Submission of written request regarding benzodiazepine type drugs
2015-10-28
On 28th October 2015, Medwatcher Japan submitted a written request, regarding benzodiazepine type drugs, to related corporations, the Ministry of Health, Labour and Welfare, the Ministry of Education, Culture, Sports, Science and Technology, and related academies.
Benzodiazepine type drugs exert the following actions: anxiolytic, hypnotic, myorelaxant, and anticonvulsant. Most of these drugs sold in Japan are used as anxiolytics and hypnotics.
Although benzodiazepine type drugs exert the above actions, within just a few weeks or months of regular use, even on therapeutic doses, tolerance develops, which can then lead to physiological and psychological dependence. The forming of physiological and psychological dependence can cause many problems including: memory impairment, cognitive dysfunction, confusion, hallucinations, paranoia / delusions, seizures, emotional detachment / depersonalization, motor sensory disturbances etc. Also, cases where these withdrawal symptoms become so severe that they impact significantly on people’s daily lives are not uncommon.
Considering the risks of tolerance and dependence, European countries and the United States have adopted controls; whereby it is basically recommended that these drugs are not be prescribed for any more than 2~4 weeks. However, in contrast to this, Japan has no such controls over the duration of continual prescribing, and there are many cases where benzodiazepines are co-prescribed in large amounts. Subsequently, it seems sufficient to say that Japan likely has the highest prescription number per unit of population in the world. It has also been pointed out that behind the current state of prescribing exists a general lack of awareness, regarding benzodiazepine type drugs and associated risks, on the part of medical workers in Japan including psychiatrists.
In recognition of this, our organization proposes to improve prescribing practices and the level of awareness shown by medical workers in Japan with regards to dependency on benzodiazepine type drugs and withdrawal symptoms. For this purpose, we have carried out investigations and inquiries while engaging in talks with psychiatrists and patients; leading to the following points being raised in this written request.
Matters per request:
1. Revision of package inserts to include:
1.1. Clearly listing the risks of dependency on therapeutic doses, withdrawal symptoms, and polypharmacy in the warning column.
1.2. Stating diazepam potency equivalents.
1.3. Placing limitations on duration of prescribing
2. Compiling, distributing and publicizing on the internet information for patients to maintain the right of informed consent.
3. Ensuring benzodiazepine type drug dependency is noted on dispensary forms.
4. Establishing and developing specialised benzodiazepine type drug dependency treatment facilities.
5. Providing training for all medical workers involved in the treatment of benzodiazepine type drug dependency.
6. Providing further educational training in all medical schools and pharmaceutical faculties regarding benzodiazepine type drug dependency.
NB: To patients currently on benzodiazepine type drugs and family members.
Regarding reduction and withdrawal, you will need to work closely with your physician, as caution must be exercised when making decisions. For this purpose, it is advisable to use The Ashton Manual referred to in this written request as a point of reference (http://www.benzo.org.uk/amisc/japan.pdf).
Contrary to intentions, it can be dangerous for patients to reduce, or withdrawal, using their own judgement; therefore, it is advisable to refrain from this.
Please be advised that our organization is unable to accommodate individual enquiries or assist with the introduction of treatment facilities.
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