Xanax withdrawal isn't pretty

November 12, 2008 5:02 AM

"The agonizing final hours" of Sean Levert ("Put Your Body Where Your Mouth Is") of the R & B group, LeVert. Deprived of his Xanax, the R & B singer "shrieked delusionally for more than 24 hours before collapsing in the overcrowded jail."

The guy was in for failure to pay child support. The son of O'Jays star Eddie Levert, he had been prescribed three, 2 milligram pills three times a day. That's a lot of freaking Xanax.

posted by Faze (131 comments total)

Your link is borked.
posted by Pope Guilty at 5:07 AM on November 12, 2008

Here's a link that seems to work.
posted by Malor at 5:10 AM on November 12, 2008

"The Cuyahoga County prosecutor's office reviewed the case and found that no laws had been broken."

God damn it.
posted by flapjax at midnite at 5:15 AM on November 12, 2008

After an extensive review, I have just cleared myself of all wrongdoing. Now, kindly piss off.

I need to run this scenario by my friend the Police Apologist. It will be interesting to see how it translates into the dead guy's fault, or if it's simply an unavoidable and blameless situation. The possibilities are always exciting.
posted by adipocere at 5:19 AM on November 12, 2008 [9 favorites]

18 mg of Xanax per day? Holy crap! I couldn't begin to figure out who was to blame for this unnecessary event. The doctor for prescribing so much? The jail staff for knowing this yet not giving him his meds? Levert himself? The drug companies? Society?

Yeah, I'll blame society.
posted by not_on_display at 5:20 AM on November 12, 2008

On the streets in Philly they call those white 2mg Xanie bars "tombstones."
posted by The Straightener at 5:33 AM on November 12, 2008

Neglecting to give a prisoner his prescribed medication doesn't break any laws?
posted by DU at 5:36 AM on November 12, 2008 [6 favorites]

Police don't break any laws.
posted by CautionToTheWind at 5:40 AM on November 12, 2008 [6 favorites]

Police don't break any laws.

They only observe the laws accidently falling down the stairs after not being pushed.
posted by chillmost at 5:44 AM on November 12, 2008 [53 favorites]

Wow. That is just horrible. Even without assigning blame or assessing legality, this is one of the worst ways to die. Psychic pain can be much worse than physical pain—especially when it's hallucinatory like that.

Mind you, I'm not saying that there isn't a whole lotta blame (and lawsuits) to go around; I'm just sayin' that this is tragic regardless of how illegal/wrong this is finally judged to be.
posted by LMGM at 5:45 AM on November 12, 2008

We're not talking about police, we're talking about corrections officials.

Kenneth Keith Kallenbach of the Howard Stern Show died somewhat similarly in a local prison when he wasn't given treatment for his cystic fibrosis after being jailed on a DUI. You don't want to get locked up if you're sick or addicted, chances are you're going to kick cold turkey on a concrete floor with no medical relief or suffer with severe complications from lack of medical attention. Unless you have an advocate outside the prison who is aware of your condition and is pressing for you to be seen by a doctor, there's a good chance you won't be seen in any fair amount of time. As a social worker when my clients with mental health conditions got locked up we had to push pretty hard to make sure they got meds, and a lot of times the only reason they did is because one of the prison staff psychiatrists used to work for the agency so we tried to make sure all our guys went to her because we knew she was good. I mean, even if you see a nurse or a psychiatrist in prison your chances of seeing a decent nurse or psychiatrist who are basically a total crap shoot.

Though, it did look like the psychiatrist ordered a haldol/ativan shot which definitely would have knocked out the psychotic symptoms he was experiencing, if only temporarily, but the nurse failed to administer.
posted by The Straightener at 5:51 AM on November 12, 2008 [2 favorites]

This is me hopping on the "Holy crap, that's a lot of Xanax" train and blowing the whistle at grade crossings.

Cold turkey withdrawal from even 1 mg a day can be an ordeal I wouldn't wish on anyone. I can't even begin to imagine the shitfit one's brain would throw if it was expecting 18 mg a day and suddenly not getting it.

You don't fuck with the benzos. You can't. This cuts both ways: Giving someone that much Xanax on a regular basis feels just as irresponsible as arbitrarily cutting him off. You give that much Freakout-Go-Bye-Bye Juice to a fellow regularly, you're making promises to his brain that can't be broken.

Dear god.
posted by Spatch at 5:51 AM on November 12, 2008 [13 favorites]

Legal issues aside, I agree with not_on_display that the idea of psychoactive drugs being a useful means of coping with anxiety issues is an absurd societal norm.

I'm always troubled when people I know who are on antidepressants/mood stabilizers etc tell me "Well, I'd be crazy if I weren't on my pills." But, as was the case here, it seems the withdrawal is worse than never having taken the medication. A girl I knew in high school one day decided to willingly take herself off Effexor. She was nuts for a solid week but afterwards had become a new person, quite different from the shy, removed person she was prior. That instance has always stuck with me as evidence that willpower can overcome both psychiatry and psychology.
posted by auralcoral at 5:58 AM on November 12, 2008 [1 favorite]

So, auralcoral, you're saying that if someone tries hard enough, they can just stop being mentally ill? Want to make sure I'm reading you right.
posted by sugarfish at 6:07 AM on November 12, 2008 [44 favorites]

Where are people getting the 18mg number? As I read it, he's taking a 2mg pill three times a day. 6mg is still quite a bit, of course.
posted by allen.spaulding at 6:12 AM on November 12, 2008 [1 favorite]

That instance has always stuck with me as evidence that willpower can overcome both psychiatry and psychology.

This is one of the most inflammatory and poorly thought out statements I've ever read on MetaFilter, and I have read some seriously dumb shit here.
posted by solipsophistocracy at 6:13 AM on November 12, 2008 [51 favorites]

Very few can, sugarfish. My main point is that societal acceptance of psychiatric drugs seems outlandish to me considering withdrawal effects and success rates (not to mention the extreme nascence of the field). There are alternatives to these drugs.
posted by auralcoral at 6:14 AM on November 12, 2008

auralcoral, no matter what has happened since, I still think your work in Rain Man and Risky Business was top notch.
posted by Kwine at 6:16 AM on November 12, 2008 [33 favorites]

Allen, it's "three, 2 milligram pills three times a day": 3 pills in the morning, 3 mid-day, 3 at night. 9 pills @2mg each - 18mg.
posted by egypturnash at 6:17 AM on November 12, 2008

Sorry solipsophistocracy, maybe I don't have enough neurochemical knowledge to attack psychiatry but I think that much of what psychology deems "mentally ill" is just based on behaviors. It's not like mentally ill people are breaking out in rashes.
posted by auralcoral at 6:18 AM on November 12, 2008

Where are people getting the 18mg number? As I read it, he's taking a 2mg pill three times a day.

Oh! You're right. The OP says "...prescribed three, 2 milligram pills three times a day" but reading the article for content again, I see the same as you: Three 2mg pills each day. Looks like a slight error on the OP's part.

But still, yeah. That's a lotta Xanax, boss.
posted by Spatch at 6:19 AM on November 12, 2008

Touché, Kwine, but I'm not a scientologist. I just think "empirical evidence" for psychology is weak.
posted by auralcoral at 6:19 AM on November 12, 2008

This bites. Having seen first hand the effects of xanax deprivation on another person, this bites. For anyone. WTF, authorities?
posted by humannaire at 6:27 AM on November 12, 2008

Ok admittedly, I recognize that willpower alone can't combat chemical imbalances in the brain. It's ridiculous to think it could and I realize that I came off badly there. I just don't trust the research of and results that have come from these drugs and the companies that make them.
posted by auralcoral at 6:29 AM on November 12, 2008 [4 favorites]

We used to get this shit in the British prison system as well, especially with regard to drug treatment. A major class action lawsuit eventually put paid to that, and now British prisoners are entitled to the same standards of care as they'd get in the community, and community medical services are now the people who provide them.

The organisation I work for had a complaint a few weeks ago, from a guy who'd been given a very long tarriff and entered the system on 180mg of methadone. We got the complaint when he'd been ghosted out over night and moved to another prison where the service isn't quite so... reasonable, so he'd been cut from 180mg to 40mg (the ceiling dose at this prison) overnight.

A few quick calls to remind people this isn't how we do shit now, and he was back in his original prison being titrated back up to the higher dose by the following day.

And withdrawal from opioids isn't usually regarded as life threatening. They take benzo withdrawals *much* more seriously.

Remember folks, the punishment is the loss of liberty, not the denial of adequate medical care.
posted by PeterMcDermott at 6:30 AM on November 12, 2008 [9 favorites]

I just think "empirical evidence" for psychology is weak.

What does this even mean?

Do you mean empirical evidence of psychological influences and behaviour? In which case please introduce yourself to basic Pavlov and see where that takes you.

Or do you mean evidence of psychology as a science? In which case prepare yourself for Metafilter: The Reckoning because them's strong words.

In summary: what
posted by like_neon at 6:31 AM on November 12, 2008 [7 favorites]

auralcoral: http://www.ncbi.nlm.nih.gov/pubmed/1980980

I'm just saying...
posted by snarfodox at 6:34 AM on November 12, 2008 [6 favorites]

I really don't want to come across as a callous pull-yourself-up-by-your-mental-bootstraps asshole. That's not my intention here. I RECOGNIZE THAT MENTAL ILLNESS IS REAL. I just think that to be prescribed drugs produced by sketchy companies that make you fucking hallucinate when you don't take them is not a healthy solution.
posted by auralcoral at 6:38 AM on November 12, 2008 [2 favorites]

Ok, guy was $90,988.96 behind in child support. If he could pay, his bad. If not, putting him in jail wasn't going to help him get caught up in backpay.

Now he won't ever get caught up. His estate might.
posted by cjorgensen at 6:40 AM on November 12, 2008

Noted, and lol at me.
posted by auralcoral at 6:40 AM on November 12, 2008

Sorry solipsophistocracy, maybe I don't have enough neurochemical knowledge to attack psychiatry but I think that much of what psychology deems "mentally ill" is just based on behaviors.

Are you suggesting that behavior is not linked to the mind? Are you really?
posted by Pope Guilty at 6:41 AM on November 12, 2008

....No, Pope Guilty....
posted by auralcoral at 6:43 AM on November 12, 2008

I think, perhaps, what auralcoral is trying to say is that far too many people in the United States are prescribed psychotropic drugs to treat perceived anti-social behavior issues. I would strongly agree with this statement, and were I in a position to prescribe powerful, mind-altering drugs I would recommend as a first recourse a regimen of exercise, healthy eating, natural stress-reduction techniques and perhaps an overall change of scenery. However, I am not in such a position.

Pharmaceutical company representatives and the doctors who work for them are.

Please understand, I am in no way saying that there aren't individuals with significant disabilities who absolutely require some kind of drugging. But I think it happens far, far too often in this country and we do not fully understand its implications and consequences. Taking drugs every day of your life is generally a bad idea, no matter how you slice it.
posted by Baby_Balrog at 6:43 AM on November 12, 2008 [13 favorites]

I RECOGNIZE THAT MENTAL ILLNESS IS REAL. I just think that to be prescribed drugs produced by sketchy companies that make you fucking hallucinate when you don't take them is not a healthy solution.

It's pretty immediately obvious that you've never been on psychoactive meds and that you're either lying about knowing people who have or simply are so astoundingly lacking in empathy that you haven't a clue what it's like.
posted by Pope Guilty at 6:43 AM on November 12, 2008 [4 favorites]

Hey, everybody! Let's go out and dance in the shitstorm unleashed by auralcoral!

(It's cool, auralcoral. Everybody here does so love a nice shitstormy day, huh?)
posted by nosila at 6:43 AM on November 12, 2008

I knew this wouldn't go over well. SELF-EDIT MORE
posted by auralcoral at 6:44 AM on November 12, 2008

auralcoral: that's all well and good to say now, but doesn't do a damn thing for someone who's already hooked on the stuff and then forcibly deprived of it. What's the point in going off on your tangent like that when the post wasn't about it?
posted by Burhanistan at 6:45 AM on November 12, 2008

Auralcoral, they may not be breaking into rashes, but being mentally ill means that a rational part of your brain is broken, and this often follows with physical damage to the brain. Maybe you hear voices. Maybe your anxiety levels are such that you wash your hands thirty times a day until they crack and bleed. Maybe your identity is so poorly defined that you can't help but suffocate everyone you meet with a love/hate dynamic that leaves them thinking they're crazy. Maybe you sink into a funk of despair that causes your brain to degenerate, as depression does. To shrug and say 'hey, that's normal human behaviour!' is to display a dangerously broad sense of normal.

I'm sure you rage against the concept that weird needs to be treated, but believe me, this stuff isn't 'weird' in the sense of dungeons and dragons and kinky sex. This is weird in a way that's potentially fatal and causes great pain to the victim and their loved ones.
posted by Phalene at 6:45 AM on November 12, 2008 [13 favorites]

what Baby_Balrog said
posted by auralcoral at 6:46 AM on November 12, 2008

I am eternally amazed at the number of people without a shred of knowledge about psychology or psychopharmacology who feel completely qualified to discuss- and dismiss- both.
posted by Pope Guilty at 6:48 AM on November 12, 2008 [13 favorites]

Yes, to demonstrate that medications were efficacious (and determine their side effect profiles) we'd need some kind of randomized blinded trial where we measure psychiatric symptoms at baseline, administer one of several drugs or placebo, then observe the level of symptom at a later time. Then we'd need some way of testing whether or not the results were different from what we'd expect by chance. Even more difficult we'd need some way of assessing whether the risks outweighed the benefits. Later, we'd need a complex system of oversight of drug manufacture to make sure that people were getting the same thing that we tested. Finally, we'd need a legal setup where falsification of any of the steps along the chain resulted in criminal and civil liability.

This is pretty implausible sounding. Did you know that if you stop half-way through your z-pack (after you feel better) you can get WORSE then when you started? I think that this whole antibiotics thing is fake.
posted by a robot made out of meat at 6:50 AM on November 12, 2008 [18 favorites]

In my early 20s I was prescribed a raft of anti-depressants. About six months in, exhausted by regular anxiety attacks and a general feeling of disconnectedness I quit the lot absolutely cold. I can still describe the moment, walking into town with my heart pounding out of my chest looking down and seeing that I'd sweated through two shirts and an overcoat and thinking to myself 'you know what, fuck this'.

I'm not going to attempt to describe the following few weeks, so let's just say that they were very very bad and not something I'd advise anyone to do or wish on anyone. Cold turkey is probably the stupidest, most painful, and desperate way you can go about getting off medication and sheer bloody-mindedness is about your only ally. After a couple of weeks my head was clear and the anxiety attacks became far less frequent.

Since then, I've been med-free and largely on an even keel. I can't say that my moods don't bounce around from time to time because they do, but understanding the causes help me ride it out as best I can and I've learnt to contain it somewhat in polite society. Over the years I've also got pretty good at spotting early signs and sometimes pulling myself out of it. If you've been here, I'm sure you know what I mean even if I can't express it very well.

I only say this because auralcoral brought it up and it does have whack-job connotations. It's not going to work for everyone (and by everyone I mean hardly anyone). Completely not recommended. There are more civilized options and I heartily suggest people look to those instead.

So, finally:

.

because that's a shitty avoidable way for anyone to go.
posted by mandal at 6:57 AM on November 12, 2008 [6 favorites]

and yeah, sorry, I know: GMOFB.
posted by mandal at 6:58 AM on November 12, 2008

auralcoral, just stop answering every post. It won't get better.

Personally, I understood you and agree with you. And I have been on such drugs and quit cold turkey and have known people hospitalized for mental illness.

I am eternally amazed at the number of people without a shred of knowledge about psychology or psychopharmacology who feel completely qualified to discuss- and dismiss- both.

Your assumptions are quite possibly wrong about auralcoral.

On preview, mandal's situation is *exactly* like my own (except for the 2 t-shirts thing), as is the situation of my former roommate.
posted by Manhasset at 7:00 AM on November 12, 2008 [1 favorite]

Taking drugs every day of your life is generally a bad idea, no matter how you slice it.

Unless the consequences of not taking them is worse. Like in this case.
posted by PeterMcDermott at 7:01 AM on November 12, 2008 [9 favorites]

Your assumptions are quite possibly wrong about auralcoral.

I'd bet more money than I have that there's no more than a Psych 101 class in that resume.
posted by Pope Guilty at 7:04 AM on November 12, 2008

I heard the jury's still out on science.
posted by SpiffyRob at 7:05 AM on November 12, 2008

.
posted by schyler523 at 7:06 AM on November 12, 2008

While this may, hopefully, lead to people questioning the propriety of failing to do medical intake assessments on convicts for several weeks after their incarceration, the other question in this case will probably not be touched, which is, how in blue bloody hell does incarcerating someone enable them to pay overdue child support?
posted by Dreama at 7:15 AM on November 12, 2008

I am eternally amazed at the number of people without a shred of knowledge about psychology or psychopharmacology who feel completely qualified to discuss- and dismiss- both.

I am eternally amazed at the number of people without a shred of knowledge about psychology or psychopharmacology who feel completely qualified to discuss- and accept- both.

I'm a skeptic at heart - and this man was intentionally placed on a powerful drug that ultimately killed him by someone calling themselves a doctor. Unbelievable.

I'm sorry about your experiences, Pope Guilty, you sound like you have a lot of emotional capital invested in this fight. But accepting on blind faith the promises that the big pharmaceutical companies have made about their drugs - promises that they routinely break - is a dangerous idea. We are an overmedicated society.

I, too, am speaking from a personal place. But it is a place where I see those I love most convinced they can overcome their psychological hurdles with drugs. Or that their curious, energetic, completely interesting children need to be drugged. Handfuls of aderall, anti-depresents and I don't know what else every single day into people who don't need it. Who are avoiding really working on their problems, working on actualizing, working on communication barriers by taking pills that alter the way they feel. And the pharmaceutical companies absolutely love inventing diseases because it means that rather than working to find cures for the diseases that are killing us, they can make more happy pills for those of us who don't really need drugs in the first place.

It's a fucked up situation.

I'm not a doctor, I don't know if he needed that much Xanax, I don't know what would have happened if no one had ever prescribed it to him. Maybe he would have died. Apparently, according to his doctor, he needed that much of the drug in him.
But I do know one thing for damn sure - if he had never been prescribed those pills, he never would have died the way he did. And after reading that account, I don't give a damn how much any doctor tells me I need Xanax, you couldn't get one of those pills in me with a gun to my head.
posted by Baby_Balrog at 7:22 AM on November 12, 2008 [15 favorites]

People are so willfuly obtuse here. It's fairly clear what auralcoral was trying to articulate, which Baby_Balrog made more clear in his comment. And yet, people can't help but be pricks because that's what the Internet is good for.

Also, this story is fucked up. What is wrong with the police here?
posted by chunking express at 7:22 AM on November 12, 2008 [2 favorites]

auralcoral: That instance has always stuck with me as evidence that willpower can overcome both psychiatry and psychology.

I might also point out that willpower is an aspect of your mind, and as such, is just as susceptible to being corrupted or disabled by mental illness as the rest of it.
posted by Mitrovarr at 7:23 AM on November 12, 2008 [9 favorites]

I'm with Dreama. It's not like you can make a fortune stamping license plates.
posted by dabitch at 7:24 AM on November 12, 2008 [1 favorite]

Eh, I know pile-ons are so much fun for everybody, but howsabout trying t disagree with auralcoral civilly? Or maybe he's even right in some cases.
posted by orthogonality at 7:26 AM on November 12, 2008 [1 favorite]

If all y'all stomp auralcoral hard enough will it change the prison system? Jesus.

Anyhoo. Depression, bipolar disorder, schizophrenia - these are illnesses I've seen successfully treated by medication. With some of the newer meds, the difference is literally unbelievable - guys who used to stand at bus stops hissing and spitting at the voices in their heads seemingly becoming normal, not just pacified but balanced and happy (anecdotal evidence, no degree or specialization here).

On the other hand at some point I noticed any messageboard I frequented that had people in their teens and 20s would eventually get around to a discussion of meds and a frighteningly high percentage of people would turn out to be on meds for mild depression and anxiety. It's a bad, bad thing to put people on psych meds when what they really need to do is get their shit together. Sometimes a damn is better than a gramme.

On preview, what baby balrog said.
posted by fleetmouse at 7:37 AM on November 12, 2008 [1 favorite]

I just wanted to share how sad I am to read about Sean Levert - he had a beautiful singing voice. I read this and I feel pretty powerless.

Meanwhile, auralcoral (love the name, by the way), I get what you were trying to say as well. Thanks for expressing your opinion. Ditto to Phalene, Popeguilty and like_neon.

Dang, mental illness is a horrible, horrible thing, complicated both by its scope and misery, and in its possible solutions.
posted by anitanita at 7:37 AM on November 12, 2008 [1 favorite]

... this man was intentionally placed on a powerful drug that ultimately killed him by someone calling themselves a doctor. Unbelievable.

Here is the disconnect: the drug did not kill him. Not having the drug killed him. Not having the drug gave his brain the ability to do what it had desired for presumably a long time, and it killed him.

You know what? It sucks that some people need drugs to not die, or to not want to die every moment they are alive. It sucks and it's not fair. But it sucks that sometimes a person's pancreas stops working and that person has to be on drugs for the rest of their lives too. Diabetics are not weak-willed; they have a disease. Diabetes is not curable; it's treatable. Major depression and major mental illness is much the same. Of course we shouldn't be unnecessarily drugging "curious, energetic, completely interesting children"; where into that continuum does that man dying on the floor of a jail fit?

But I do know one thing for damn sure - if he had never been prescribed those pills, he never would have died the way he did.

No. You're right. There are other dire, hollowing ways to die, and many of them take years and years to finish. Perhaps we should have subjected him to one of those, or hey, maybe somebody could have just LET HIM TAKE HIS PRESCRIBED MEDICINE.
posted by penduluum at 7:42 AM on November 12, 2008 [7 favorites]

cuyahoga county? oh ohio, i thought you were done disappointing me.
posted by fuzzypantalones at 7:43 AM on November 12, 2008

howsabout trying t disagree with auralcoral civilly?

People need their daily dose of indignation.
posted by pracowity at 7:43 AM on November 12, 2008 [1 favorite]

You know what? I'm sorry. I know you're speaking from a place of compassion, Baby_Balrog and everybody else. I apologize.
posted by penduluum at 7:44 AM on November 12, 2008

That's not my intention here. I RECOGNIZE THAT MENTAL ILLNESS IS REAL. I just think that to be prescribed drugs produced by sketchy companies that make you fucking hallucinate when you don't take them is not a healthy solution.

What I've gleaned from various experiences is that prescribing drugs is very much a triage situation i.e. "yeah we know it sucks and it can ruinous to your long term health and has various ugly side effects, but otherwise you'll be running around completely crazy and unable to take care of yourself. If we give you drugs, we can at least get you to some level of basic functionality, however hellish that might be."

I'm currently reading Manic by Terri Cheney, which documents her struggles with being bipolar. It's riveting and terrifying and I'd recommend to anyone so they can better understand mania. But what really stands out to me is the opening of the book, where Cheney says that as hellish as being bipolar can be, the treatment of it is even worse.
posted by Brandon Blatcher at 7:45 AM on November 12, 2008

Anytime a discussion comes up that involves psychopharmacology, this dichotomy will always rise from the murky depths; the two-headed hydra of Big Pharmaceuticals and Tom Cruise.

Yes, it is true that pharmaceutical companies are a business, sometimes seemingly more concerned with turning a profit than healing people. And I've witness my sure of psychiatric flavor-of-the-month script writing. Hell, Prozac was practically sitting in piles in candy dishes in therapist offices in the early 90s.

But this doesn't mean that pharmaceuticals are evil, it doesn't mean that they don't help anyone, and it certainly doesn't mean that we can make blanket declarations about a pill.

Everyone needs to be looked at on a case-by-case basis. Of the ten friends I knew who were perscribed Prozac, two benefitted. But man, did they ever benefit. Some people actually need that medication, and it's grossly irresponsible to make claims from a distance about someone's need or lack thereof for medication.
posted by Marisa Stole the Precious Thing at 8:02 AM on November 12, 2008 [4 favorites]

Personal anecdote.

I was on the anti-med bandwagon for a long time... After hitting a peak of despair I did not know existed, and wasn't entirely sure where it came from, I was prescribed Wellbutrin for several months, believing it necessary based on family history and "diagnosis."

It was good to pick me up out of the pit I had fallen into... I went back to being a functional member of society, and I was staying in therapy to deal with issues. And I was happy for the first time in a long time.

Here's where the problem starts - There was no plan to get me off of it, it was just accepted as a "Keep doing this, forever" thing. In fact, I actually increased the dosage based on doctor recommendation, not realizing at the time that the negative effects I was having were actually side effects of the medication.

So after a while, I started to feel like a more tightly wound spring every day. I was acting very crazy at times, saying things that I would never say, and acting very manic - My wife (who wasn't even my Fiancee at the time) had to bear the brunt of it.

One of the things I was told about Wellbutrin by my Dr. was that if I didn't like how it made me feel, I could quit at any time, that it didn't need the same "step-down" that other medications did. This is a lie.

I quit cold-turkey. After about 2 days, I went completely nuts, bawling LOUDLY, talking nonsense. I don't even remember that much of it.

It took a long time for normal to set it, but once it did, I haven't looked back, as I've been happy, and it's felt more genuine. I do think that many of these medications are good tools, and I'm sure some people need them. Did I? Maybe at the time, I'll never know for sure. But I am very VERY skeptical about their prescription to the masses, and I do NOT trust the companies and doctors behind them. But at the same time, I'll always wonder if I would have had the willpower to pick myself out of that pit if I had never had anything at all.

Was it evil to completely quit the Xanax in this case? Absolutely. My withdrawal from a medicine that's generally been accepted as easy to cease was pretty awful... I can't even imagine how bad it would be for something that's stepped up and down as Xanax is.

Now, should anyone be on that much for the long term with no real solution? My guess is as a general rule, no.
posted by MysticMCJ at 8:04 AM on November 12, 2008 [1 favorite]

And yet, people can't help but be pricks because that's what the Internet is good for.

is there a drug they can take for that?
posted by pyramid termite at 8:05 AM on November 12, 2008

Mods - Can you fix the post so it correctly says he was taking 6 mg a day instead of 18? Thanks.
posted by lukemeister at 8:05 AM on November 12, 2008

What a surprise...another individual with mental illness swept under the carpet until it was too late. This just pisses me off.
posted by scarello at 8:06 AM on November 12, 2008

I'd bet more money than I have that there's no more than a Psych 101 class in that resume.

I like your style. You don't by chance happen to have any mortgage-backed securities for sale, do you?

I have nothing of value to add.
posted by Nonce at 8:07 AM on November 12, 2008

any messageboard I frequented that had people in their teens and 20s would eventually get around to a discussion of meds and a frighteningly high percentage of people would turn out to be on meds for mild depression and anxiety.

What used to be a last resort is now the first.
posted by pracowity at 8:11 AM on November 12, 2008

What I've gleaned from various experiences is that prescribing drugs is very much a triage situation.

In addition, most people tend *not* to be taking them for long periods unless they're getting some significant benefits from them. The cost, the inconvenience, the side effects and the stigma all mitigate against that.

Which, presumably is why some posters here, finding themselves in that situation, have said 'Fuck it, I'm not doing this any more. I'm gonna stop, cold.' My experience is that it's very rare to meet someone on meds long term who hasn't made numerous attempts to stop using them, either under clinical supervision or off their own bat. They tend to go back on the meds because their quality of life off is worse than it is on.

Which isn't to say that they should be a first line treatment, or that there shouldn't be a wide range of other, more benign forms of therapeutic help. It's simply to say that my experience is that people who are on any kind of psychic med long term is there because they're getting a benefit from that med that they've struggled to achieve without it. And I've no doubt that a lot of the stigma attached to these meds (and by extension to the people who use them) stops people from benefitting when they might otherwise get some respite from their condition.

That said, this is a general statement of principle. Giving someone huge quantities of benzos for an anxiety disorder (as was happening here) sounds almost clinically negligent to me (IANAD, etc but I do know its far from best practice.) But that doesn't make his treatment in hospital right. That was unquestionably negligent, IMO.
posted by PeterMcDermott at 8:11 AM on November 12, 2008 [2 favorites]

Jail. Not hospital, jail.
posted by PeterMcDermott at 8:13 AM on November 12, 2008

That article was hard to get through.

I lived with two roommates, one on Xanax for anxiety and one on Prozac for depression, and they both decided to quit cold turkey together. I would come home after work to find the two of them wrapped in blankets in the living room rocking back and forth on the couch, or sprawled on the floor staring at the ceiling, or manically cleaning the kitchen. The one on Xanax would go into a fit of rage, screaming and throwing things at the other one, for no apparent reason. This went on for about a week, then they both went back on their respective dosages and never talked about going off of them again. That week still stands out as "most horrible week" and it could have only been worse for them. These drugs can be a huge help to many people, as I've seen up close, but it's playing with fire if you are suddenly cut off from your dose (whether intentionally or unintentionally.)
posted by ahdeeda at 8:13 AM on November 12, 2008

The prevalence of doctor-issued benzodiazepines is really a scary one. It's only my anecdotal observations of others on these fuck-you-up pills, but they seem only a bit better than if the doctor told you that you could deal with your anxiety by starting your morning with a couple shots of vodka and continuing thusly throughout the day.

(Indeed, at a broad neuropharmacological level, they're both GABA-A agonists, though the specifics and other effects are different.)

Another scary one is Ambien (zolpidem) for insomnia.
posted by TheOnlyCoolTim at 8:16 AM on November 12, 2008

The idea that a person in a correctional facility is to be deprived of necessary care and medication is disquieting. Is that supposed to be part of the punishment or something?

It didn't occur to anyone at the jail that someone needing 18mg of Xanax is no joke? That such is not the equivalent of a dime bag or a bump? I refuse to believe the medical staff at the jail was that stupid. Capricious, perhaps, but not stupid, and someone or some process needs to be called onto the carpet here.
posted by droplet at 8:20 AM on November 12, 2008 [2 favorites]

The idea that a person in a correctional facility is to be deprived of necessary care and medication is disquieting. Is that supposed to be part of the punishment or something?

It didn't occur to anyone at the jail that someone needing 18mg of Xanax is no joke?

As I understood the article, it seemed "anxiety" doesn't warrant immediate medical attention.
posted by Marisa Stole the Precious Thing at 8:24 AM on November 12, 2008

At that stage, he wasn't suffering from "anxiety", he was suffering from withdrawal from a powerful drug. What a crock the whole thing is.
posted by tiny crocodile at 8:37 AM on November 12, 2008

Also saddening to read about his older brother, Gerald's, similar death less than 2 years earlier.
posted by kingbenny at 8:43 AM on November 12, 2008

What a shitty fucking way to die.
posted by Divine_Wino at 8:54 AM on November 12, 2008

I'm not even going to address the "taking medication for mental illness is bad because if you stop taking it you have withdrawal/bad things" argument here. I'm trying to limit my rage.

But as far as people going to jail who have mental illness, usually they do go off their meds in jail. Because meds cost money. If the local jail has a psychiatrist on call, you're lucky. At the jail I often visit to work with those with mental illness, the jail doctor (the lowest bidder) is an allergist and he's the one deciding who gets psychoactive meds and who doesn't and what they get. He takes everyone off their meds and if he puts them on anything he puts them on the cheapest drug he can find that might be related, regardless of effectiveness or side effects. It's lovely.

Point number two: Damn I hate Xanax. It's a dangerous, dangerous drug that many ignorant family doctors prescribe at the first sign of anxiety or depression and just keep increasing if the patient continues to complain. It's addictive as hell and withdrawal can be fatal. The psychiatrist I work with NEVER prescribes Xanax. Never. There are alternatives, but unfortunately doctors tend to give patients whatever they want, and trust me, a lot of people want Xanax. There really needs to be some education in the medical community about the dangers of Xanax. If anything, it should be a last resort for someone who responds to nothing else.
posted by threeturtles at 8:54 AM on November 12, 2008 [1 favorite]

I think auralcoral should be accused of poor wording before being too hastily grouped into the Tom Cruise crowd (but if he is, yes Top Gun was good too).

My own story sounds similar to mandal, except it was my entire teen years that were heavily prescribed on several medications at once. It wasn't "will power" that allowed me to live without it, but conscious, daily effort using multiple methods to counter the effects of a permanent illness. I have a close friend who is very prescribed, without which I am fairly certain she wouldn't be here. She will most likely remain medicated for the duration of her life and if that preserves her presence in my life, I am all for it. Life is hard. Answers are fleeting.

But this from the xanaz site: "More hopelessly, many of the descriptions resemble the emotional or psychiatric problem for which they originally started taking Xanax" sums up the conundrum of medication for mental illness for me. I am very thankful I have found methods that do not involve heavy prescriptions (tho herb is definitely part of my "plan").

I think the post brings up a more pressing issue of law enforcement in an utterly uncompassionate conservative era where people are being actually penalized with torture (involuntary withdrawal is just that) and death for minor crimes due to negligence and an attitude of "it ain't my problem". If we're going to allow such medicating for mental health, we should expect law enforcement to be so aware as to prevent this kind of negligence. But we do live in a society where police are not liable for actions that anyone else would be held responsible. This is criminal negligence defined. I expect no cops will suffer incrimination much less discipline. Man, need some self prescribed medicine myself about now... where's that digaman post...
posted by sarcasman at 9:13 AM on November 12, 2008 [1 favorite]

It's only my anecdotal observations of others on these fuck-you-up pills, but they seem only a bit better than if the doctor told you that you could deal with your anxiety by starting your morning with a couple shots of vodka and continuing thusly throughout the day.


Problem is, you can get withdrawal symptoms from that too.

Friend of mine has had horrible insomnia his entire life, complete with screaming-fit nightmares and sleepwalking. He's taken every treatment under the sun for it and the worst, the absolute worst ones who transition off where the benzos.

Shit is powerful and not to be taken lightly or ..taken away lightly. I can't imagine what kind of torture this guy was in.

on the lighter side, he was taking Ambien for a while but kept finding himself on the living room floor, cup in hand, with no memory of the previous 12 hours. Turns out, in a small % of people, drinking grapefruit juice with your Ambien (as was his custom) leads to passing out and retroactive amnesia. Do not, however, let your friends know this or they will keep pranking you ala Memento
posted by The Whelk at 9:14 AM on November 12, 2008 [1 favorite]

Baby_Balrog: were I in a position to prescribe powerful, mind-altering drugs I would recommend as a first recourse a regimen of exercise, healthy eating, natural stress-reduction techniques and perhaps an overall change of scenery. However, I am not in such a position.

I am in such a position (ok, not to prescribe but to refer to the doctor for him to prescribe). I often do try to refer people for therapy and give these kinds of suggestions to people asking for help. Guess what? Either they've already had this advice and it didn't work or they are totally unwilling or unable to take it. I am in the position of turning people away when they ask for mental health treatment every single day. It's the single most soul-numbing part of my job to have to look in someone's eyes who has gotten to possibly the lowest point of their life and tell them you can't do anything for them because compared to other people their problems just aren't bad enough.

The truth is that people want drugs. Whether it's prescribed medication or alcohol or street drugs or somebody else's prescription that you only take every so often, the vast majority of people use drugs to control their moods. That's just not going to stop anytime soon. I advocate people consulting a doctor before messing with their brain chemistry.
posted by threeturtles at 9:15 AM on November 12, 2008 [3 favorites]

Baby_Balrog: I'm a skeptic at heart - and this man was intentionally placed on a powerful drug that ultimately killed him by someone calling themselves a doctor. Unbelievable.

Well, no. Just no. Because this story involved Xanax, it seems that a lot of people are missing the point in order to engage in their own ill-informed axe-grinding. (And what does that say of you? You admit that you speak from a position of ignorance and bias but hold forth anyway?) It's not about psychiatric drugs, your relatives, kids in school or your own medical choices.

It's about the fact that people die in the correctional system because they don't get adequate medical care. It could have happened with insulin. It could have happened with anti-seizure medication. It could have happened because he caught a nasty case of Influenza. It could have happened because he didn't get wafarin. It could have happened because of an undiagnosed but lethal concussion during arrest.

He died because he did not get appropriate medical treatment while in the criminal corrections system. Everything else is just noise. Even if you disagree with his treatment protocol, which is none of your fucking business anyway, the corrections system was responsible for his health and well-being while he was in custody. The failure of the corrections system to exercise due diligence in meeting Levert's medical needs was a violation of his 5th amendment right to protection from cruel and unusual punishment.
posted by KirkJobSluder at 9:27 AM on November 12, 2008 [23 favorites]

Straightener: please note the nurse didn't want to give him the injection without more information on his medical background. That strikes me as a perfectly logical thing for a medical professional to want; in between starting the nurse's call to his mother and its completion, something broke in him.

He went in there with the pills he needed, it wouldn't have cost the jail anything to give them to him, and they didn't. And because they didn't, he went through withdrawl, hallucinations, unknown terrors, and died.

And yet... they looked at themselves and said 'we're fine'. I disagree.
posted by mephron at 9:38 AM on November 12, 2008 [2 favorites]

Even if you disagree with his treatment protocol, which is none of your fucking business anyway, the corrections system was responsible for his health and well-being while he was in custody.

the problem is the corrections system thought his treatment protocol was none of their fucking business either
posted by pyramid termite at 9:49 AM on November 12, 2008

Baby_Balrog: Taking drugs every day of your life is generally a bad idea, no matter how you slice it.

Please, such dogmatic black/white statements do nothing for this kind of discussion. People I love would have suffered miserable and painful deaths already without a daily pill or shot. It is interesting how this discussion only comes up with psychiatric medications and not medication for heart disease, heart implants, diabetes, or chronic lung disease.
posted by KirkJobSluder at 9:50 AM on November 12, 2008 [9 favorites]

pyramid termite: the problem is the corrections system thought his treatment protocol was none of their fucking business either

The supreme court dictated over a generation ago that corrections systems are obligated to provide a basic level of health care. It doesn't matter what the corrections system thought, it failed in its court-ordered mandate.
posted by KirkJobSluder at 9:57 AM on November 12, 2008

Brain meds:
• Some people need 'em and get 'em and they help, either just to get through a crisis or for the rest of their lives, depending on what's wrong.
• Some people need 'em and don't get 'em; whether they're afraid of the effects, can't afford 'em, or are denied prescriptions based on bad decision-making from docs.
• Some people don't need 'em and and somehow end up on 'em, anyway, thinking it'll solve problems that should be solved some other way, convinced by ads or addled docs.
• Some people give 'em to other people who don't need 'em and neuter their brains because they're scared, frustrated, or angry when people don't act the way they expect or demand.
• Some people don't need 'em and do 'em recreationally because they are idiots.

I think that covers most of the bases. Our healthcare and medication policies, understanding, and treatment are deficient, overall, and the variety of scenarios is a damning testimony.

Anyway. Whichever situation you were in, Mr. Levert, thanks for the songs before it all went to hell.

.
posted by batmonkey at 10:00 AM on November 12, 2008

Whoops, 8th amendment, not 5th.
posted by KirkJobSluder at 10:01 AM on November 12, 2008

believe me, this stuff isn't 'weird' in the sense of dungeons and dragons and kinky sex

Now hold on, do you mean that conjunctively or disjunctively?

Cause, I mean, Dungeon Master... you work it out.
posted by Durn Bronzefist at 10:02 AM on November 12, 2008

"two weeks to have new inmates medically evaluated"

This is unbelievable. Diabetes, asthma, heart trouble?
Yeah, we'll get around to checking that out in a couple of weeks, now shut up and sleep on the floor.
posted by 2sheets at 10:39 AM on November 12, 2008

The treatment of people in our Justice system is abhorrent. Just because one has been accused of a crime, or in this case a civil penalty, does not mean that one has lost all civil liberties and rights.

That they can say "no laws were broken" is unbelievable. That a man can die strapped to a chair because people refused to give him his prescribed medication SHOULD be criminal. That it isn't only proves that the system is broken.

Leave the argument about the pyschoactives out of the equation. It doesn't matter *what* the drugs were for, what matters is that the drugs were prescribed, he brought them with him, and the system unilaterally REFUSED to give him his medication. They watched him die, rather than open a fucking pill bottle.

This would be like letting a diabetic die while playing catch with the insulin bottle. There is no, absolutely no excuse for this. That it isn't criminal is absurd. That we, and I mean WE, the American people who continue to fund this travesty of a justice system, closing our eyes and pretending that if we ignore it maybe it'll somehow magically get better, that WE allow this behavior on the part of corrections facility workers is a travesty.

Every single one of you that is outraged needs to find out what happens in the jail cells of your own city. Start lobbying to change it. Wanna do something to help the justice system? Work for decriminalization of soft drugs. Save prisons for real criminals, and clean the system that deals with suspects and misdemeanor offenses up.

It's your system folks. We pay for it. We elect those that run it. We can put pressure on the city councils to change it. Let Levert be a reminder that without us, this shit happens every day, only you don't hear about the non-famous folks lying dead in restraints.

This is an outrage. Take that energy you want to use arguing about the merits, or lack thereof, of psychotropic medications, and instead channel it into anger about a system that lets this sort of thing happen. Do something to stop it from happening in your backyard.
posted by dejah420 at 10:53 AM on November 12, 2008 [7 favorites]

That instance has always stuck with me as evidence that willpower can overcome both psychiatry and psychology.

This is one of the most inflammatory and poorly thought out statements I've ever read on MetaFilter, and I have read some seriously dumb shit here.

My experience is that, much like conservative Republicans politicians denouncing homosexuality, the only reason people go out of their way to make outrageous statements on this topic is that they're projecting their own issues on everyone else.

Fortunately these people are seldom in positions of power, so they can be safely left alone to work out their own problems.
posted by tkolar at 11:23 AM on November 12, 2008 [1 favorite]

Oh, and on the main topic of this thread: I'm usually one to give the benefit of the doubt to everyone involved until I see some hard evidence, but in this case it seems like a pretty clear cut case of negligence on the part of the corrections department.

Oh and also: A typical dosage of Xanax for Panic Disorder is 6mg. If the guy was up to 18mg on doctor's orders, there's a serious malpractice suit waiting to happen.
posted by tkolar at 11:29 AM on November 12, 2008

Can someone please explain the actual biological process that leads from Xanax withdrawal to death?

Another scary one is Ambien (zolpidem) for insomnia.

If you don't mind, I'd be interested to hear why you think this as well.
posted by Civil_Disobedient at 11:49 AM on November 12, 2008

Man, fuck the man.

I speak not only out of sympathy for the deceased, and the horrible, inexcusable way in which he died but also partially from personal experience.

I had chosen a sentence of 9 days in jail earlier this year, but only after (as full as possible) arrangements could be made for my Type 1 Diabetes, Chronic insomnia and allergies. I require quite a bit of medication just to stay alive. After multiple discussions with the facilities nurses, doctors notes being faxed back and forth to confirm my illness, and a cooler full of medications i went in to serve my sentence.

Booking took 10 hours, i missed two insulin shots. By the time i was finally placed into my cell it was past dinner, and i had to plead with the guard for a good hour, until i was flushed and sweaty from high blood sugar to go see the nurse. Though my blood sugar was treated that night, i was told that i'd probably need to suffer again the next day as regular scheduled medications do require seeing the doctor, getting his approval before they go into effect.

So that night, i lay awake wheezing and coughing. I was not given my claratin or temazepam (a benzodiazepine) to sleep.

The next morning i was bitter, but still managed to explain my situation to everyone that would listen, and was denied the claratin and temazepam again -- had i known that this part of the system was so broken, i would have gotten a loan to pay the fine instead of opting to do the time.

I'm not surprised by this story, but still angered. By the time i left, my blood sugars were so constantly high (and i never did get to see the doctor), and i was suffering both from allergies and benzodiazepine withdrawal to such a terrible extent that i had to go to urgent care immediately to make sure i was eased back into things properly.

NAMI needs to do more than issue a statement regarding this. Maybe i should, too.
posted by phylum sinter at 11:50 AM on November 12, 2008 [8 favorites]

mephron: in between starting the nurse's call to his mother and its completion, something broke in him.

Oh yes, the phone call. As he was dying alone/terrified, his mother was being informed:

"Your son is fine. He's not in any danger of hurting himself or anybody else. Yes, we have him restrained right now because he lost his cool in that cell quite a bit. He just went a little wild. We can't allow him to hurt himself, but he's safe right now and we'll be watching him very closely tonight."


I can't imagine her sorrow when they called her back.

.
posted by asspetunia at 11:50 AM on November 12, 2008

From the article: "Cuyahoga County Coroner Frank Miller ruled that Levert died of complications of sarcoidosis, high blood pressure, heart disease, diabetes and withdrawal from Xanax. Miller said withdrawal from Xanax is severe and can cause biological symptoms as well as panic, anxiety, emotional instability and hallucinations."

It's not really clear to me that being deprived of Xanax was why Levert died, although it's implied that's why he was panicking and hallucinating. I'm not saying I believe Levert's jailers are necessarily blameless, but perhaps it's why the internal investigation eventually decided that no one could be punished for his death. He wasn't solely mentally ill, he was physically deteriorating as well. It's unclear from the article whether he was being medicated for the other conditions.

This is a tragedy but I find myself pitying his caretakers as well. They were overtaxed and out of their element. My guess is that it's very hard to get funding to better the conditions of a correctional facility in any way, because the general attitude is that anyone who is incarcerated deserves whatever bad fate befalls him. I know that when my younger, more cynical self heard about the "Books for Prisoners" program, I couldn't figure out why anyone would want to waste perfectly good books on criminals while "real" libraries went begging. And it's well-known that the public turns their back on the crime of prison rape, thinking of rape as a sort of bonus round of punishment meted out to The Bad Guys by peers.

It should be the policy of any detention facility, in a just country, to simply verify a prescription already in the detainee's possession with the prescribing physician, then give it to the detainee at the interval on the label. My pharmacy prints my doctor's name, and my dosage, on every vial they give me. This seems like this death could have been averted with a single phone call--and not a call to Levert's mother that was made only after six days of withdrawal.
posted by cirocco at 11:52 AM on November 12, 2008

cirocco: Yes. Contrary to popular belief, there really isn't such a thing as "easy time" from a medical standpoint. I did some design work for a criminal justice course and was shocked at the rather frank assessment of the health of people who spend considerable time in the criminal justice system. A 5-10 year sentence doesn't look so nice when you factor in the extremely high risks of hepatitis, HIV, heart disease and diabetes. It's not as bad as the old workhouses, but we really need to consider that a prison sentence statistically shaves years off of one's life span.
posted by KirkJobSluder at 12:39 PM on November 12, 2008

he had been prescribed three, 2 milligram pills three times a day

Whoever prescribed him that much of any benzo is more than irresponsible, they're a total quack. There's no way there's any medical need for that much. Even extreme agoraphobics aren't prescribed anywhere near that much. 1-2mg is enough to get me high, and I'm 6'3"/220. 18mg would probably put me in a coma.

A similar thing happened to Andy Partridge of XTC: a quack doctor had been prescribing him ridiculous amounts of valium for years, and one day his wife decided it was time for him to quit and flushed his whole supply. He went into severe, screaming-fit withdrawl and had to cancel the band's tour, and they never played live again after that.
posted by DecemberBoy at 1:07 PM on November 12, 2008

The over-prescription is disasterous, yes: jail, however, isn't the best place to go through withdrawal.

As to the 'meds/healthy living' argument: I've just started anti-depressants, in my mid-40's. Only been on them about three months: a mild dose (the minimum).

There's a fair amount of crazy in the family tree: my grandmother committed suicide when I was 13; my great-uncle, her brother, murdered his wife and killed himself; his son's been hospitalized for depression numerous times; two second cousins have been in and out of hospital for most of their lives, with symptoms ranging from psychosis to 9th-circle-of-Dante's-Hell misery; one of my three cousins spends her time randomly phoning members of the family and delivering death threats; the 'healthy' member of that family tried to burn my parents' house down a few years ago; the third is aggressive, volatile and is on husband #4. Oh, and my father hoards--crap to the ceiling in every room -- and I suspect he's depressed, but he'd never take anything.

This count doesn't include the 'normal' problems, ranging from alcoholism to mood disorders, that the 'normal' members of the family have.

Now, there are two ways to deal with this genetic inheritance: die immediately as soon as you become conscious of it, or live with it. Choosing to live with it means doing so in the certain knowledge that there may come a time when the huge black rocs of rage and misery will come streaming out of the sky, and there won't be a freakin' thing that you can do about it except fight back, which is pretty tough when the huge black rocs are actually part of your brain.

I think meds make living with it easier.

Like I say, I've done the positive thinking, therapy, healthy living route many a time and oft: this time was bad (fetal with guilt, convulsive sobbing, utter lack of interest in universe, contempation of suicide for first time ever) and got me on medications for the first time ever.

It's a freaking revelation.

This is how normal people feel? Every day?

Yes, a major pharma company probably owes a bit of my soul, but you know, I'm not sure it isn't worth it...
posted by jrochest at 1:52 PM on November 12, 2008 [4 favorites]

If you don't mind, I'd be interested to hear why you think this as well.

It causes blackout, sleepwalking, and "complex behavior" - example below - rarely, but I don't think rarely enough.

"In a series of 1972 insomniac patients in Switzerland, the adverse effects of anterograde amnesia/somnambulism that were observed in 1.1% of those using zolpidem (Ganzoni et al., 1995). Our data of 5.1% (13 out of 255) incidence of the adverse effects was more than the above mentioned report."

Jui-Hsiu Tsai, Pinchen Yang, Cheng-Chung Chen, Weilum Chung, Tze-Chun Tang, Shing-Yaw Wang, Jong-Kang Liu, Zolpidem-induced amnesia and somnambulism: Rare occurrences?, European Neuropsychopharmacology In Press, Corrected Proof, , Available online 25 September 2008.

This was in Taiwan - saw some speculation about the 5% vs. 1% in Switzerland being due to genetic differences. Those were the two attempts to quantify the problem that I found, everything else was just case reports that are variously amusing and scary:

"The man reported taking 10 mg of zolpidem at bedtime. He was then witnessed by his son to leave his house, enter and start his truck, and subsequently back into a tree. This caused a large scrape on the back of his truck, although there were no injuries to the patient. He then drove back into his driveway where the vehicle had been parked originally and went back inside. He went back into his bedroom, had trouble opening the door, kicked down the door to his bedroom, and went back to sleep. On awakening the following day, he felt disoriented and had no recollection of the previous night's events. He drove to work and although later had no recollection of driving to work, he still felt somewhat confused. The patient reports having had an episode more than 1 year ago when he took 30 mg of zolpidem and on the following day totaled his sport utility vehicle after falling asleep at the wheel."

John A. Doane, Anthony S. Dalpiaz, Zolpidem-induced Sleep-driving, The American Journal of MedicineVolume 121, Issue 11, , November 2008, Page e5.

Anecdotally there also seems to be a tendency for people to wake up in the middle of the night after taking it, take more to go back to sleep, and repeat, or wake up and chow down on ten pills, then get amnestic about it and finally in the morning wake up and only find out about this when they see their pills are gone. Luckily it's hard to OD on...
posted by TheOnlyCoolTim at 2:01 PM on November 12, 2008 [2 favorites]

auralcoral: Legal issues aside, I agree with not_on_display that the idea of psychoactive drugs being a useful means of coping with anxiety issues is an absurd societal norm.

Personally, I love a small amount of lorazepam now and again; it hits the spot for me if I'm in a temporarily jaw-clenching situation.

But if you depend on benzos to get through your day, every day, it's a sign that you have bigger, more longterm, and more overarching problems than a mere pill (or at least that particular one) can solve, and that you should go through some sort of psychological counseling, spiritual cleansing, fill-in-the-blank, ctrl-alt-del.

I say, "Blame Society" because the people surrounding him, his friends, jailors, doctor, just had no clue at all how and why this can fuck someone up, both over time and in particular situations. And that we as a nation of overindulgers have no idea that we are a nation of overindulgers.
posted by not_on_display at 2:02 PM on November 12, 2008 [1 favorite]

I thought I was terribly pissed off after reading the first link.

Then I started reading the thread.
posted by captainsohler at 2:13 PM on November 12, 2008 [1 favorite]

Can someone please explain the actual biological process that leads from Xanax withdrawal to death?

It sounds as though benzo withdrawal was a single factor in a multifactoral incident. However, people are focusing on the paranoia, the psychosis and the anxiety and nobody has mentioned the convulsions and grand mal seizures.

The cases presented above involved people taking normal therapeutic doses. The guy in this story was taking three times the maximum therapeutic dose. Combine abrupt withdrawal from that with a man who also suffers from sarcoidosis, high blood pressure, heart disease and diabetes, and you've got a disaster just waiting to happen.
posted by PeterMcDermott at 2:24 PM on November 12, 2008 [1 favorite]

not_on_display: But if you depend on benzos to get through your day, every day, it's a sign that you have bigger, more longterm, and more overarching problems than a mere pill (or at least that particular one) can solve, and that you should go through some sort of psychological counseling, spiritual cleansing, fill-in-the-blank, ctrl-alt-del.

*sigh* I've posted this before. But much of the confusion around this is due to an unfortunate twist of linguistics in that, rather than following the convention of using Greek terms for medical disorders and symptoms, we have "anxiety disorder" and "depression." Which causes no end of confusion when people think that "depression" is the same thing as getting the blues, or "anxiety disorder" is the same thing as your usual daily stress and strain. We don't have this confusion around schizophrenia for example. While we may joke about hearing voices, we certainly don't think that the disordered mental torture they experience is the same thing as our nagging internal monologues.

Personally, I'm sick of the armchair quarterbacking around this issue. And this is the only issue on which it happens. No one gives a flying fuck about kidney cancer, gall stones, or root canals. But on this one issue, which has involved complex and emotionally-loaded decisions made in collaboration with multiple specialists and trying multiple therapies before finding one that lets me live a mostly normal life, everyone seems to feel qualified in putting in their two bits.
posted by KirkJobSluder at 2:47 PM on November 12, 2008 [1 favorite]

Taking drugs every day of your life is generally a bad idea, no matter how you slice it.

I shall pass this information on to my friends who have type-1 diabetes. I am sure they will be interested to hear it.
posted by phearlez at 3:04 PM on November 12, 2008 [4 favorites]

• Some people don't need 'em and do 'em recreationally because they are idiots.

• And some people don't need 'em and do 'em discretionally because they are intelligent and genuinely interested in something you don't understand.

You forgot that one.
posted by humannaire at 4:06 PM on November 12, 2008 [3 favorites]

Yes, to demonstrate that medications were efficacious (and determine their side effect profiles) we'd need some kind of randomized blinded trial where we measure psychiatric symptoms at baseline, administer one of several drugs or placebo, then observe the level of symptom at a later time.

Yes, that's exactly what we should do.

This story is terrible. As many above me have stated, no body should be denied medical care just because they are in jail.
posted by markr at 4:21 PM on November 12, 2008

Ok, this could be malpractice-- or it could be a case of simple tolerance. Tolerance means you need more of a drug to get the same effect. The guy might have been doing well on that high dose (probably not-- given the situation he got himself into, but theoretically). So the doctor could have been monitoring him and his body chemistry required that high a dose to be effective.

There is lots of research showing that benzo withdrawal can kill. Therefore, the prison is probably going to lose a serious lawsuit here-- and should do.

If drugs experts-- like me, and Peter and some others here-- know that benzo withdrawal can kill, all docs and nurses should know. It's an outrage.
posted by Maias at 4:58 PM on November 12, 2008

If drugs experts-- like me, and Peter and some others here-- know that benzo withdrawal can kill, all docs and nurses should know.

Withdrawal from any physically addicting substance can kill under the right (wrong) circumstances if one is consuming a large enough daily dose. Alcohol and benzos are the most likely to, though.

Ok, this could be malpractice-- or it could be a case of simple tolerance.

If one's tolerance has become that enormous, the responsible thing for the doctor to do would be to wean the person off them, or at least down to a lower dose. Just prescribing bigger and bigger doses is malpractice.
posted by DecemberBoy at 5:05 PM on November 12, 2008

At what age?
posted by ginky at 5:08 PM on November 12, 2008

At what age?:

Fate Riske, 3, of Fond du Lac, Wis., takes two antipsychotics and a sleeping medicine to control what her mother, Elizabeth Klein-Riske, said were hours-long tantrums, a desire to watch the same movies repeatedly and an insistence on eating the meat, cheese and bread in her sandwiches separately.

FUCK. Unfit mother, our foster care and so on is shitty as hell but in this case it really might have been better to take the kid away.

Still, most of the parents interviewed for this article said their children’s behavior deteriorated rapidly without medication.

Yeah, you fucking addict them to powerful psychoactives and then when they have a withdrawal it's proof that the drugs are the solution. FUCK FUCK FUCK. For fucking three year olds that don't want to eat how mommy says?

These kids are FUCKED. Shit.
posted by TheOnlyCoolTim at 7:28 PM on November 12, 2008 [5 favorites]

Interesting article from the other side of the coin, talking about the experience of practicing in prison and some of the legal issues doctors grapple with.
posted by The Straightener at 7:44 PM on November 12, 2008

It's been said already, but needs to be said again: the lack of adequate medical care in correctional facilities (among other fucked up conditions) is a crime. This is a sad, sad story. But I won't be quick to judge the particular individuals working at that particular jail. Let's , first and foremost, make sure we keep criminal justice reform high on our social change agenda.

As to the role of psychiatric meds in our society. . . (*sigh*). Clearly this is an important issue that deserves careful scrutiny. We certainly have reason to mistrust the pharmaceutical industry. But, as has been said before, blanket statements denying the therapeutic value of psych meds get us us nowhere. That they are effective, even life-saving, for some individuals is well-documented. So my advice to you, if you have concerns about your mental health: work with qualified professionals that you trust. As a general rule, don't take this to your M.D. Go to a specialist. And hold out for someone that you feel good about. What I really recommend, is to work with a talk therapist first, and explore the issue. Same advice as above. Shop around until you find a therapist that you trust. After exploring the issue with your therapist, if you want to try psych meds, your therapist can refer you to a specialist. If you don't have health insurance, your ability to shop around is limited, but there are public clinics where you can get treatment on a sliding scale. Universities that train mental health professionals generally have clinics where you can get therapy from trainees at a greatly reduced cost. Still, do what you can to follow the advice above, and work the system till you're connected with someone you trust. Psychiatric services (meds) are generally also available at these clinics. If you're a parent seeking treatment for your child, same advice.

If a friend or family member is getting mental health treatment, educate yourself before making judgments. The quickest way to piss off a loved one, or really damage the relationship, is to make uneducated judgments about their mental health needs and treatments. The simple fact is: some people need psychiatric meds. For some, it's a matter of life and death. Or really terrible suffering.
posted by flotson at 8:47 PM on November 12, 2008

Fate Riske, 3, of Fond du Lac, Wis., takes two antipsychotics and a sleeping medicine to control what her mother, Elizabeth Klein-Riske, said were hours-long tantrums, a desire to watch the same movies repeatedly and an insistence on eating the meat, cheese and bread in her sandwiches separately.

i suggest this girl be tested for autism - and no, pills aren't going to work with that
posted by pyramid termite at 8:50 PM on November 12, 2008

i suggest this girl be tested for autism - and no, pills aren't going to work with that

I suggest that the child is three and acting like... a three year old. The idea that prolonged tantrums, repetitive movie watching and finicky eating is mental illness in a toddler is the most incredibly fucked up thing I've seen in... ever, perhaps.
posted by Dreama at 9:24 PM on November 12, 2008 [3 favorites]

Taking drugs every day of your life is generally a bad idea, no matter how you slice it.

I shall pass this information on to my friends who have type-1 diabetes. I am sure they will be interested to hear it.

Don't forget type 2s. I think I'll stick to taking insulin and avoid going blind, kidney failure, stroke, amputation, liver failure, etc.
posted by deborah at 9:53 PM on November 12, 2008

Ok, this could be malpractice-- or it could be a case of simple tolerance.

It could also be a case of a wealthy asshole celebrity who is able to find and pay doctors to write for whatever the fuck they like.

Interesting article from the other side of the coin

I'm not unsympathetic to the challenges of practicing medicine in the prison system. Here in the UK, a large proportion of your intake will have drug problems, which means that many may be on all manner of weird and inappropriate medications prescribed from dreadful pill-mill type practitioners.

Which is all the more reason to ensure that they get appropriate care and treatment within 24 hours of intake -- rather than withholding all treatment for a week because the state is too stingy to pay for more than a single clinical session, once a week.
posted by PeterMcDermott at 11:35 PM on November 12, 2008

The way we think about torture of captive enemy soldiers now (more-or-less), is how we should be thinking about jail. It does no-one, especially and in particular victims of crime, the slightest good whatsoever for criminals to be jailed. It's horrendously expensive, deeply dehumanizing and soul-destroying to all involved, and all it achieves ever is to make good, bad and indifferent people worse, wherever on that spectrum they started off.

More than anything else, crime is an issue of personal inadequacy rather than personal immorality. While it is entirely fair and valid to say that criminality is immoral, it is pointless and worse than pointless to pursue that fact past the simple acknowledgement of the truth of the assertion, because absolutely nothing can be done with it. It leads to punishments which make criminals worse, and encourages onlookers to sadism and indifference. I don't think it matters whether, for example, child molestation is worse than murder, or burglary worse than rape, and accordingly ought be more or less harshly punished, especially by periods forced confinement in the company of similar people to model oneself on, with unrelenting reinforcement of the self-view as a murderer, rapist, etc. What matters, the underlying purpose, is that child molestation, murder, rape, burglary, and all the vast panoply of human abilities to harm and interfere with and disrupt each others' lives, must be minimized. Jail doesn't minimize future crime, it increases it. That jails are in any way useful is a similar delusion to the idea that the profit drive will inherently restrain corporations from predatory behavior. It doesn't survive a second of questioning, yet seems to operate unquestioned in the minds of vast numbers of people.
posted by aeschenkarnos at 2:17 AM on November 13, 2008 [1 favorite]

This post has ruined my day. I wish I hadn't read it. Just tragic.
posted by sswiller at 8:32 AM on November 13, 2008

I shall pass this information on to my friends who have type-1 diabetes. I am sure they will be interested to hear it.

Don't forget type 2s.

I didn't, but wasn't interested in providing an opening an opening for a hurf durf fatties rant.
posted by phearlez at 8:49 AM on November 13, 2008

PeterMcDermott : "It could also be a case of a wealthy asshole celebrity who is able to find and pay doctors to write for whatever the fuck they like."

Wealthy? What makes you think Levert was rich? The fact that he was a musician? Music's not an industry that pays well except at its very upper echelons, which Levert did not occupy. If he'd been wealthy, don't you think he would've paid his child support instead of taking a jail term?

Asshole? Why would you use such an inflammatory term (for a dead man with a grieving family!) and what are your grounds for this characterization? I think it says a lot about Levert that although he was in incredible agony, he never attacked another individual. The article says he cried, beat his fists on the floor, and "shot into [his jailer's] arms." Furthermore, "[i]n a videotape of Levert being placed in the chair, he repeatedly shouts, 'No, no, no' and strains against the straps, but he doesn't fight the jailers." I didn't know him, but that doesn't sound like an asshole to me. Assholes lash out. Assholes insist on special treatment. Assholes demand a lawyer.

Celebrity? I'd never heard of him till now. Had you? This was an obscure R&B musician whose long-since-disbanded group had one Grammy nomination 20 years ago, not Dr. Dre.

If he were a wealthy asshole celebrity I don't think he would've met this end... do you? Really? It seems more like he was a poor black man who got killed by a broken penal system.
posted by cirocco at 9:39 AM on November 13, 2008

Wealthy? What makes you think Levert was rich?

The extent of his outstanding child support might be one clue. Courts generally don't levy amounts that the father is unable to pay.

Of course, I've no idea whether he was rich or not. I wasn't claiming he was. We were listing possibilities, and this is another possibility. Of course, you don't have to be rich to have access to a pill mill, but celebrities definitely have an easier job of it when it comes to getting what they want from doctors.

Also, wasn't his dad Eddie Levert out of the Ojays? The Ojays sold a few million records in their time. The royalties should still be rolling in fairly steadily from the Ojay's back catalogue. It doesn't mean Eddie sees any, but it's a possibility.

Grammy nomination 20 years ago.

Oh, OK. So that might be twenty years of child support he had outstanding there. Not rich then, but possibly still something of an asshole?
posted by PeterMcDermott at 10:20 AM on November 13, 2008

Well, I'm a songwriter, I've had a couple of hits. Got a couple of cars and a pretty nice house...
posted by PeterMcDermott at 10:27 AM on November 13, 2008

Oh, that previous link was his brother and co-star in Levert, Gerald. Who died of an overdose of prescription painkillers and OTC drugs in 2006.

Gerald's OD cocktail included "Vicodin, Percocet, and Darvocet, along with anxiety medication Xanax and two over-the-counter antihistamines"

It makes Sean's death all the more tragic, but I'm starting to see something of a pattern here.
posted by PeterMcDermott at 10:34 AM on November 13, 2008

It makes Sean's death all the more tragic, but I'm starting to see something of a pattern here.

I sure am glad the correctional officers showed Sean some tough love.
posted by Marisa Stole the Precious Thing at 11:04 AM on November 13, 2008 [1 favorite]

Decemberboy, this is wrong:

Withdrawal from any physically addicting substance can kill under the right (wrong) circumstances if one is consuming a large enough daily dose. Alcohol and benzos are the most likely to, though.

There's no evidence that simple opioid withdrawal can kill-- like any other stress, it can kill in the presence of disease, but not by itself. However, benzo and alcohol withdrawal can kill normal people with no underlying conditions.

This is also incorrect:

If one's tolerance has become that enormous, the responsible thing for the doctor to do would be to wean the person off them, or at least down to a lower dose. Just prescribing bigger and bigger doses is malpractice.

High tolerance has nothing to do with addiction. One can be addicted to cocaine and have no tolerance at all. One can be on massive amounts of opioids and be physically dependent but not be an addict: some pain patients and methadone maintenance patients are on doses that would kill most people several times over and you wouldn't know it to talk to them because they are effective as treatment in these cases.

Physical dependence and tolerance are related but neither is necessary or sufficient to define addiction. Addiction is compulsive use of a substance despite negative consequences-- this can happen without physical dependence (see: crack) and physical dependence can happen without addiction (see: certain blood pressure medications for which no one robs pharmacies but withdrawal from these can kill).

Addiction is a complicated subject made even more so by the stupidity of the people who decided that it should be called 'substance dependence' in the DSM. Fortunately, DSM V will probably go back to addiction, hopefully sparing pain and anxiety patients additional pain and anxiety.
posted by Maias at 1:01 PM on November 13, 2008

humannaire:
"And some people don't need 'em and do 'em discretionally because they are intelligent and genuinely interested in something you don't understand."

Um...I'm sorry, but I think you've misread/misunderstood what I was saying.

I was speaking specifically of prescription medications used to control brain chemistry/mood disorders being used recreationally by people who are not prescribed said medications.

Man. This thread sure set the knees-a-jerkin'.

:(
posted by batmonkey at 2:00 PM on November 13, 2008

man, erroneous, condescending assumptions are irritating. good reminder to me to be careful and not do that to others.
posted by batmonkey at 2:05 PM on November 13, 2008

Taking drugs every day of your life is generally a bad idea, no matter how you slice it.

Looks like someone needs to be on anti-stupid pills for the rest of his life...
posted by c13 at 6:19 PM on November 13, 2008

Wow, this is some tragic shit. Both the article and the anti-meds assholes.

Anxiety is a real and sometimes disabling disorder. I'm glad I don't have such issues.

However, in general, maintenance doses of benzos aren't the best way to go about treating anxiety. They're much better for people with occasional anxiety episodes who just need one to get them through without becoming a blabbering mess.

Not that it really matters. A person in jail should get their meds, whatever they are.
posted by wierdo at 1:30 AM on November 14, 2008