Transcript: Rethinking Anxiety Meds | May 06, 2019

Steve sits in the studio. He's slim, clean-shaven, in his fifties, with short curly brown hair. He's wearing a gray suit, pale pink shirt, and checked blue tie.

A caption on screen reads "Rethinking anxiety meds. @spaikin, @theagenda."

Steve says YOU MAY KNOW THEM BY
BRAND NAMES SUCH AS VALIUM,
XANAX, AND ATIVAN.
MORE BROADLY, THEY ARE A CLASS
OF TRANQUILIZERS REFERRED TO AS
BENZODIAZEPINES, OR SIMPLY
"BENZOS."
THEY ARE PRESCRIBED PRIMARILY AS
AN ANTI-ANXIETY MEDICATION.
HOWEVER, THERE ARE SIGNS THAT'S
NO LONGER ALL THEY'RE BEING USED
FOR, AND EVEN IN THAT CONTEXT,
THERE MAY BE MORE MISUSE THAN
THERE OUGHT TO BE.
WITH US NOW FOR MORE:
IN QUEENS, NEW YORK, VIA SKYPE:
ROGER McINTYRE, PROFESSOR OF
PSYCHIATRY AND PHARMACOLOGY AT
THE UNIVERSITY OF TORONTO, AND
HEAD OF THE MOOD DISORDERS
PSYCHO-PHARMACOLOGY UNIT AT THE
UNIVERSITY HEALTH NETWORK.

Roger is in his late forties, clean-shaven, with short curly blond hair. He's wearing a black suit and a white shirt.

Steve continues AND IN OUR STUDIO:
TAMINA EAPEN, LECTURER AT THE
U OF T, AND A PSYCHIATRIST ALSO
WITH CAMH, THE CENTRE FOR
ADDICTION AND MENTAL HEALTH...

Tamina is in her thirties, with long curly black hair. She's wearing a black blazer and a black turtleneck.

Steve continues ALEXANDER CAUDARELLA, FAMILY AND
ADDICTIONS PHYSICIAN AT THE
UNIVERSITY OF TORONTO AND
ST. MICHAEL'S HOSPITAL...

Alexander is in his forties, clean-shaven, with short curly brown hair. He's wearing glasses, a blue suit and a white shirt.

Steve continues AND YARISSA HERMAN, CLINICAL
PSYCHOLOGIST WITH WEST END
PSYCHOLOGICAL SERVICES AND CAMH,
THE CENTRE FOR ADDICTION AND
MENTAL HEALTH.

Yarissa is in her forties, with long curly brown hair. She's wearing a printed black blouse.

Steve continues WHO ARE WELL-REPRESENTED ON THIS
PROGRAM TODAY.
GOOD TO HAVE EVERYBODY ON... IS
THIS YOUR FIRST TIME ON TV?

Yarissa says IT IS.

Steve says WE ARE DELIGHTED
YOU'VE DECIDED TO HAVE IT WITH
US.
THANK YOU VERY MUCH.
ROGER McINTYRE, GOOD TO HAVE
YOU ON TODAY.
IT IS CERTAINLY NOT YOUR FIRST
TIME ON THIS PROGRAM.
WE'RE HAPPY YOU COULD MAKE TIME
FOR US IN NEW YORK.
LET'S PUT THIS FACT FILE UP,
EVERYBODY, TO GET BACKGROUND IN
PLACE.
SHELDON, IF YOU WOULD, BRING THE
GRAPHIC UP, AND HERE WE GO.

A slate appears on screen, with the title "Benzodiazepine use in Canada."

Steve reads data from the slate and says
A REPORT FROM 2017 SHOWED THAT
10 PERCENT, 10 PERCENT OF THE
GENERAL POPULATION TOOK A BENZOS
AT SOME POINT IN THE PAST YEAR.
WOMEN ARE ALMOST TWICE AS LIKELY
TO BE PRESCRIBED THESE DRUGS AS
MEN ARE, AND 51 PERCENT OF THE
FATAL OPIOID OVERDOSES IN THIS
PROVINCE INVOLVED BENZOS.
SO LET'S FIND OUT MORE, FIRST OF
ALL, ABOUT WHAT THEY ACTUALLY
ARE.
ROGER, YOU WANT TO GET US
STARTED?
WHAT ARE BENZOS AND WHAT DO THEY DO?

The caption changes to "Roger McIntyre. University Health Network."
Then, it changes again to "Too many benzos?"

Roger says SURE, STEVE.
YOU'RE RIGHT.
YOU HAD MENTIONED
TRANQUILLIZERS.
THESE WERE FIRST ISOLATED BACK
IN 1955.
THEY HAD BEEN FIRST APPROVED
BACK IN THE EARLY '60s FOR THE
TREATMENT OF REALLY A BROAD SET
OF PURPOSES.
THESE PURPOSES INCLUDE ANXIETY,
INSOMNIA, ALCOHOL WITHDRAWAL,
AND DISORDERS AND THE USE OF
THESE MEDICATIONS OVER THE LAST
FOUR TO SIX DECADES HAS WAXED
AND WANED, PEAKING IN THE MID
'70s, COMING DOWN SLIGHTLY IN
THE '80s AND '90s, AND BEEN
INCREASING... IN FACT IN THE
LAST 15 YEARS, WE'VE SEEN A
SIGNIFICANT INCREASE.
YOU CITED THE PERCENTAGE, THE
TRAJECTORY IS GOING UP AND UP OF
PEOPLE WHO ARE BEING PRESCRIBED
THESE MEDICINES.
SECONDLY, THE NUMBER OF PEOPLE
WHO ARE RECEIVING REPEAT
PRESCRIPTIONS IS GOING UP.

A map of eastern U.S.A. pops up briefly, highlighting the location of Queens, New York.

Roger continues AND THIRDLY, WHICH IS VERY
CONCERNING, IS THE NUMBER OF
PEOPLE BEING PRESCRIBED A
BENZODIAZEPINE WITH ANOTHER
CONTROLLED SUBSTANCE SUCH AS
OPIOIDS HAS ALSO BEEN
INCREASING.
SO TAKEN TOGETHER, THIS IS WHAT
WE CALL HAS BEEN CONCERNING TO US.

Steve says HOW ADDICTIVE ARE BENZOS?

The caption changes to "Tamina Eapen. The Centre for Addiction and Mental Health."

Tamina says THEY'RE VERY ADDICTIVE.
WE KNOW DOPAMINE IS INCREASED.
LIKE ANY ADDICTIVE MEDICATIONS,
LIKE CANNABIS, LIKE ALCOHOL,
WE'RE DISCOVERING
BENZODIAZEPINES ARE VERY STICKY
IN OUR BRAINS.

Steve says THAT DOESN'T SOUND
LIKE A PHARMACOLOGICAL TERM.

Tamina says IT'S PRETTY TECHNICAL.
IT'S A GOOD WAY TO THINK OF IT.
CERTAIN MOLECULES ARE MORE
STICKY THAN OTHERS AND CERTAIN
BENZOS ARE UP THERE.

Steve says DO YOU THINK THEY'RE
OVERPRESCRIBED?

The caption changes to "Alexander Caudarella. University of Toronto."

Alexander says YEAH.
WE'VE SEEN A LOT OF PEOPLE WHO
HAVE BEEN PREVIOUSLY PRESCRIBED
AND A LOT OF PEOPLE ARE
STRUGGLING TO EITHER TAKE PEOPLE
OFF THE MEDICATIONS OR TO FIND
ALTERNATE TREATMENTS.
THEY MAY BE OVERPRESCRIBED IN A
CERTAIN WAY BUT I THINK THEY'RE
CONTINUING TO BE PRESCRIBED IN
ANOTHER WAY BECAUSE PEOPLE
AREN'T COMFORTABLE REMOVING
THEM.

Steve says DO YOU THINK THEY'RE
OVERPRESCRIBED?

The caption changes to "Yarissa Herman. The Centre for Addiction and Mental Health."

Yarissa says YES.
ALSO, I THINK IT'S IMPORTANT TO
RECOGNIZE THAT THERE ARE
ALTERNATIVE POSSIBILITIES TO
TREAT ANXIETIES, SUCH AS
PSYCHOTHERAPY AND POTENTIALLY
WITH THE ADDITION OF
PSYCHOTHERAPY PLUS THE ADDITION
OF BENZOSES, WE'VE SEEN QUITE
GOOD OUTCOMES.
ALSO CBT, COGNITIVE BEHAVIOURAL
THERAPIES.
I THINK THAT THEY ARE
OVERPRESCRIBED AND I THINK IT'S
IMPORTANT TO RECOGNIZE THAT
THERE IS SOME ALTERNATIVES.

Steve says YOU KNOW, I GUESS IT
WOULD BE EASY JUST TO SAY WE'RE
GOING TO BLAME ALL THE DOCTORS
FOR OVERPRESCRIBING, BUT I
PRESUME PATIENTS ALSO PUT A LOT
OF PRESSURE ON DOCTORS TO GET
THESE PILLS BECAUSE THEY'VE
HEARD SO MUCH ABOUT THEM.

Yarissa says SURE.
THEY'RE EFFECTIVE AND THEY'RE
EASILY ACCESSIBLE AND THEY'RE QUICK.

Steve says QUICK.
MEANING WHAT?

Yarissa says THEY WORK FAST.
LIKE PSYCHOTHERAPY CAN TAKE A
LOT LONGER AND IT CAN BE A LOT
MORE WORK.

Steve says ROGER, WHO GETS TO
PRESCRIBE THESE MEDICATIONS?

Roger says WELL, ALL HEALTH CARE
PROVIDERS LIKE PRESCRIBING THEM.
THERE'S CERTAINLY BEEN A WIDE
USE OF THESE MEDICATIONS IN
SPECIALTY SERVICES APPROPRIATELY
IN SOME SETTINGS LIKE PSYCHIATRY
AND ALSO NEUROLOGY SETTINGS, ARE
JUST TWO EXAMPLES.
BUT WHAT WE'VE OBSERVED AND
THERE'S BEEN A RECENT REPORT
HERE IN THE UNITED STATES IS IN
PRIMARY CARE THERE'S BEEN A
STEADY INCREASE IN THE
PRESCRIPTION OF BENZODIAZEPINES
DURING THE LAST 15 TO 20 YEARS.
AS I WAS PAYING EARLIER, THIS IS
CO-INSIDING WITH OTHER
WE KNOW THAT WHEN
BENZODIAZEPINES ARE COMBINED
WITH OPIOIDS, IT INCREASES THE
TOXICITY OF THESE MEDICINES AND
OVERDOSE ARE VERY CONCERNING.
I AGREE WITH MY COLLEAGUES THAT
ARE WITH YOU IN STUDIO THAT I DO
THINK THERE IS IN FACT AN
OVER PRESCRIPTION, AND MORE
SPECIFICALLY, I DO NOT THINK IN
FACT THERE'S BEEN THE
APPROPRIATE ASSIGNMENT OF
TREATMENT OF PATIENTS.
I'VE SPENT THE LAST 15, 20
YEARS, ALMOST A FULL-TIME JOB
TRYING TO TAKE PEOPLE OFF THESE
MEDICINES.
PEOPLE TAKE THEM FOR A VARIETY
OF REASONS.
I ENUMERATED ONE OF THE
INDICATIONS.
ONE OF THE PRIMARY REASONS THEY
TAKE THEM IS THEY WORK AND THEY
VERY WORK QUICKLY.
THAT BEING SAID, THE SHORT-TERM
GAINS ARE OVERSHADOWED BY THE
LONG-TERM LIABILITY, AND I AGREE
WITH THE COMMENT ABOUT
PSYCHOTHERAPY, AND I THINK THAT
THERE ARE CLEARLY LOTS OF
EVIDENCE NOW TO SUGGEST OR
INDICATE THAT CBT, COGNITIVE
BEHAVIOURAL THERAPY IS THE BEST
WAY TO TREAT ANXIETY IN THE LONG
TERM.
THE ISSUE WE GET INTO IS REAL
WORLD.
THE REAL WORLD IS MOST BUSY
PRIMARY CARE PROVIDERS SAY I
DON'T HAVE A PSYCHOTHERAPIST
NEXT DOOR.
AND PATIENTS LACK THE
MOTIVATION.
SO SOME OF THESE STRUCTURAL
ISSUES UNFORTUNATELY END UP
CONSPIRING AGAINST US LEADING TO
BENZODIAZEPINE OVER
PRESCRIPTION.

Steve says ALL OF THAT HAVING
BEEN SAID, ALEXANDER, WOULD A
WAY TO REDUCE THE PROLIFERATION
OF WRITING SCRIPS FOR THIS
MEDICATION BE TO PREVENT FAMILY
DOCS FROM DOING IT ANY MORE,
MAKING IT MORE RESTRICTIVE?

The caption changes to "Alexander Caudarella, @acaudarella."

Alexander says I DON'T THINK YOU CAN LOOK TO
BLAME FAMILY DOCS.
A LOT ARE CONTINUING OLD
PRESCRIPTIONS.
WE DON'T NECESSARILY WANT PEOPLE
RIPPED OFF THESE MEDICATIONS.
THAT COMES WITH A LOT OF HARM
TOO.
PEOPLE WANT TO HELP THE PEOPLE
IN FRONT OF THEM.
AS WAS JUST MENTIONED WE HAVE TO
PROVIDE MORE SERVICES AND MORE
HELP FOR FAMILY PHYSICIANS TO BE
ABLE TO DO THINGS.
THE LAST THING IS IT'S NOT ONLY
THE OVERPRESCRIBING IT'S THE WAY
THEY'RE PRESCRIBED.
THE HIGH DOSES BUT ALSO THE
FACT THAT PEOPLE ARE GOING HOME
WITH MONTHS OF PRESCRIPTIONS AT
A TIME.
SOME OF IT CAN BE DIVERTED TO
THE STREET OR TAKEN
INAPPROPRIATELY.
TRAINING PEOPLE TO PRESCRIBE IT
IN A SAFER WAY MIGHT BE A WAY WE
CAN HELP CURB SOME OF THESE
OVERDOSES THAT ARE HAPPENING.

The caption changes to "Connect with us: Twitter: @theagenda; Facebook, agendaconnect@tvo.org, Instagram."

Steve says WOULD YOU PUT IN A
NEW REGULATION THAT SAID, SORRY,
YOU'RE NOT GOING TO BE ABLE TO
PRESCRIBE SIX MONTHS' WORTH OF
BENZOS ANYMORE?

The caption changes to "Yarissa Herman. West end Psychological Services."

Yarissa says I GUESS I WOULD.
IT'S HARD FOR ME TO SUGGEST A
REGULATION OF THAT SORT.
IT SOUNDS LIKE THAT WOULD MAKE
SENSE.
I THINK A AN ADDITIONAL OPTION
WOULD BE TO INCREASE THE AMOUNT
OF AVAILABLE PSYCHOTHERAPY
WITHIN FAMILY PHYSICIAN OFFICES.

Steve says WE'RE AT A MOMENT
RIGHT NOW WHERE WE'RE TRYING TO
SPEND LESS ON HEALTH CARE THAN MORE.

Yarissa says FAMILY PHYSICIANS ARE
GENERALLY TRAINED WITHIN A
MEDICAL MODEL AND SOME DO
RECEIVE ADDITIONAL TRAINING AND
PSYCHOTHERAPY, SO THERE ARE SOME
OPTIONS FOR OHIP-COVERED
PSYCHOTHERAPY.
THE WAIT LISTS ARE QUITE LONG.

Steve says INDEED.
TAMINA, I WANT YOU TO HELP US
UNDERSTAND WHY, AS WE SUGGESTED
IN THE INTRO, WOMEN ARE TWICE AS
LIKELY AS MEN TO BE PRESCRIBED
THESE MEDICATIONS.

The caption changes to "Tamina Eapen. University of Toronto."

Tamina says I SUSPECT IT'S BECAUSE WE'RE
MORE ARTICULATE AND GENERALLY
MORE IN TOUCH WITH OUR FEELINGS.
WE TEND TO BE HEALTH-SEEKING.
WE MAKE CONNECTIONS WITH HEALTH
CARE PROVIDERS, AND THERE'S LESS
STIGMA AROUND WOMEN EXPRESSING DISTRESS.

Steve says THE LESS GENEROUS
INTERPRETATION MIGHT BE THAT
MORE MALE DOCTORS THINK WOMEN
OUGHT TO TAKE A PILL AND CALL ME
IN THE MORNING AND SEE HOW IT
GOES.

Tamina says THAT CERTAINLY IS LESS GENEROUS.
THERE IS A BIAS TOWARDS
PRESCRIBING FOR STRESS.
WE'RE MEDICALIZING A LOT OF
FEELINGS IN ADDITION TO TRYING
TO ADDRESS THEM.

Steve says YOU DO ACKNOWLEDGE
IT WAS A LESS GENEROUS
INTERPRETATION BUT AM I WRONG IN
SUGGESTING THAT.

Taminasays WE HAVE A LOT OF FEMALE
PHYSICIANS NOW.
MORE THAN HALF OF THE CLASSES
ARE FEMALE.
WOMEN ASK FOR HELP AND (b)
FOLLOW THROUGH WITH CARE WE
SUGGEST.

Steve says I WONDER WHETHER
ANYONE HAS DONE A STUDY ON
WHETHER MALE AND FEMALE
PHYSICIANS PRESCRIBE IN THE SAME
RATIOS.

Alexander says THAT'S NOT SOMETHING I'VE
HEARD OF BEFORE.
I THINK IF YOU LOOK
HISTORICALLY, THERE'S A LOT OF
ADVERTISING SPECIFICALLY AT
WOMEN FOR VALIUM AND LIKE WE'RE
SAYING, A LOT OF THIS MIGHT BE
NEW PRESCRIBING BUT SOME OF IT
MIGHT BE PEOPLE THAT HAVE BEEN
ON THIS FOR 30 YEARS TO HELP
THEM SLEEP.
MAYBE THEY'RE STILL REAPING SOME
OF THAT BENEFIT FROM THE OLD
MAYBE IMPROPER ADVERTISING.

Steve says ROGER, I WANT TO GET
A BETTER UNDERSTANDING BECAUSE I
THINK THE ROLLING STONES IN THE
1960s HAD A SONG CALLED
"MOTHER'S LITTLE HELPER," AND,
YOU KNOW, THE IDEA WAS TAKE A
VALIUM AND YOU'LL FEEL BETTER.
10 percent OF THE POPULATION IS TAKING
IT EVERY YEAR.
HOW DOES IT BECOME SO NORMAL TO
TAKE THESE DRUGS?

Roger says FOR A VARIETY OF REASONS.
YOU'RE RIGHT, THAT GOES WAY BACK
TO THE '70s.
BACK IN 1977, BENZODIAZEPINES
WERE THE MOST PRESCRIBED
MEDICATIONS IN THE WORLD.
THEY WERE VERY POPULAR.
THE SECOND PART OF THIS IS THAT
THE WORLD HEALTH ORGANIZATION
HAS WHAT THEY CALL A MODEL LIST
OF ESSENTIAL MEDICINES.
THIS IS A LIST OF MEDICINES THAT
ACCORDING TO THE WORLD HEALTH
ORGANIZATION ARE CENTRAL FOR THE
SAFETY AND THE HEALTH OF THE
GENERAL POPULATION AND IT SHOULD
BE STATED THAT BENZODIAZEPINES,
A FEW OF THEM, ARE ACTUALLY ON
THAT LIST.
THESE ARE MEDICATIONS THAT ARE
NOT ONLY REGULATORY APPROVED BUT
THEY HAVE BEEN ACCREDITED BY
ORGANIZATIONS FOR APPROPRIATE
USES.
THIS FOSTERS THE USE OF THESE
MEDICATIONS.
WHAT'S SO INTERESTING TO ME,
STEVE, FROM A CONTEXT AROUND THE
BENZODIAZEPINE USE AND THE
UPTICK IN THE LAST TEN YEARS IS
THAT THIS IS NOT NECESSARILY
BEING FOSTERED BY THE
PHARMACEUTICAL INDUSTRY.
THE PHARMACEUTICAL INDUSTRY
PROMOTES THEIR MEDICATION.
THAT LEADS TO AN INCREASE IN THE
PRESCRIPTION OF THESE MEDICINES.
THAT'S A WHOLE SEPARATE
CONVERSATION.
WHAT'S INTERESTING IS THAT
BENZODIAZEPINES ARE GENERIC.
THEY'RE NOT BEING ACTIVELY
PROMOTED FOR PROMOTIONAL
PROGRAMS FOR PHYSICIANS,
PHYSICIAN ASSISTANTS, NURSE
PRACTITIONERS AND MORE RECENTLY
PHARMACISTS AND WE'RE SEEING
THIS UPTICK.
I THINK THEREFORE WE NEED A
DIFFERENT KIND OF
CONCEPTUALIZATION OR ADDITIONAL
FACTORS TO CONSIDER AND MORE
RECENTLY WE'VE BEEN WONDERING
ABOUT THE EPIDEMIC GLOBALLY OF
THE LONELINESS SCENARIO THAT'S
UNFOLDING.
AS A PSYCHIATRIST I SEE THIS.
AS AN ACADEMIC AND A SCIENTIST,
WE WRITE ON THIS IN TERMS OF THE
GLOBAL EPIDEMIC OF LONELINESS IS
GENERATING REALLY, IF YOU WILL,
THE FOUND DAYS, THE EDIFICE, FOR
ANXIETY SYNDROMES AND ALSO
SHORTENED LIFE SPAN FOR MANY
PEOPLE IN THE GENERAL
POPULATION.
WE'VE BEEN A MORE DISTRESSED
SOCIETY, IF YOU WILL.

Steve says YOU DON'T HAVE TO GO
BACK TO THE '60s OR '70s TO
FIND MUSIC THAT PROMOTES THESE
MEDICATIONS.
DRAKE TALKS ABOUT XAN, XANAX, I
PRESUME HE'S TALKING ABOUT.
IS THE CULTURE PROMOTING
NORMALIZED, IF I CAN USE THAT
TERM, USE OF THESE MEDICATIONS?

Yarissa says I DO.
I SEE YOUNG PEOPLE TAKING XANS
TO GET HIGH, ESSENTIALLY.

Steve says I PRESUME YOU DON'T
THINK THAT'S A GOOD IDEA.

Yarissa says I DON'T.

Steve says WHAT'S A BETTER
ALTERNATIVE FOR A 16 OR
17-YEAR-OLD... HOW DO YOU TELL
THEM THIS IS A REALLY DUMB IDEA?

Yarissa says WE TRY TO LOOK AT, AS WAS
STATED, THE SHORT-TERM GAINS AND
THE LONG-TERM CONSEQUENCES SO WE
CAN BUILD SOME INTERNAL
MOTIVATION FOR CHANGE.
HAVING SOMEONE REALIZE THAT
MAYBE OVER THE LONG TERM THIS
ISN'T THE BEST THING FOR ME TO
DO AND LEARNING WHY THEY'RE
USING IT, WHAT THE PURPOSE OF
THEIR USE IS, THE FUNCTION OF
THEIR USE, SO WE CAN TARGET THAT
AND PROVIDE OTHER STRATEGIES TO
HAVE FUN OR OTHER STRATEGIES TO
COPE WITH ANXIETY SO THEY'RE NOT
RELYING ON XANAX OR WHATEVER IT
MAY BE.

Steve says HOW DOES A
16-YEAR-OLD TEENAGER GET A
PRESCRIPTION FILLED FOR XANAX?

Yarissa says I'M NOT SURE IT'S ALWAYS
LEGALLY PRESCRIBED.

Steve says A HA.
THERE WE GO.

Roger says CAN I COMMENT ON THAT POINT?
YOU ASKED, YOU KNOW, IS IT SAFE
AND EFFECTIVE OR YOU ALLUDED TO
IS IT SAFE AND EFFECTIVE TO GIVE
XANAX TO A 16-YEAR-OLD.
I CERTAINLY DON'T BELIEVE IT IS.
IT'S ENTIRELY INAPPROPRIATE.
HERE'S WHAT I'M CONCERNED ABOUT.
WE HAVE IN FACT THE WIDESPREAD
MARKETING OF RECREATIONAL
MARIJUANA AND IT'S BEING USED
FOR MANY PURPOSES INCLUDING BUT
NOT THE LIMITED TO ANXIETY AND
SLEEP, AND CERTAINLY IN A
16-YEAR-OLD, I'VE GOT
SIGNIFICANT CONCERNS ABOUT THE
CONSUMPTION AND THE INCREASED
UTILIZATION OF MARIJUANA FROM
THE POINT OF VIEW OF DOUBLING
THE RISK OF PSYCHOSIS IN PEOPLE
AT RISK AND ONLY IN FACT
WORSENING SOME OF THE UNDERLYING
REASONS PEOPLE FEEL ANXIOUS
LIKE, FOR EXAMPLE, DEPRESSION.
WE'RE TALKING ABOUT
BENZODIAZEPINES.
I THINK WE HAVE AGREEMENT ON THE
PANEL THAT WE'RE ALL VERY MUCH
REACTING WITH DISQUIET TO WHAT
WE'RE SEEING.
BUT I ALSO WOULD LIKE TO IN FACT
CALL OUT THE ELEPHANT IN THE
ROOM THAT WE'RE SEEING A MASSIVE
UPRISE, UPTICK IN TERMS OF
RECREATIONAL MARIJUANA.
PEOPLE ARE THINKING THIS IS A
SAFER ALTERNATIVE TO MANAGE
THEIR ANXIETY AND THAT IS
CLEARLY NOT TRUE.

Steve says DO YOU AGREE THAT
THERE ARE... IT'S PRECIOUS FEW
CIRCUMSTANCES UNDER WHICH A
16-YEAR-OLD OUGHT TO BE
PRESCRIBED XANAX OR ATIVAN, THAT
KIND OF THING?

Tamina says I CAN ONLY THINK OF ONE IS
THAT'S WITHDRAWAL FROM A
BENZODIAZEPINE OR ALCOHOL.

Steve says TALK TO ME ABOUT
THAT.
WHAT'S WITHDRAWAL LIKE FROM
THESE KINDS OF THINGS?

Tamina says IT'S TERRIBLE.
FROM NEVER BEING IN WITHDRAWAL,
I CAN'T SAY FROM PERSONAL
EXPERIENCE.
REALLY, WE HAVE AN ENTIRELY
PHYSIOLOGICAL RESPONSE WHERE OUR
HEART DOESN'T KNOW WHAT TO DO,
OUR LUNGS DON'T KNOW WHAT TO DO
AND WE CAN GO INTO A PANIC ZONE
AND IT CAN LEAD TO DEATH WHEN
THE BENZODIAZEPINE RECEPTORS ARE
NOT ABLE TO MITIGATE THE
WITHDRAWAL MORE SAFELY WITH
BENZODIAZEPINES OR ALCOHOL.

Steve says WE HAVE THE
STEREOTYPICAL IMAGE I SUSPECT IN
OUR HEADS OF EVERYBODY GETTING
THE DTs AND SHAKING IN THE
CORNER AND HALLUCINATING.
WOULD YOU HAVE THAT KIND OF
EXPERIENCE TRYING TO GET OFF BENZOS?

Tamina says THAT WOULD BE THE EXTREME
CASE OF WITHDRAWAL FROM
BENZODIAZEPINES, ALCOHOL.
MORE MODERATE WOULD BE A SENSE
OF ANXIETY, ALSO A VERY RAPID
HEART RATE, INCREASED BLOOD
PRESSURE, DECREASED OR INCREASED
RESPIRATORY RATES.

Steve says HAVE YOU SEEN THIS?

Alexander says OF COURSE.
IT'S SOMETHING WE SEE IN THE
HOSPITAL ALL THE TIME.
ALCOHOL YOU START TO GO INTO
WITHDRAWAL QUICKLY.
BENZODIAZEPINES CAN TAKE WEEKS
UNTIL YOU SHOW SIGNS.
PEOPLE CUT BACK PEOPLE'S
MEDICATION AND THOSE PEOPLE
START TO MANIFEST MORE ANXIETY A
COUPLE OF WEEKS LATER AND SAY I
CAN'T SURVIVE WITHOUT THIS.
WHEN WE TAKE PEOPLE OFF THEIR
BENZODIAZEPINE, IT CAN OFTEN
TAKE ONE OR TWO YEARS TO TAKE
THEM OFF.
YOU HAVE TO DO IT SLOWLY TO BE
SUCCESSFUL.
THERE'S A LOT OF HAND HOLDING
THAT NEEDS TO HAPPEN.

Steve says WHEN A PATIENT SAYS I CAN'T LIVE WITHOUT THESE
THINGS, YOU CAN'T WEAN ME OFF
THEM, WHAT DO YOU DO?

Alexander says WE HAVE A CONVERSATION.
MANY PEOPLE TAKING IT,
ESPECIALLY THOSE TAKING IT FOR A
LONG TIME, DON'T UNDERSTAND THE
RISKS.
THEY DON'T UNDERSTAND IT'S
ASSOCIATED WITH MORTALITY.
THEY ALSO DON'T UNDERSTAND IF
THEY'RE TAKING IT TO SLEEP, IT'S
IMPACTING THEM THE NEXT MORNING.
IT'S IMPACTING THEIR JUDGMENT,
THEIR ABILITY TO THINK.
WHEN YOU REALLY LAY THESE THINGS
OUT, THEY SAY I DON'T WANT IT.
WHEN YOU SAY I'M GOING TO BE
THERE TO MAKE SURE YOU'RE NOT
GOING TO BE SICK, WE'RE GOING TO
DO IT SLOWLY.
THE PATIENT SHOULDN'T BE SEEN AS
THE ENEMY.
THE FAMILY PHYSICIAN SHOULDN'T
BE SEEN AS THE ENEMY.
IT'S ABOUT MORE TOOLS AND TIPS
TO BE ABLE TO DO THAT.

Steve says LET'S PUT THIS IN
PERSPECTIVE BECAUSE WE DON'T
WANT TO GIVE PEOPLE THE
IMPRESSION THAT EVERYBODY TAKING
THESE THINGS IS HAVING THESE
WILD HALLUCINOGENIC NIGHTMARES
AND SO ON.
WHAT PERCENTAGE OF YOUR
PATIENTS, FOR EXAMPLE, OR THE
PEOPLE THAT YOU DEAL WITH IN
YOUR PROFESSION WOULD BE IN A
PROBLEMATIC PLACE WITH THESE
DRUGS AND WHAT PERCENTAGE ARE
TAKING THEM JUST FINE ACCORDING
TO PRESCRIPTION AND IT'S GOING
TICKETY-BOO, AS IT WERE?

Yarissa says A LOT OF PEOPLE I SEE
PARTICULARLY IN MY PRIVATE
PRACTICE COME TO ME PRIOR TO
TAKING THESE MEDICATIONS BECAUSE
THEY ALREADY WANT TO LEARN THEIR
OWN INTERNAL COPING STRATEGIES.
FOR THOSE I SEE THAT ARE TAKING
THEM AS PRESCRIBED, I OFTEN WORK
WITH DOCTORS TO HELP THEM REDUCE
SAFELY AND UNDER MEDICAL
SUPERVISION WHILE ALSO
INCREASING THEIR COPING
STRATEGIES BY USING SOMETHING
LIKE COGNITIVE BEHAVIOURAL
THERAPY.

Steve says ROGER, WHAT WOULD BE
YOUR SENSE OF THE PERCENTAGE OF
PEOPLE WHO ARE ACTUALLY TAKING
THESE THINGS FINE AND AS
PRESCRIBED VERSUS THOSE WHO ARE
EITHER ABUSING THEM OR REALLY
OUGHT NOT TO BE ON THEM AT ALL?

Roger says I JUST WANTED TO CLARIFY
SOMETHING YOU BEGAN TO REFRAIN
FOR US AND THAT IS THAT AS A
CLASS WE KNOW THAT
BENZODIAZEPINES HAVE A LIABILITY
TO ABUSE.
BUT THAT LIABILITY TO ABUSE IS
ACTUALLY VERY DIFFERENT ACROSS
THE DIFFERENT TYPES OF
BENZODIAZEPINES.
SOME ARE MORE SHORTER-ACTING,
SOME ARE LONGER-ACTING, AND THE
SHORTER-ACTING AGENTS FOR A HOST
OF REASONS ARE MORE LIABLE TO
ABUSE.
MOREOVER, IN THE GENERAL
POPULATION, THERE'S CLEARLY AN
ABUSE LIABILITY, BUT THAT ABUSE
LIABILITY IS DISPROPORTIONATELY
HIGHER IN SUB POPULATIONS,
PEOPLE WHO ABUSE OTHER DRUGS AND
ALCOHOL.
LET ME BE SURE WE'RE NOT
CONFLATING PHYSIOLOGIC
DEPENDENCE FROM ABUSE.
WHEN YOU TAKE ANY BENZODIAZEPINE
FOR A PERIOD OF TIME.
ABUSE IS OFTEN USED
THIS IS LANGUAGE INTERCHANGEABLE
WHERE PEOPLE ARE USING IT FOR
NON-THERAPEUTIC REASONS.
IN MY CLINICAL EXPERIENCE, MORE
THAN 75 TO 80 PERCENT OF
PATIENTS PRESCRIBED
BENZODIAZEPINES IN MY CLINIC ARE
TAKING THEM APPROPRIATELY.
NOW, I SAY THAT IN SO FAR AS
THEY'RE NOT ABUSING IT, MISUSING
IT, IT'S NOT A GATEWAY ACTIVITY.
THAT BEING SAID, WHAT I COUNSEL
PATIENTS IS, I'D LIKE YOU TO
SWITCH OVER TO OTHER STRATEGIES,
WE CAN ORGANIZE PSYCHOTHERAPY
FOR YOU, A BETTER SAFETY
PROFILE, AND I SHOULD UNDERSCORE
IN THE LONG TERM THERE ARE
SIGNIFICANT IMPLICATIONS IN
TERMS OF COGNITIVE, FUNCTION
REDUCTION AS WELL AS SOME PEOPLE
BELIEVE THE CONCERN ABOUT A
HIGHER RISK OF DEMENTIA.
THIS IS WHY I ALSO THINK THAT
PEOPLE OVER THE AGE OF 45 OR 50
SHOULD NOT BE PRESCRIBED THESE
MEDICATIONS ROUTINELY.
THERE'S A BEERS CRITERIA THAT IS
A SET OF MEDICATIONS YOU DON'T
LIKE TO GIVE TO THE ELDERLY FOR
THIS VERY REASON.
BENZODIAZEPINE CAUSES IMPAIRMENT
AND THEY'RE ON THAT LIST.
THEY SHOULDN'T BE PRESCRIBED.
LIKE MANY THINGS IN LIFE, WE
LIKE TO TALK ABOUT IT AS JUST
ONE LARGE TOPIC BUT THERE ARE
SOME POPULATIONS THAT I BELIEVE
DESERVE MORE NUANCED
CONVERSATION.

Steve says I APPRECIATE THAT
CLARIFICATION VERY MUCH.
THAT'S VERY IMPORTANT TO PUT ON
THE RECORD.
LET ME, SPEAKING OF PUTTING ON
THE RECORD, SHARE A NUMBER WITH
ALL OF YOU HERE.
ABACUS DOES SURVEYS, ABACUS
DATA.
LAST YEAR THEY DISCOVERED THAT
41 PERCENT OF CANADIANS,
41 PERCENT, SAY THEY STRUGGLE
WITH ANXIETY.
NOW, WHEN YOU HEAR THAT NUMBER,
WHAT DO YOU THINK?

Yarissa says IT MAKES ME FEEL SAD.

Steve says ARE YOU TRYING TO BE
FUNNY OR WHAT?

The caption changes to "A normal part of life?"

Yarissa says NO, IT'S A SHAME.
THAT'S A HIGH NUMBER.
AND I THINK THAT FROM A VERY
YOUNG TIME IN MOST OF OUR LIVES,
WE'RE TAUGHT NOT TO FEEL THESE
SORTS OF EMOTIONS OR THAT THESE
SORTS OF EMOTIONS ARE BAD IN
SOME WAY.
IN SOCIETY WE WANT TO HOLD ON TO
THE HAPPY EMOTIONS, YOU WANT TO
PUSH BACK THE SADNESS AND
ANXIETY, AND SO WE'RE NOT TAUGHT
TO SIT WITH OUR ANXIETY, TO BE
WITH OUR ANXIETY.
ANXIETY CAN BE A REALLY HEALTHY
THING.
YOU KNOW, ANXIETY CAN LET ME
KNOW THAT I CARE ABOUT SOMETHING
OR IT CAN MOTIVATE ME TO STUDY
FOR AN EXAM.
IT'S NOT ALWAYS BAD.
WHEN WE AVOID IT, WHEN WE PUSH
IT AWAY, IT BECOMES SCARY AND
BAD AND UGLY.
AND SO A NUMBER I THINK
REPRESENT SOME OF OUR BELIEFS
AROUND THE FUNCTION OF ANXIETY.

Steve says LET ME PICK UP ON
THE EXAM.
IF YOU'RE A STUDENT AND YOU HAVE
AN EXAM COMING UP AND YOU KNOW
THAT A SIGNIFICANT AMOUNT OF
YOUR FUTURE CAREER DEPENDS ON
YOU PASSING OR ACING THIS EXAM,
ARE BENZOS... YOU KNOW THIS IS
GOING TO BE A SHORT-TERM ISSUE,
RIGHT?
IS "I'VE GOT TO PASS THIS EXAM
NEXT WEEK."
WOULD IT BE A WISE IDEA TO GET
PRESCRIBED FOR BENZOS UNDER
THOSE CIRCUMSTANCES?

Tamina says I WOULD LIKE TO MEET A
PHYSICIAN WHO SAYS IT IS A WISE IDEA.
I CAN'T IMAGINE THAT THAT COULD
BE CLASSIFIED AS WISE AT ALL.

Steve says OKAY.

Tamina says AS DR. McINTYRE POINTED
OUT, WE'RE NOW SEEING A LOT MORE
COGNITIVE IMPAIRMENT, NOT JUST
WITH LONGER-TERM
BENZODIAZEPINES, BUT ALSO A
LOWER AGENT.
IT WOULD BE COMPLETELY
CONTRADICTORY TO IMPROVE YOUR
STUDY ACUMEN.

The caption changes to "Watch us anytime: tvo.org, Twitter: @theagenda, Facebook Live."

Steve says LET ME GIVE YOU
ANOTHER SCENARIO.
IT IS NOT UNUSUAL FOR SOME
PEOPLE TO COME HOME AFTER A LONG
DAY'S WORK AND POUR THEMSELVES A
SCOTCH AND PUT THEIR FEET UP AND
JUST... 'CAUSE THAT, WHAT'S THE
EXPRESSION, KIND OF TAKES THE
EDGE OFF OF THE DAY?
SHOULD YOU DO THAT WITH BENZOS?

Tamina says YOU SHOULD NOT DO THAT WITH
BENZOS AT ALL.
UNLESS YOU HAVE A DIAGNOSED
ANXIETY DISORDER AND YOU'RE ON A
TREATMENT PROGRAM AND YOU'RE
UNDER THE SKILFUL GUIDANCE OF A
PHYSICIAN SUCH AS DR. McINTYRE
AND YOU'RE LUCKY ENOUGH TO HAVE
A PSYCHOLOGIST LIKE DR. HERMAN
HELP YOU WITH COPING SKILLS.
THEN I SUPPOSE THERE WOULD BE A
SCHEDULE THAT'S POSSIBLE WHEREIN
YOU HAVE A PSEUDO SCOTCH IN THE
FORM OF A BENZO.

Steve says DO YOU WANT TO WEIGH
IN ON THAT?

Alexander says OBVIOUSLY WE'RE ALL IN
AGREEMENT THAT PRESCRIBING IN
SITUATIONS COULD BE DANGEROUS.
BUT WHAT WE'RE ALSO SEEING IS
THOSE ARE THE KINDS OF PEOPLE
THAT MIGHT GO OUT AND BUY ONE ON
THE STREET OR BUY ONE OF THOSE
DIVERTED PILLS.
WHAT WE'RE SEEING IN THIS
PROVINCE RIGHT NOW IS A TOXIC
DRUG SUPPLY.
IT USED TO BE MAYBE SOMEBODY
WOULD TAKE SOME XANAX AND GET
DEPENDENT OR DEVELOP A PROBLEM.
IT MAY HAVE FENTANYL OR OPIOIDS.
THIS MIXING OF DRUGS THAT
ANYTHING BOUGHT ON THE STREET
CAN'T BE TRUSTED.
WHEN YOU'RE SAYING A LOT OF
PEOPLE ARE DYING OF
BENZODIAZEPINES IN THEIR SYSTEM,
I'M NOT SURE MANY OF THOSE
PEOPLE WOULD KNOW THEY'RE TAKING
BENZODIAZEPINE.
THE TOXIC SUPPLY ON THE STREET
IS PART OF THAT.
THE STUDENT THAT GOES, BUYS A
XANAX BECAUSE THEY WANT TO FEEL
BETTER, WHAT IF IT'S NOT XANAX?
IT'S SOMETHING MORE POTENT AND
THEY DON'T WAKE UP THE NEXT DAY.
THAT'S A REALITY OF WHAT WE'RE
SEEING TOO.

Steve says ROGER, COME IN ON
THIS ONE.
WOULD YOU EVER, NOW THAT
MARIJUANA IS LEGAL IN CANADA...
AND AGAIN SOMEBODY IS MAYBE
TRYING TO TAKE THE EDGE OFF FROM
A TOUGH DAY OR THEY'RE ANXIOUS
ABOUT A BIG EVENT IN THEIR LIFE
COMING UP... WOULD YOU EVER SAY
TO THEM IF THEY ASKED YOU FOR A
VALIUM, "I'M NOT GOING TO GIVE
YOU A VALIUM.
JUST GO SMOKE A JOINT"?

Roger says NO, I WOULD NEVER TELL A
PATIENT, "GO SMOKE A JOINT."
I HAVE A TREMENDOUS CONCERNS AS
AN ADVOCATE OF THIS SPACE AND A
DEDICATED ACADEMIC IN THIS
SPACE, WHAT'S HAPPENING IN TERMS
OF RECREATIONAL USE OF WEED,
CANNABIS IN CANADA AND
ELSEWHERE, IT'S ASSOCIATED WITH
BRAIN TOXICITY IN TERMS OF
DOUBLING THE RISK OF PSYCHOSIS.
I MENTIONED THAT EARLIER IN
YOUNG PEOPLE AT RISK.
IT IS HIGHLY ASSOCIATED WITH
PROFOUND MOTIVATIONAL STATES.
CANNABIS CAN AFFECT DOPAMINE IN
THE BRAIN.
AS WELL, IT CAN PROFOUNDLY
INCREASE COGNITIVE IMPAIRMENT.
I THINK IN FAIRNESS,
RECREATIONAL WEED IS A SEPARATE
CONVERSATION.
THAT'S WHAT I THINK ANY
LEGITIMATE PHYSICIAN HAS
CONCERNS, I THINK FROM AN
ACADEMIC PERSPECTIVE THERE'S
SOME VERY INTERESTING QUESTIONS
THAT ARE ARISING.
FOR INSTANCE, IN THE ACADEMIC
SPACE, THERE ARE QUESTIONS, FOR
EXAMPLE, CAN... BE THERAPEUTIC,
CAN IT MITIGATE ANXIETY AND
DEPRESS, IMPROVE COGNITION AND
SLEEP.
THE ANSWER IS WE THINK IT MIGHT
BUT WE NEED MORE RESEARCH AND WE
CERTAINLY WOULD NOT RECOMMEND
IT, IT'S NOT FOR PRIME TIME.
I SEE THIS PROMISSORY BUT NOT
FOR PRIME TIME.
RECREATIONAL MARIJUANA, I WOULD
NOT RECOMMEND THAT.

Alexander says ONE OF THE THINGS TOO I THINK
IS VERY IMPORTANT, MAYBE PEOPLE
USE IT OCCASIONALLY IS ONE
SITUATION.
BUT FOR PEOPLE USING EVERY DAY,
ONE OF THE WITHDRAWAL SYSTEMS OF
MARIJUANA OR CANNABIS IS
ANXIETY.
SO SOMETIMES PEOPLE FEEL ANXIETY
WHEN THEY STOP IT AND THEN THEY
TAKE IT AGAIN AND FEEL BETTER
AND THEY FEEL LIKE THEY'RE
TREATING THEIR ANXIETY.
REALLY THEY'RE JUST TREATING
THEIR WITHDRAWAL.

Steve says YOU MENTIONED
DOPAMINE EARLIER.
ARE THERE EVER ANY CIRCUMSTANCES
UNDER WHICH YOU WOULD SAY, I'M
NOT GOING TO GIVE YOU AN ATIVAN,
GO SMOKE A JOINT?

Tamina says HOW NOT AN ATIVAN, GO FOR A RUN.

Steve says GO FOR A RUN?
EXERCISE, BETTER.

Tamina says DO SOMETHING ELSE.
HAVE A CONVERSATION.
MAKE A SOCIAL CONNECTION.
EVERYTHING WE DO FUNDAMENTALLY
IS MODULATING OUR BRAIN
CHEMISTRY IN SOME WAY.
SO THE IDEA THAT THERE'S ALWAYS
AN EXOGENOUS OR EXTERNAL
SOLUTION TO THE INTERNAL PROBLEM
IS A BIT OF AN ISSUE AND WE NEED
TO WORK ON SELF-REGULATION, JUST
SO LITERALLY AS A COGNITIVE OR
BEHAVIOURAL FRAMEWORK BUT ALSO
IN TERMS OF WHAT ARE SOME
BEHAVIOURS WE CAN DO ON OUR OWN,
INCLUDING DEEP BREATHING, HAVING
A GLASS OF WATER, TAKING A STEP
BACK AND THINKING.
EVERYTHING WE'RE DOING, JUST THE
WAY I'M SPEAKING IS IMPACTING
YOUR NEUROCHEMISTRY HAS AN
IMPACT.
WE CAN EVEN TALK TO OURSELVES TO
MITIGATE SOME OF OUR OWN STRESS.

Steve says HOW ARE YOU
IMPACTING... I SHOULDN'T USE
IMPACTING AS A VERB.
HOW ARE YOU HAVING AN IMPACT ON
MY NEUROCHEMISTRY IN THE WAY
YOU'RE SPEAKING.
I'M LISTENING TO WHAT YOU'RE
SAYING BUT I'M UNAWARE WHAT'S
GOING ON NEUROCHEMICALLY IN MY
HEAD AS I'M TRYING TO PROCESS
THE INFORMATION YOU'RE SAYING.

Tamina says IT WOULD BE WEIRD.
I THINK HOW IT MAKES YOU FEEL.
I THINK YOU KNOW WHAT YOU LIKE
ABOUT IT, WHAT YOU DON'T LIKE
ABOUT IT, WHETHER YOU THINK I'M
SPEAKING TOO QUICKLY, WHETHER
YOU THINK I'M NERVOUS.
THERE'S SOMETHING THAT'S
HAPPENING THAT'S FUNDAMENTALLY
ALTERING YOUR BRAIN.
WHAT WE TRY TO DO WITH
MEDICATION AND THERAPY IS ADJUST
THAT IN A MORE DIRECTED AND
GOVERNED MANNER.

Steve says YOUR PATIENTS ARE
VERY LUCKY, I GUESS.
THAT WAS A VERY GOOD ANALYSIS OF
WHAT'S HAPPENING RIGHT NOW IN MY
HEAD.

Tamina says THANK YOU.

Steve says YOU DON'T MAKE ME
NERVOUS, FOR WHAT IT'S WORTH.

Tamina says AM I SPEAKING TOO QUICKLY?

Steve says NO, YOU'RE NOT.
YOU'RE INFORMING ME, WHICH IS
GREAT.
CAN YOU WEIGH ON THIS THE WHOLE
MARIJUANA VERSUS XANAX DEBATE?

Yarissa says I WOULD NEVER RECOMMEND
SOMEONE SMOKE RECREATIONAL
MARIJUANA, PARTICULARLY BEFORE
THE AGE OF 25 WHEN OUR BRAINS
ARE DEVELOPING.
SIMILARLY, I WOULD STATE... YOU
KNOW, FOR CENTURIES, PEOPLE HAVE
BEEN USING SUBSTANCES TO EXPLORE
OUR CONSCIOUSNESS.
AND I THINK, YOU KNOW, THERE'S A
FINE LINE BETWEEN USING
SOMETHING TO RELAX AT THE END OF
THE DAY OR TO HAVE FUN AS
OPPOSED TO NEEDING IT TO
FUNCTION.
LIKE, IF I NEED A BENZO TO GET
TO WORK, IF I NEED ALCOHOL TO, I
DON'T KNOW, FALL ASLEEP, THAT'S
WHERE I THINK A PROBLEM LIES.
I DO THINK THAT THAT LINE IS
QUITE FINE IN TERMS OF
RECREATIONAL, SELF-EXPLORATORY,
CONSCIOUSNESS, HOW THEY WORK,
AND DEPENDENCY OR THE NECESSITY
IN ORDER TO FUNCTION.

Steve says I DON'T THINK YOU'RE
SPEAKING TOO QUICKLY EITHER.
AND I'M ALSO VERY INFORMED BY
WHAT YOU'RE SAYING.
IN THE INTERESTS OF EQUAL TIME,
HERE.
ROGER, COME IN ON THIS.
IS TAKING SUBSTANCES TO HELP YOU
COPE WITH LIFE'S CHALLENGES
CAUSING US LONG-TERM PROBLEMS IN
TERMS OF OUR ABILITY TO ACTUALLY
COPE WITH LIFE'S CHALLENGES?

The caption changes to "Learning to cope."

Roger says WELL, I THINK THE ANSWER IS
INFORMED BY REALLY WHAT'S THE
UNDERLYING FRAMEWORK BUT WHAT'S
THE OVERARCHING FRAMEWORK FOR
WHY WE THINK THAT PEOPLE ARE
RESORTING TO THESE TYPES OF
BEHAVIOURS?
NOW, WE'RE TALKING ABOUT
BENZODIAZEPINES, TO USE XANAX AS
AN EXAMPLE, WE'VE TALKED ABOUT
MARIJUANA.
LET'S NOT FORGET ABOUT FOOD.
FOOD IS A DRUG.
WE'RE SEEING AN OBESITY EPIDEMIC
THAT'S OCCURRING.
SO THERE'S A LARGER QUESTION:
WHY ARE WE AS HUMANS SO INCLINED
TO REACH FOR EXOGENOUS
SUBSTANCES THAT PROVIDE EITHER A
TEMPORARY REWARD AND-OR
TEMPORARY ANXIETY REDUCTION?
AND I THINK THIS IS A VERY
INTERESTING REALLY... A PROCESS
TO WALK THROUGH WHAT'S ACTUALLY
HAPPENING AND CLEARLY IT WOULD
BE IMPOSSIBLE TO HAVE A
COMPREHENSIVE MODEL OF THIS
WITHOUT BRINGING IN SOCIAL
DETERMINANTS.
IN OTHER WORDS, WHAT'S HAPPENING
IN SOCIETY AT LARGE?
WE HEAR STATISTICS, FOR EXAMPLE,
WAGE STAGNATION.
WE HEAR ABOUT INCOME INEQUALITY.
WE HEAR ABOUT CANADIANS AND
AMERICANS WHO ARE HOUSE POOR AND
IN DEBT, STUDENT DEBT.
WE HEAR ABOUT, YOU KNOW, THIS
DICHOTOMY BETWEEN THE HAVES AND
HAVE-NOTS.
THIS ASPECT IS PLAYING CLEARLY
SOME ROLE IN THE GENERAL STRESS
THAT PEOPLE ARE EXPERIENCING.
WE ALSO IN FACT HAVE TO ALSO
WONDER TO WHAT EXTENT THIS IS
CAUSING AND-OR IS A CONSEQUENCE
OF WHAT I REFERRED TO EARLIER,
MURPHY, THE SURGEON-GENERAL IN
THE UNITED STATES A WHILE AGO
CALLED THE LONELINESS EPIDEMIC.
I AGREE.
I THINK PSYCHOSOCIAL TREATMENTS
ARE THE BED ROCK OF TREATING
SOME OF THESE PROBLEMS.
BUT IT BEGINS WITH A VERY
CAREFUL FORMULATION AS TO WHY
THE PERSON IS EXPERIENCING THIS
INABILITY TO REDUCE THEIR
ANXIETY AND-OR FEEL A SENSE OF
FULFILLMENT AND REWARD AND FOR
DIFFERENT PEOPLE THERE'S
DIFFERENT ANSWERS.
WE VERY MUCH BELIEVE THAT SOME
OF THE BASICS, GOOD SLEEP,
EXERCISE, AND GOOD SOCIAL
ENGAGEMENT AS WELL AS A GOOD
DIET... THESE ARE ALL KEY
FACTORS.
BUT I THINK THAT THERE'S A
LARGER ANALYSIS HERE WHICH I
THINK IS REALLY INTERESTING, NOT
JUST FROM THE POINT OF VIEW OF
CONCEPTUALIZING IT BUT HOW CAN
YOU PREVENT AND REALLY REDUCE
THIS STRESS THAT IS OCCURRING IN
THE GENERAL POPULATION.
PEOPLE LIKE TO POINT THEIR
FINGER AT SOCIAL MEDIA.
I THINK SOCIAL MEDIA MAY BE A
CAUSE, CONSEQUENCE THAT HAS NO
IMPROVEMENT IN THE PROCESS OF
THE LONELINESS EPIDEMIC AND SOME
OF THE STRESS BUT CERTAINLY HAS
BEEN CAUGHT UP INTO THIS
CONVERSATION AS WELL.

Steve says FOR ARGUMENT'S SAKE,
ALEXANDER, LET'S GO TO YOU FOR
THIS, AND WE HAVE A LITTLE LESS
THAN A MINUTE AND CHANGE TO
TACKLE THIS.
IF PEOPLE WATCHING THIS HAD A
HEADACHE, THEY WOULDN'T THINK
TWICE ABOUT TAKING AN ASPIRIN.
WE'VE CERTAINLY SPENT A LOT OF
TIME TRYING TO CONVINCE PEOPLE
THEY SHOULDN'T IGNORE THEIR
MENTAL HEALTH PROBLEMS AND
THEREFORE THEY MAY LOGICALLY
INFER THAT IF THEY'VE GOT A
MENTAL HEALTH ISSUE, THEY SHOULD
TAKE SOMETHING FOR THAT TOO.
HAVE WE GONE TOO FAR ON THAT?

Alexander says EVERYTHING IS A BALANCE, RIGHT?
YOU KNOW WHAT?
FOR MOST PHYSICIANS AND
PATIENTS, YOU WANT TO SEE THEM
GET BETTER.
BUT WE'VE SEEN CREATIVE
PRESCRIPTIONS PEOPLE GET HANDED.
PEOPLE GET HANDED PRESCRIPTIONS
TO GO TO AN ART GALLERY OR A
PRESCRIPTION TO GO GET EXERCISE.
SO YOU'RE LEAVING THE DOCTOR'S
OFFICE WITH SOMETHING, SOMETHING
PHYSICAL IN YOUR HAND OR A
TICKET, BUT AT THE SAME TIME
SOMETHING THAT MIGHT HELP YOUR
MENTAL HEALTH IN THE LONG TERM
MUCH MORE THAN A PILL.

The caption changes to "Producer: Cara Stern, @carastern."

Steve says GOTCHA.
I WANT TO THANK EVERYBODY FOR
COMING ON TO TVO AND HELPING US
OUT WITH THIS.
THIS WAS REALLY INTERESTING.
ROGER McINTYRE HEAD OF
PHARMACOLOGY AT THE U OF T.
THANKS FOR BEING ON THE LINE IN
QUEENS, NEW YORK.
TAMINA EAPEN FROM CAMH, AND
ALEXANDER CAUDARELLA FROM THE
U OF T AND YARISSA HERMAN FROM
CAMH AS WELL.
THANK YOU ALL FOR COMING ON TO
TVO TONIGHT.
WE REALLY APPRECIATE IT.

The caption changes to "Subscribe to The Agenda Podcast: tvo.org/theagenda."

All the guests say THANK-YOU.

Watch: Rethinking Anxiety Meds