazepines, they will be able to reduce mental confusion, drug addiction and hip fractures caused by drug-induced falls.
There is a place for such medicines, but physicians, pharmacists and patients must not take them for granted. Restrictions like the one in New York force doctors to review the benefits of a tranquilizer or sleeping pill on a regular basis. We hope other states will soon follow suit.