Antonio E. Nardi, Richard Balon, Guy Chouinard, Fiammetta Cosci, Steven Dubovsky, Giovanni A. Fava, Rafael C. Freire, David J. Greenblatt, John H. Krystal, Karl Rickels, Thomas Roth, Carl Salzman, Richard I. Shader, Edward K. Silberman, Nicoletta Sonino, Vladan Starcevic and Steven J. Weintraub: The value of long-term clinical experience with benzodiazepines. International Task Force on Benzodiazepines

Malcolm Lader’s Preliminary Commentary

            I had one initial question about the announcement. The authors have stated categorically that none of the members of the expert group have any financial conflicts of interest related to the prescription of benzodiazepines. However, my concern remains: how were the International Task Force chosen for their task?

            It is early days, but the preliminary announcement does not mention any of the adverse effects which concern those who have even more experience using the benzodiazepines, in my case since 1960.

            The fundamental problem is that apart from patients clearly at risk, such as those who have misused alcohol or other psychotropic agents, it is very difficult, if not impossible, to predict who will unexpectedly develop misuse or normal-dose dependence on these agents. Thus, this uncertainty magnifies the adverse effects of the otherwise useful compounds. Accordingly, benzodiazepines should be reserved for those severely ill patients who have not responded to psychological treatments or to safer medications. Constant vigilance is needed to ensure that a hidden proportion of patients does not misuse that medication or become dependent upon it. Some have major problems with withdrawal and take inordinate times to discontinue or sometimes remain permanently on unnecessary medication.

            This issue is only part of a covert encouragement to widespread over-prescribing which has engulfed opioid and antidepressant usage, as well as the longstanding overuse of benzodiazepines.

            I await more detailed claims.

March 14, 2019