Reviews

Benzodiazepines

A rich language has developed on the street to describe drugs, and some of the terms give a fair idea of the user's experience. According to the extraordinary US government archive of over 2000 street terms for drugs (www.whitehousedrugpolicy.gov/streetterms), heroin is known as the "galloping horse," crack cocaine is the "devil's dandruff," and opium is "God's medicine." A mixture of crack and phenylcyclidine is called a "Beam me up Scottie." Is cataloguing these names a good use of government funds? The White House thinks so, because "the ability to understand current drug-related street terms is an invaluable tool for law enforcement, public health, and other criminal justice professionals." How frightening that the US government considers public health professionals to be part of the criminal justice system.

Benzodiazepines ("downers," "dolls," or "tranqs") continue to form part of the repertoire of drugs that people become addicted to. US News Online gives a lively history of the rise and fall of Valium (www.usnews.com/usnews/issue/991227/sternbach.htm), immortalised by the Rolling Stones in their 1967 song Mother's Little Helper. Those wishing "to end benzodiazepine addiction and recover from the withdrawal syndrome" can join the online support group www.benzo.org.uk, while those who "have suffered medical and legal problems resulting from these drugs" can find guidance from Victims of Tranquillisers (www.benzo.org.uk/peart.htm). The Royal College of Psychiatrists publishes a balanced factsheet on the risks and benefits of tranquillisers, helpful for doctors and patients, at www.rcpsych.ac.uk/info/factsheets/pfactranq.htm.

But the much hyped concerns about benzodiazepines are not, it would seem, always justified. A paper in this week's BMJ (p 704), for example, shows no association between these drugs and hip fractures in elderly people. Searching the online version of the British National Formulary (www.bnf.org) gives a reminder of the huge range of indications for these drugs, including epilepsy, movement disorders, and temporomandibular joint dysfunction.

Gavin Yamey. 

BMJ gyamey{at}ewjm.com