Tranquilizers (Encyclopedia of Drugs and Addictive Substances)
- What Is It Made Of?
- A History of Valerian
- "Someone Must Have Slipped Him a Mickey"
- Mom's an Addict
- The Thalidomide Tragedy and the Woman Who Said "No"
- Treatment for Habitual Users
- The Law
What Kind of Drug Is It?
Tranquilizing drugs slow normal brain function. For that reason, they are often referred to as depressants. These kinds of drugs work by affecting the neurotransmitter gamma-aminobutyric acid (GABA). Neurotransmitters are brain chemicals that help brain cells communicate with one another by spreading nerve impulses from one nerve cell to another. The higher the level of GABA activity in the brain, the greater the calming effect produced. Tranquilizers are prescribed by doctors only and are usually dispensed as pills or capsules. Some types come in liquid or solution form.
Because tranquilizers slow down normal brain activity and produce a calming or drowsy effect, they are among the most common drugs prescribed to patients suffering from insomnia. Insomniacs are patients who either have trouble falling asleep or cannot fall asleep at all. Tranquilizers are also prescribed to patients diagnosed with anxiety, a type of mental disorder that causes extreme restlessness, uncontrollable feelings of fear, excessive worrying, and panic attacks. According to Jim Parker in Tranx: Minor Tranquilizers, Major Problems, about 70 million prescriptions for tranquilizers are written each year in the United States. Tranquilizers are also among the most commonly abused medications. In 2005, the National Center on Addiction and Substance Abuse (CASA) at Columbia University released a 214-page report titled "Under the Counter: The Diversion and Abuse of Controlled Prescription Drugs in the U.S." That report indicates that in 2003 nearly 6 million Americans abused prescription tranquilizers and sedatives.
In general, tranquilizers fall into two categories: major tranquilizers and minor tranquilizers. Major tranquilizers are drugs used to treat severe mental illnesses, such as schizophrenia and psychosis (sy-KOH-sis). A mental disease, schizophrenia causes patients to withdraw from reality and suffer other intellectual and emotional disturbances. Psychosis is a severe mental disorder that often causes hallucinations, or visions, and makes it difficult for people to distinguish what is real from what is imagined. Major
tranquilizers are more commonly called neuroleptics or antipsychotics. These drugs help decrease the symptoms of serious psychiatric disorders by targeting areas of the brain that deal with emotion. They are not typically abused by patients.
Minor tranquilizers, also known as sedative-hypnotic or anxiolytic drugs, are a group of medications that are prescribed to treat sleep and anxiety disorders. Although different sedative-hypnotic and anxiolytic drugs work in the brain in slightly different ways, they all produce a calming effect that is beneficial to patients who cannot sleep or who suffer from severe anxiety attacks. These drugs are among the most abused in the United States.
Minor tranquilizers can also be broken down into two main categories: barbiturates, which are used to treat anxiety, tension, and sleep disorders; and benzodiazepines (BZDs), which can be prescribed to treat anxiety, severe stress reactions, and panic attacks. Panic attacks are unexpected episodes of severe anxiety that can cause shortness of breath, dizziness, sweating, and shaking. (Entries on barbiturates and benzodiazepines are included in this encyclopedia.) The main difference between the two groups is that BZDs target specific receptors (groups of cells that receive stimuli) in the brain instead of affecting the entire brain. Therefore, BZDs do not produce many of the negative side effects associated with major tranquilizers or barbiturates, such as impaired judgment or breathing problems. Most tranquilizers and sleeping pills prescribed as of 2005 belonged to the BZD chemical group because of their higher safety ratings. The best-known examples of BZDs are Ativan, Halcion, Librium, Valium (VAL-eum), and Xanax (ZAN-ex).
In some form or another, tranquilizers have been around since ancient times. Virtually every culture discovered the sedative effects of certain herbs and plants growing in nature. (A separate entry on herbal drugs is available in this encyclopedia.) Through years of trial and error, these cultures were able to identify specific plants thathen prepared a particular wayould have a tranquilizing effect. By drying these plants or their roots and grinding them into food or mixing them with liquids, herbalists found that the substances could relieve stress, insomnia, and the symptoms of severe mental disorders in people who consumed them.
The first major tranquilizer was developed from Rauwolfia serpentina, also known as the Indian snakeroot. Rauwolfia is known for its ability to lower blood pressure. Used for many years in India for the treatment of serious mental illness, it was frequently referred to there as the "insanity herb." Most often, its roots were crushed and consumed in a tea. In 1943 an Indian physician named Rustom Jal Vakil (1911974) wrote about the plant's success in treating mental illness. It wasn't long before Western doctors began studying Rauwolfia, hoping that it could help patients with severe psychiatric disorders.
American doctor Robert Wallace Wilkins (1906003) of Boston University Medical School conducted extensive research on Rauwolfia serpentina after hearing about its use in India. In 1954, he showed that reserpine, an and the active ingredientThe chemical or substance in a compound known or believed to have a therapeutic, or healing, effect. in Rauwolfia, was successful in treating both high blood pressure and severe psychiatric disorders such as schizophrenia and other psychoses. Almost immediately the new drug (sold under the brand name Serpasil) became the most popular way to treat such disorders.
Wilkins' work inspired further research, which resulted in the development of other drugs used as major tranquilizers. With neuroleptic and antipsychotic drugs came the possibility that mentally ill patients would not have to spend their lives committed
to institutions and under a doctor's strict supervision. Instead, they could return to their homes and families as long as they followed prescribed drug therapy and other treatment.
Herbs such as valerian, kava, and lavender produce tranquilizing effects and have been used by various cultures for centuries. There were no alternatives to natural tranquilizers until the 1860s, when the first synthetic minor tranquilizer, bromide, was created. (Synthetic drugs are those created in a laboratory.) But the dangerous side effects it produced made it rather unpopular. The drug caused stomach problems and, if taken for a long time, proved toxic (harmful or poisonous). Bromides were replaced by barbiturates in 1903. Barbiturates are effective in reducing anxiety and causing drowsiness, but can very quickly become addictive or habit-forming. Amytal, Nembutal, and Seconal are all examples of barbiturates.
The danger with barbiturates is the high rate of death connected with overdose. An overdose of barbiturates affects the heart and the respiratory system, causing shortness of breath, extreme drowsiness, and an unusually slow heart rate. The user then slips into a and dies. Because of this, chemists knew they had to find an alternative to barbiturates drug that could ease anxiety without slowing breathing rates to dangerously low levels. The answer came with the discovery of benzodiazepines.
In 1954, Austrian scientist Dr. Leo Sternbach (1908005) discovered the first benzodiazepine while conducting research on chemical compounds for the New Jersey-based Hoffmann-La Roche drug company. He did not recognize the importance of his discovery until 1957, when he realized that one of his compounds would make a great tranquilizer. Known as RO 5-0690, the drug eventually became Librium. Sternbach also developed Valium in 1963. Over time, BZDs became popular drugs for the treatment of anxiety and sleep disorders.
What Is It Made Of?
Although all tranquilizers have the same general effects, they vary widely in chemical makeup. Most are synthetic, which means they are made in a lab from chemicals. Other tranquilizing drugs are found naturally in plants and have been used for centuries to cure such troubles as tremors, insomnia, and heart problems. An example of a natural tranquilizer is valerian, which is a plant that grows in mild climates. Other herbal supplements that are thought to decrease stress responses and improve sleep include kava, skullcap, chamomile, passion flower, lemon balm, and lavender.
How Is It Taken?
Most tranquilizers are taken by mouth in pill, capsule, or liquid form. If a pill or capsule is taken, doctors recommend drinking a full glass of water along with each dose. Since most pills or capsules are formulated to release the medication in the body slowly, it is important not to chew or break them. Concentrated liquid forms should be diluted, or mixed with another liquid, such as coffee, milk, tea, water, or fruit juice. Tranquilizers also can be injected into a vein or administered rectally in a . Illegal tranquilizers, like Rohypnol (roh-HIPP-nahl) or ketamine (KETT-uh-meen), are sometimes dissolved in drinks, snorted, or sprinkled on tobacco or marijuana and then smoked. (Entries on Rohypnol and ketamine are included in this encyclopedia.)
Are There Any Medical Reasons for Taking This Substance?
Major tranquilizers such as Clozapine, Haldol, or Thorazine are powerful drugs that are prescribed to relieve the symptoms of major psychiatric disorders such as schizophrenia. Some have been developed to treat the following: 1) dementia, a brain disorder that causes a reduction in a person's intellectual functioning, most often affecting memory, concentration, and decision-making skills; 2) autism, a psychological disorder, usually diagnosed in children, that affects emotional development, social interactions, and the ability to communicate effectively; 3) bipolar disorder, a psychological disorder that causes alternating periods of depression and extreme happiness; 4) Tourette's syndrome, a severe tic disorder that causes distress and significant disability to those affected by it; and 5) attention-deficit/hyperactivity disorder (ADHD), a condition characterized by impulsive behavior, difficulty concentrating, and hyperactivity that interferes with social and academic functioning. These drugs may also be used in individuals exhibiting signs of severe agitation, violence, hostility, or paranoid behavior. In rare cases, they have been used to ease severe pain.
There are a number of medical reasons why doctors prescribe tranquilizers. Because minor tranquilizers produce a calming or drowsy effect, the most common reasons are insomnia and anxiety disorders. Minor tranquilizers are also considered effective in treating anxiety in patients suffering from Alzheimer's disease, which is a brain disease that usually strikes older individuals and results in memory loss, impaired thinking, and personality changes. Minor tranquilizers are sometimes prescribed to help with alcohol and drug . Others help to prevent epileptic seizures, which are sudden violent spasms or convulsions resulting from epilepsy, a disorder involving the misfiring of electrical impulses in the brain. In some instances, certain types of barbiturates and BZDs have been used as an anesthetic to deaden pain in outpatient procedures. In some states, a form of barbiturate is used to execute criminals by lethal injection.
By the end of the twentieth century, usage trends for tranquilizers had shifted. In the 1980s, tranquilizers were used mainly to treat . In the 1990s, they were prescribed more often for anxiety and stress disorders. As diagnoses of anxiety and stress disorders
increased in the 1990s and early 2000s, so did the demand for tranquilizers. The 2005 CASA report states that prescriptions filled for benzodiazepines alone increased nearly 50 percent between 1992 and 2002. In addition, BZDs account for 20 percent of all prescriptions written for controlled substances in the United States. As the use of BZDs has increased, the demand for barbiturates has decreased dramatically.
Trends in the Use of Major Tranquilizers
According to Parker in Tranx: Minor Tranquilizers, Major Problems, "The major tranquilizers do not produce effects generally experienced as pleasurable, and are thus rarely abused." However, doctors are increasingly prescribing neuroleptics for children with severe cases of autism, ADHD, Tourette's syndrome, and childhood bipolar disorder. Moreover, neuroleptics are also commonly prescribed for elderly patients in nursing homes and other institutions, particularly those who have been diagnosed with Alzheimer's disease.
Trends in the Use of Minor Tranquilizers
The National Survey on Drug Use and Health (NSDUH) is conducted by the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA). This well-known survey obtains information on nine different categories of illicit drug use. One of these categories includes the nonmedical use of prescription-type pain relievers, tranquilizers, stimulantsA substance that increases the activity of a living organism or one of its parts., and sedatives. The NSDUH report refers to these drugs collectively as "any psychotherapeutics" (SY-koh-ther-uh-PYOO-tiks).
The latest NSDUH results available as of mid-2005 covered drug usage trends for the year 2003. NSDUH statistics showed that teenagers and young adults were increasingly turning to prescription drugs to get high. A large number of Americans became "new users" of psychotherapeutic drugs in 2003. Roughly 1.2 million people began using tranquilizers that year, and 225,000 began using sedatives. Among fifteen benzodiazepines, the nonmedical use of two specific drugslprazolam (Xanax) and lorazepam (Ativan)ose the most, from 3.5 percent to 4 percent of those surveyed in 2003. Usage among eighteen to twenty-five year olds was particularly high, increasing from 6.7 to 7.5 percent in 2003.
The results of the 2004 Monitoring the Future (MTF) study, conducted by the University of Michigan (U of M) and sponsored by research grants from the National Institute on Drug Abuse (NIDA), reveal similar findings. MTF data indicate that about 2.5 percent of eighth graders, 5.1 percent of tenth graders, and 7.3 percent of high school seniors reported using drugs such as Xanax between 2003 and 2004. Barbiturate use among twelfth-grade students held steady between 2003 and 2004.
According to the Drug Abuse Warning Network (DAWN), psychotherapeutic agents were "the drugs most frequently involved in overmedication" emergency room visits in the last six months of 2003. More females than males were hospitalized for overmedication cases, and young people age eighteen to twenty were involved in overdose visits more often than any other age group. These statistics were the latest available from DAWN as of mid-2005.
A 2001 NIDA Research Report titled "Prescription Drugs: Abuse and Addiction" indicates that, historically, females are twice as likely as males to become addicted to sedative-hypnotic-type drugs. Furthermore, women who have been abused or have witnessed abuse in their family are more likely to use and be addicted to tranquilizers, alcohol, and illegal drugs. In general, women of all ages, older individuals of both sexes, people with low levels of education, and people with unsatisfying family lives or jobs are most likely to abuse tranquilizing drugs.
Effects on the Body
Tranquilizers act on the brain by affecting the neurotransmitter known as GABA. Although different types of tranquilizers work in different ways, ultimately they all decrease brain activity by increasing GABA activity. This action produces a drowsy, calming effect that helps those suffering from anxiety or sleep disorders. Some tranquilizers are absorbed into the bloodstream very quickly, and others are timed to be released in slower amounts. For example, barbiturate classification is determined by how quickly the drugs start to work and how long the effects last. An ultrashort-acting barbiturate starts working in less than one minute. Long-acting barbiturates take effect in about one hour, and their effects can last for about twelve hours.
Effects on the body also differ depending on what kind of tranquilizer is ingested. Most tranquilizers produce a general calming feeling, a reduction in stress and anxiety, and sometimes a feeling of happiness. Other effects include slowed heart rate, reduced muscle spasms, pain relief, a decrease in convulsions, and even sedation.
Dangerous Side Effects
Depending on the dose, frequency, and duration of use, tolerance and dependence can occur rapidly among users of tranquilizers. Tolerance is a condition in which higher and higher doses of a drug are needed to produce the original effect or high experienced. Dependence occurs when a user has a physical or psychological need to take a certain substance in order to function. As tolerance develops, users may increase their doses to dangerous levels that can result in or death.
Other harmful side effects may develop if an individual uses tranquilizers for a long time period. At high doses, both major and minor tranquilizers may cause convulsions, slowed breathing, loss of speech, and kidney problems. Major tranquilizers can also cause confusion, agitation, heart and breathing problems, weight gain, lowered blood pressure, tremors, and muscle stiffening. In the long term, one of the most serious side effects of neuroleptics is tardive dyskinesia (TAR-div diss-kih-NEE-zhuh; TD). TD is a nerve disorder that causes involuntary tics and uncontrollable movements of the face, mouth, tongue, and limbs. It can also interfere with breathing if it affects the chest. The onset of TD usually begins between six months to two years after the use of neuroleptics starts. It occurs in about 20 percent of patients treated with these types of tranquilizers.
Another possible side effect of major tranquilizers is the development of a life-threatening disorder called neuroleptic malignant syndrome. Symptoms of neuroleptic malignant syndrome include a very high fever, sweating, rapid heart rate, high blood pressure, incontinenceThe loss of bladder and/or bowel control., stupor (profound drowsiness or lethargy), , extreme muscle rigidity, and coma. Once the syndrome is diagnosed in a patient, steps are taken to minimize the risk of brain damage. The neuroleptic drug is discontinued immediately, and efforts are made to reduce the fever as quickly as possible.
Minor tranquilizers can also have serious side effects, such as dizziness, irritability, confusion, and loss of memory. Some long-term users have also reported blurred and double vision, increased anxiety, insomnia, hallucinations, depression, agitation, and aggression. The ability to drive or operate machinery can be extremely impaired in people taking minor tranquilizers.
Other long-term effects have been harder to determine. Some researchers believe that prolonged use of minor tranquilizers affect overall brain function and may cause brain shrinkage. Because very few studies have measured these effects, there is little evidence to support such theories. It is generally agreed that taking a low dose over a long period of time has little impact on a user's brain and nervous system. However, if individuals begin to take these drugs at a higher dosage than prescribed or more frequently than recommended, they run the risk of developing serious health problems.
Reactions with Other Drugs or Substances
Tranquilizers can be used with other medications, but only under a doctor's supervision. A person should not use tranquilizers along with similar drugs that affect the brain and nervous system. These include drugs such as other tranquilizers, prescription pain medications, some over-the-counter cold and allergy medications, and alcohol. Even herbal remedies such as valerian may intensify the sedative effects of barbiturates, so these substances should not be taken together. Combining them can result in an overdose or a serious accident.
Treatment for Habitual Users
Tranquilizers are often abused. Even users who take them at a prescribed dose run the risk of developing an addiction after just six weeks of use. In general, the best way to treat an addiction to tranquilizers is to gradually reduce the dose of the drug under the supervision of a qualified physician. If an individual decides to just stop taking the drug, there can be serious physical consequences, such as seizures, psychosis, paranoia, heart palpitations, and depression. Inpatient or outpatient counseling is also recommended during the and withdrawal processes.
Doctors match the withdrawal process to the type of tranquilizer the patient is abusing. Patients who are taking high-dose BZDs follow a program that takes one of three approaches: 1) the dosage and amount of the abused drug is gradually decreased over time; 2) another BZD is substituted for the original tranquilizer abused, then the substitute BZD is gradually decreased over time; or 3) the barbiturate phenobarbital (Luminal) is substituted for the original tranquilizer abused and then the withdrawal process begins. The chosen method depends on the substance of abuse. Detoxification and the withdrawal process typically occur in a medical setting and require the patient to follow the doctor's orders exactly.
Minor tranquilizers can be effective for short periods of time. However, long-term use can result in the buildup of a tolerance to the drug. This means that the body adjusts to the prescribed dosage and the individual has to take more of the drug to achieve the same effect. Individuals who increase the dose they take are in danger of over-dosing on the drug, which can result in coma and possibly death.
Tranquilizer addiction can have a damaging impact on an individual's life. Marriages may break up; families may go bankrupt; jobs may be lost; and some addicted individuals may turn to criminal behavior to obtain the drugs they crave. Addicts may turn to other drugs to try to achieve the same effects they get from tranquilizers or to ease withdrawal symptoms from tranquilizer use.
Since the 1990s and early 2000s, there has been a great deal of research conducted on the consequences of overprescribing certain major tranquilizers, especially for elderly people living in nursing homes. This research suggests that an older person living in a nursing home receives four times as many prescription drugs as an older person living in his or her own home. Critics argue that drugging these patients may make life easier for caregivers, but it leaves the patients unresponsive and alienated from their surroundings. Rather than just using drugs, they suggest trying other therapies that may result in a better quality of life for the patient. Similar concerns have surfaced for children who suffer extreme cases of autism and ADHD and are heavily medicated with major tranquilizers.
Tranquilizers are legal drugs that are only available with a prescription from a licensed doctor. In the United States, they are classified as Schedule II, III, or IV controlled substances under the Controlled Substances Act (CSA) of 1970. However, it is not legal to manufacture, distribute, or sell these drugs without a proper license. A person who illegally distributes tranquilizers can face up to fifteen years in prison and fines of up to $25,000.
A few types of minor tranquilizers are so addictive that they have been outlawed. Doriden and Quaaludes are examples of drugs that were once legally prescribed but are now banned from the United States because they were so frequently abused. Rohypnol, known as a "date rape drug," is illegal in the United States as well, but legal in countries in Europe, Central America, and South America.
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See also: Alcohol; Barbiturates; Benzodiazepine; Herbal Drugs; Rohypnol