Alprax Attack

All this especially as Al has become the new asp, an always-at-hand ‘stress reliever’ and ‘anti-anxiety’ pill in these stressful times where lack of sleep, constant jetsetting, too much partying, emotional strains and other ailments constantly nag the new chic. Any inclination to stress — real or imagined — and trembling hands reach out for the familiar, comfort bottle in the Prada bag.

Explains Dr Rakhi Anand, a Delhi-based psychologist, ‘‘In recent times, the rate of abuse of prescription drugs has increased dramatically among the elite class because they have money but lack of a good support system.’’ If it is boyfriend problems, pop a pill. Anxiety over a new contract? Pop a pill. In fact, as a well-known fashion designer reveals, Alprax is also often popped to come down after getting ‘‘wired.’’

Says the designer, ‘‘When people indulge in substance abuse like Coke or Ecstacy, it leads to too much energy in the body and, in the case of some drugs, you can be hyper-energised for 24 hours non-stop. A lot of people pop Alprax to calm down after the high.’’

The pill’s link – however remote – to the tragic twin suicides has had the chatterati look at the wee little bottle in new light. Is Alprax really the best friend they believe it to be or is it something so sinister so as to swallow you up one day?

Doctors say the link between Alprax addiction and suicide is not one to be ignored. Dr Promilla Kapur, a Delhi-based sociologist and psychologist, issues a timely warning when she says, ‘‘Alprax abuse may lead to disbalance in the natural instinct for self-destruction and self-preservance. When a person is on drugs, the tendency to kill may overcome the tendency to preserve which can lead to suicide.’’ According to pharmacologists, benzodiazepine drugs — which, besides Alprax, includes other stress relievers such as Calmpose, Valium, Restill, Placedox, Restyl, Activan, Larpose and Trikaare — are among the highest selling medicines in the country. The drugs, when taken in large doses, give the same high as alcohol.

Explains Dr Samir Parikh, Consultant Psychiatrist, Max Health Care-Biochemically: ‘‘A high dosage of Alprax and other drugs of the benzodaizepine group have the same affect as alcohol. Even the effect on metabolism, the nature of dependence and withdrawal is similar to alcohol.’’ Doctors are equally candid when they admit that with the easy availability of prescription drugs over the counter — with most chemists rarely insisting on a written prescription — these drugs are becoming alternatives to conventional substances of abuse like cocaine, heroin and opium.

Lack of effective regulations for the sale of prescription drugs is the major cause of abuse problem. The fact it is much easier and cheaper to procure these medicines here than in most countries was revealed recently when, at a glittering but discreet celeb wedding in India, where guests were flown in from all over the world, one invitee from England went on a shopping spree. His destination: chemists across the city. His list: Alprax .5, Alprax .25, Viagra, and other innumerable pills. ‘‘My friends back home will be thrilled with all the presents I’ve got them,’’ he noted happily.

‘‘People also get hooked if they continue the medication without consulting the physician,’’ explains Dr Alok Sarin, psychiatrist, Sitaram Bharatiya Institute of Medicine and Research. ‘‘These medicines may be prescribed to give relief in cases of severe depression but they are prescribed for not more than a couple of weeks, till the anti-depressants start acting. However, many patients don’t come back to the doctors after the initial cure but they continue with the drugs as they have a prescription for the pills.’’ As benzodiazepine falls in the Schedule X drugs, procuring and selling them without prescription is a noncognisable offence and those caught violating the the norms stand to get their licences cancelled. Chemists are not only required to ask for prescriptions but also to check that the prescriptions have been updated.

Yet, the lapses continue. Recalls Suhel Seth, CEO, Equs Advertising: ‘‘When we were handling the account for Lifespring, the perennial problem we faced was that we were losing business to those who were being unethical in the trade. When we asked for a doctor’s prescription for these pills or ‘escape medicines,’ they would simply go to other stores. We need stronger regulations and a sustained campaign from departments like the Ministry of Health.’’

In a city increasingly riddled by stress, where psychologists and emotional-disturbance fixers are mushrooming like fashion boutiques, some blame must go to doctors too. A young student in Delhi recounts going to see a reputed psychoanalyst who, right after the first session, prescribed her three Prozac tablets a day. ‘‘I refused to take them,’’ she recounts, horrified, ‘‘because as far as I know, analysts are not allowed to prescribe these drugs.’’ She is right, these drugs can be prescribed only by a qualified MBBS doctor.

In cases of dependency, the problem starts when people cannot differentiate between stress and clinical depression. ‘‘Doctors normally do not prescribe medicines for stress but if a person feels a little stress he may pop a pill,’’ says Dr Sarin. Experts also suggest abuse of prescription drugs is more prevalent in women, as it has less stigma attached. ‘‘Since benzodiazepine is less of a sedative than alcohol, they can be consumed even during the day and go unnoticed,’’ adds Dr Sarin. Cases of addiction range from mild to severe.

Five years ago, Aarti Verma (46), at the advice of her sister, started with a tablet as she suffered from insomnia. ‘‘I started with an occasional pill but now I need at least six to seven tablets to induce sleep,’’ says Verma. Pooja Agarwal (48) took refuge in Alprax as she found it an easy way of relaxation — after 12 years, she pops a pill if her water supply is not on schedule or if her maid does not turn up on time. According to her doctor, Agarwal has now restricted her activities and mostly remains confined to her house. ‘‘She never knows when she might develop the craving. Her social interaction has suffered and she cannot even do routine chores,’’ says her psychiatrist.

Besides dependence and dose addition, the drugs can lead to several side effects. Long-term use can lead to difficulties in memorising, increase in anxiety, loss in inhibition, agitation and irritation, drowsiness, lack of coordination and balance while driving and handling heavy machinery. The drugs can also cause secondary impotency in males. Gynaecologists suggest that women who abuse drugs are prone to having children with congenital defects such as mental retardation and premature birth. According to doctors the most severe of the side effects is the ‘‘lack of inhibition’’ — people start doing things which they would not do if not on medication. A study conducted by WHO shows depression to be the second largest cause of morbidity. Perhaps the time has come for a wake-up call on prescription drug abuse.

(Names of patients have been changed to protect identities)