State lawmakers consider oversight on anxiety and sleeping medications


BOSTON (STATE HOUSE NEWS SERVICE) – Less than a month after the signing of a law aimed at preventing opioid addiction, legislators shifted focus Monday afternoon to another class of drugs as supporters of a bill to regulate benzodiazepines warned of the potential for a public health crisis.

Legislation filed by Rep. Paul McMurtry would require warnings be attached to the hypnotic drugs, which doctors testified at a hearing Monday can be a life-saving and effective treatment, but should be issued cautiously and only when appropriate.

“When prescribed properly and followed up and short-term and as [doctors’] expertise provides, that’s OK,” Rep. Carole Fiola, a member of the Joint Committee on Mental Health and Substance Abuse said during the hearing. “Just like opioids, that’s OK, but we see things got out of hand with opioids and we are at the beginning of believing that might be the case here.”

[Watch: Hearing Testimony]

Benzodiazepines, according to the National Institute of Health’s U.S. National Library of Medicine, are a class of hypnotic drug often used to treat insomnia and anxiety, though long-term daily use can lead to addiction in some patients, and withdrawal can cause serious symptoms and side effects. Brand-name benzodiazepines include Klonopin, Ativan and Xanax.

Under McMurtry’s bill (H 4062), the Department of Public Health would be charged with establishing protocols to help patients safely taper off and discontinue their use of benzodiazepines and nonbenzodiazepine hypnotics so that withdrawal is minimized.

After thanking the committee for its work on the opioid law, McMurtry described the situation around benzodiazepines as “another serious problem.” The Dedham Democrat said his bill, which has 47 co-sponsors, would also require benzodiazepine prescriptions to be written on brightly colored paper bearing a cautionary label, ban refills on prescriptions of less than a 10-day supply, and require patients to give written informed consent before a prescription is administered.

In tearful testimony that was recorded by a North Adams-based documentary crew, patients and relatives told emotional stories of lives upended by benzodiazepine withdrawal and urged support for the bill.

John Zielin, a licensed social worker from Andover, said his adult daughter was left confined to her room in “unending fear states,” with difficulty sleeping, thinking and holding conversations while withdrawing from Ativan. Three and a half years after she stopped taking the drug, she is “significantly healed” but still unable to work, he said.

“If indeed there is a place called hell…that is where my daughter lived for 24/7 during the early phase of this withdrawal,” Zielin said. “I’m not prone to exaggerating or using an image like that, but that is as close as I can come to describing the torture my daughter went through.”

Janet Kraft told the committee that it was a “three-year battle” for her body to recover after she stopped taking Xanax, including a period in which she could only sleep for half hour increments and experienced hypersensitivity to light, noise, heights and texture.

“While I have been able to regain some pieces of my life, like my job as a school counselor, most parts will never be put back in place and that I have to live with every day, so I beg you. I’m begging you,” she said. “Please, please. The doctors don’t know. There are so many of us. Please. I can’t press rewind, but you all can press stop.”

Testifying against the bill, Tufts Medical Center psychiatrist Dr. Edward Silberman said that the stories patients told Monday were unlike experiences he had in his practice.

“I’ve been in academic psychiatry my whole life,” he said. “Maybe I’ve been a little bit sheltered and people do things that I would be horrified to do, such as prescribing benzos or any other medications for vague reasons or insisting that a person stay on them who doesn’t feel well on them. That, I think would be, to coin a phrase, madness on the part of the treater, so I think the problem with legislation of this kind from my point of view is that it tars everything with the same brush.”

Silberman and other psychiatrists expressed concern that the regulations would dissuade doctors from prescribing the medications under appropriate circumstances when they could improve a patient’s life.

Dr. Jerrold Rosenbaum, the chief of psychiatry at Massachusetts General Hospital, said hypnotic drugs are typically not the first line of treatment and an estimated 15 percent of the population “periodically and safely use these medications to manage stress, peaks of anxiety, insomnia.”

Committee members said they viewed Monday’s hearing as the start of a discussion.

“We’re all trying to learn as we go through the investigation into what’s happening in the real world, for all of us, and the reason there is a committee on mental health and substance abuse issues is because we have found over time is that there are a lot of issues that have not been addressed through the legislative process in any fashion that’s comprehensive,” Rep. Liz Malia, the committee’s House chairwoman, said.

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