Michael Jackson's Benzodiazepine Tolerance

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For many of us, the news of Michael Jackson's untimely transition was deeply saddening. It would be further disheartening, however, if the current focus on painkillers and anaesthetics overshadows the impact his benzodiazepine use had on his life. A recent CNN news article stated that, "Michael Jackson took more than 10 Xanax pills a night, asking his employees to get the prescription medicine under their names and also personally travelling to doctors' offices in other states to obtain them."

When more of a drug is needed in order for the desired therapeutic effect to be achieved, this is known as 'tolerance'. Michael's behaviour is a classic example of someone in benzodiazepine tolerance. He was truly hooked and was desperate to acquire more to increase his doses. We will never know if he fully understood how the drug was affecting him, or whether he tried to discontinue but could not cope with the withdrawal effects. Did any of the doctors who treated him since his first prescription know enough about benzodiazepines to be able to differentiate between his tolerance symptoms and other presenting issues? If so, how was this handled?

Chronic benzodiazepine use can result in the most bizarre and unlikely manifestations of side effects. In addition, if tolerance has developed and the safe maximum dose has been achieved, withdrawal symptoms will surface. A user can therefore experience memory impairment, paranoia, agoraphobia, insomnia, muscle pain and a host of other physical and psychological symptoms long before discontinuing the drug.

There are also far-reaching social repercussions. Many survivors of benzodiazepine addiction recall having experienced a lack of discernment combined with intense incoherence while on the drug. They made unsound relationship, financial and other life decisions while struggling to function in a constant zombie-like state. People who have not been directly affected sometimes find this devastation difficult to fathom and may blame it on 'other psychological issues'.

While we can't attribute all Michael Jackson's challenges to his benzo use, those familiar with this class of drugs may easily spot the parallels and can now appreciate how unwell he must have been. Anyone who knew him personally and happens to research benzodiazepines will inevitably identify links between his usage, behaviour patterns and health crises.

It is possible that Michael did try to quit. Discontinuing benzos is often problematic and, sadly, many people reinstate in order to be able to function in their daily lives. Abrupt withdrawal or quitting 'cold turkey' can be dangerous. Users should taper under medical supervision with adequate additional support. Those with mild dependencies recover within weeks or a few months. Long-term users, on the other hand, can be subject to a much more prolonged and challenging withdrawal experience. According to Professor Malcolm Lader of the UK's Institute of Psychiatry, "It is more difficult to withdraw people from benzodiazepines than it is from heroin."

The 'king of pop' left us his legendary music. It would be premature to conclude that the outcome of current investigations will impact the general atmosphere of denial regarding the damaging effects of long-term benzodiazepine use. Still, we remain hopeful. In the meantime, for the vulnerable ones in the 'land of benzos', he has brought awareness and much-needed attention to a hidden, global problem - one of epidemic proportions.