The opioid epidemic is now a well-known phenomenon, drawing justified attention in medicine, politics and pop culture. But how much do you know about benzodiazepine dependence? In this episode, author Melissa Bond tells us how she unintentionally ended up becoming deeply dependent on benzos, a journey chronicled in her memoir “Blood Orange Night.” Mayo Clinic pharmacist Dr. Michael Campbell joins us to provide expert insight on this complex issue. This episode was made possible by the generous support of Ken Stevens.
The opioid epidemic is now a well-known phenomenon, drawing justified attention in medicine, politics and pop culture. But how much do you know about benzodiazepine dependence? In this episode, author Melissa Bond tells us how she unintentionally ended up becoming deeply dependent on benzos, a journey chronicled in her memoir “Blood Orange Night.” Mayo Clinic pharmacist Dr. Michael Campbell joins us to provide expert insight on this complex issue.
This episode was made possible by the generous support of Ken Stevens.
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Dr. Denise Millstine:Welcome to the “Read. Talk. Grow” podcast, where we explore women's health topics through books. In the same way that books can transport us to a different time, place, or culture, “Read. Talk. Grow.” demonstrates how they can give us a new appreciation for health experiences. Books can provide understanding of health topics and provide a platform from which women's health can be discussed. At “Read. Talk. Grow.,” we use books to learn about health conditions in the hopes that we can all lead happier, healthier lives.
I'm your host, Dr. Denise Millstine. I'm an assistant professor of medicine at Mayo Clinic, where I practice women's health, internal medicine, and integrative medicine. I am always reading and I love discussing books with my patients, my friends, my professional colleagues, and now with you.
I'm so excited about our episode today. Our book is “Blood Orange Night: My Journey to the Edge of Madness” by Melissa Bond. Our episode will focus on a tricky and inadequately discussed group of medications called benzodiazepines. These sedative, relaxant and anti-anxiety medications have enormous potential for dependance and addiction, with dangerous, even lethal, withdrawal symptoms for those who try to come off them too rapidly.
They're commonly known by brand names such as Ativan, Valium, Xanax and others, as well as generic names like lorazepam, diazepam, and alprazolam. These medications can be prescribed for any number of clinical indications but have to be used with care.
Our guests today include Melissa Bond. She's a narrative journalist and poet. Her memoir, “Blood Orange Night” was selected by The New York Times as one of the best audio books of 2022. Melissa has been a regular contributor for Mad in America, and she's been interviewed and featured on “ABC World News Tonight,” PBS's “Story in the Public Square,” “RadioWest,” and many podcasts. She lives in Salt Lake City with a wild bunch of teenagers. Melissa, welcome to the show.
Melissa Bond: Thank you so much. I'm really excited to be here.
Dr. Denise Millstine:My second guest is Dr. Michael Campbell, who's a board-certified Ambulatory Care Pharmacist. He works under a collaborative practice agreement with Mayo Clinic providers to improve patient outcomes in a wide variety of disease states. Largely, his focus involves resolving medication-related problems with individuals for chronic disease, including medication dependance.
Dr. Michael Campbell: Dr. Millstine, Melissa, thanks for the invite, and I'm really excited to talk about this very important topic for our listeners today.
Dr. Denise Millstine: “Blood Orange Night: My Journey to the Edge of Madness” is Melissa Bond's memoir of what starts as severe insomnia that's initially dismissed and unsupported by health care professionals and her support system alike.
As the mother of young children, Melissa finally meets a doctor she calls in the book “Dr. Amazing,” who prescribes a medication that initially provides her with a glorious full night of sleep and starts what will become her dependance on and tolerance to benzodiazepines that she doesn't even recognize until she's deep in it, facing the arduous task of attempting to slowly wean down on the medications to get her life back.
Melissa, this book is so brave and we're going to talk about these medications, but let's start talking about insomnia. So many of our listeners will have had sleepless nights, but this was insomnia to another degree. Can you describe that for us?
Melissa Bond: Yeah. Because it was it was shocking to me. I had what I call the like, chamomile-popsicle kind of insomnia, where you have like an hour or two, you know, and you're up and you're sort of like, when am I going to get back to sleep? Or you're restless.
But this truly, the description, I'm pretty sure I put this in the book, was a scene out of “Pulp Fiction” where the character Uma Thurman has overdosed on heroin and John Travolta, his character, he realizes, has got to do something and shoves like a huge needle into the heart that's, I think, of adrenaline. And she lurches up, this is what I remember, is Uma Thurman lurching up.
The night that it happened, it was a very distinct night. I remember putting my son to bed and around 9:30, I literally felt a sudden rush in my chest and a breathlessness, and I lurched up and I felt jittery and that was the first night of what I believe, the first night I did not sleep at all.
There's probably times where you drop off and you get maybe a minute or two or something like that, but what I experienced was night after night of truly barely sleeping, maybe 20 minutes, maybe an hour or two, such that I was truly on the verge of a psychotic break for that first trimester that I was pregnant.
It was unlike anything I've ever experienced and for those of your listeners who've experienced it, you know, you start having cognitive decline. You can't think straight. You can't remember things. Your body starts falling apart. There's a tremendous amount of pain. So it truly felt like CIA level interrogation techniques, you know, but as a mom.
Dr. Denise Millstine: Yeah and oh, by the way, you had to be up and functioning during the day, not feeling well and also being really dismissed when you say, I didn't sleep at all last night, you describe some scenes where people say to you, “Oh, surely that's wrong, you just don't know that you slept, right?” And I think that adds just insult to injury.
Michael, there are a lot of medications that we use short term for insomnia, maybe if somebody is traveling between time zones or they have an abrupt stress or situation, can you give us a high-level understanding of what some of those medications might be?
Dr. Michael Campbell:Sure. I think some of the medications that Melissa discusses in her book or that we've talked about today, are predominantly the benzodiazepine drugs. So you mentioned three, those are probably the three most popular alprazolam, lorazepam, clonazepam, which the brand name for that medication is Klonopin. Those drugs can be utilized short-term. They're generally not the first class of drugs we would go to. We usually utilize medications like zolpidem, zaleplon, and eszopiclone. Those drugs are newer, what we call benzodiazepine receptor agonists. So you can think about those like drugs that piggyback on the same location in your brain where alprazolam, lorazepam and diazepam work at. They were thought to have fewer side effects, but as we'll discuss later, we've later found out that that's not necessarily true in most instances.
Dr. Denise Millstine: And a lot of people would use an over-the-counter antihistamine for some short-term sleep support. Would you agree? So often this will come labeled as a P.M. and very often it's going to be a generic formulation of diphenhydramine, which is also called Benadryl. But those too, while they can make you sleepy, can give you a hangover effect and can build up tolerance. So one of the main points to make here is that there are some medications to support sleep in the short term, but all of them are going to have side effects and need to be used with caution.
Okay. So Melissa, you're not sleeping. You're absolutely desperate. You're pregnant. So (there are) very few medications that doctors feel comfortable giving to pregnant women. You finally see somebody who believes the severity of what you're experiencing. And zolpidem, which Michael just mentioned, also called Ambien, is prescribed to you. Talk about what happens with that medication.
Melissa Bond:So I had gone, I was just past my first trimester milestone, and I've gone in to see one of the nurse midwives that was in this clinic that I was seeing and really think I scared (her), it was this sort of young nurse midwife, and she was completely unprepared for the level of distress I was in. I was not being coherent. I was talking to her and then I would flash to the painting that was on the wall and say like, “Oh, that's so lovely.” I think I actually said to her, “If I don't get help, I'm going to ram my head into a concrete wall.” I just kept thinking, “I've got to knock myself out.” So she put her hands up and backed out of the room and said, “I'm going to go get a consult.”
So she prescribed Ambien, as you said, with Benadryl. And that first night I slept like seven hours and I thought, “Oh my gosh, I can be the “Cat in the Hat” of motherhood now. I can teach my son to sign in Egyptian. I have got this nailed. Good.” But one of the things about pregnancy is you have all kinds of bizarre body symptoms, and we don't clinically know. We know a lot, but there's so many things that can happen. And I was having lots of side effects. I was having heart palpitations. I always felt like I needed a chaise lounge right next to me because I might faint and I didn't know, is this the pregnancy? Is this Ambien?
And I did have a lot of what I've heard people be cautioned against — is the breakthrough waking. And so there was several nights that I would wake up after three hours of sleep, and I would be convinced I had to drive to southern Utah to buy a donut or something like that. You know, like, I mean, it was just like real craziness. And then the sleep, actually, because I was prescribed it throughout the rest of my pregnancy, the efficacy of the drug waned fairly quickly, and I was back down to maybe three or four hours a night, which felt awful, but I at least wasn't on the verge of a psychotic break.
Dr. Denise Millstine: So, Michael, these are common effects of using zolpidem for a long time. This behavior where you kind of wake up or maybe you don't even fully come awake and you're going to drive your car, we call those parasomnia. Is that something that you see in people who are on these medications? And are there other side effects to the medications when they're used longer than a very short term?
Dr. Michael Campbell: That's a very good question, Dr. Millstine, and it's multiple factorial. And I want to start by mentioning for the audience that as pharmacists, we like to break patients into two buckets. So patients 18 to 64, they oftentimes experience different side effects in the beginning and late in therapy with these drugs. And then patients over the age of 65, experience a different set of, I'll say, benefits and concerns with these drugs. So customarily, everyone, whether you're 18 years old to 98 years old, will experience a lot of benefits in the first four weeks. Okay.
But after the first four weeks, that's when we start to see, you know, the deleterious effects where, you know, I've seen patients or had their loved ones tell me, you know, my husband woke up and he, in his underwear, was watering the neighbor's grass at 2 in the morning and he didn't recall that that ever transpired.
Other spouses have said, well, you know, my spouse went to the grocery store, bought a bunch of foods he's never eaten, and returned home with them. I've had other patients tell me, you know, I baked an entire chicken overnight and the only reason I know I did that was because I was awoken because it was burning. So those things can transpire. They're not common, but maybe 5% of patients will experience effects like that if they take the drug months to years on in.
Dr. Denise Millstine: No matter what, it's terrifying because the idea that you would operate a car or interact with other people or expose yourself is really so frightening. And Melissa, you talk in the book about, you called your memory just vapor the next day. You don't even necessarily have any recollection of this.
Okay, let's keep moving the story forward. So we just said you were early in this pregnancy. You took the medication and the messaging I think you were getting from your team was, this is just the pregnancy and your stress. Once you have your baby, you'll go back to being able to sleep. But unfortunately, this is not what happens for you. You continue to struggle and now have two small people to take care of on a regular basis, one who's an infant. And you find Dr. Amazing. So he gives you an explanation: “This is your cortisol. You're just too stressed. Here's what we're going to do.” Tell our listeners.
Melissa Bond: So I had gotten off the Ambien when I delivered my daughter thinking, you know, as you said, that it was hormonal. And three months in, I was just clawing at the walls again. She was a high-need baby, I was nursing but felt, at that point ,I was back to one or two hours a night.
So I go to see Dr. Amazing, who to me felt as though he straddled the line between sort of Western medicine and then traditional, more homeopathic, really was interested in Chinese medicine and I thought, oh my gosh, this is great. I've got someone who doesn't want to just throw medication at me but isn't resistant to it, you know?
And he said, yes, it's a cortisol issue, but we need to get you sleeping or your adrenals will not repair themselves. So I'm going to give you this wonderful drug. It's a sedative hypnotic. The two lines I remember he said, “It's about as addictive as coffee” and “I know someone who has taken them for 19 years with no problem. This is a wonderful drug.” And so I just took that at face value because it had been so many months of just basically surviving. As you said, I had a child with a disability who was a year and a half, and then I had a newborn.
Dr. Denise Millstine: This part really made me cringe because of course, I practice integrative medicine, and while I'm glad you got somebody to finally listen to you and be thoughtful about your care, here started the beginning of what we'll talk about more and how it manifested.
So, Michael, do you want to talk about the benzos in terms of how they work, why Melissa started to need higher doses as she continued to use them?
Dr. Michael Campbell: Yeah. The first thing that I want to highlight for the audience is that
these benzodiazepine drugs and the other subset of piggyback medications, zolpidem, zaleplon, and eszopiclone. So Ambien, Sonata and Lunesta, those are the brand names. All those medications are controlled substances, meaning that the Drug Enforcement Agency has labeled those medications as things that pharmacists and physicians can utilize to help patients with insomnia or whatever disorder we're treating but we need to be aware of and, more importantly, counsel patients that these medications have a higher potential to cause harm than the shorter term drugs that are over the counter, like Benadryl, ZzzQuil, Unisom, diphenhydramine, doxylamine. So those medications are not controlled substances, and they can be used and safely purchased over the counter, without a pharmacist or doctor's advice, counseling, prescription, or an order. Even those medications, after two weeks, you should still consult,
your physician about this.
The benzodiazepine drugs, they bind to the same part in your brain that alcohol binds to. So they bind in a different fashion as well and have a different set of effects. And we know alcohol is not necessarily a drug. It's more of a food, but it has regulatory parameters behind it and people are counseled on that just by the manufacturers. When with benzodiazepines, sometimes we only talk about the benefits and not the concerns. The reason I think, or know, that Melissa developed tolerance to these medications is that when you take them long-term, longer than four weeks, these receptors in your brain, unlike (drugs like) caffeine, which is in coffee, and unlike Benadryl and Unisom, your brain starts to make less of these receptors.
So every time, you know, the four milligrams breaks into its tiny chemical and hits its one receptor, let's say you have a million of those in your brain. Well, after four weeks, that may only turn into 750,000. A year later, it could only be 500,000. So the moral is over time, the same dose is less effective, requiring more of it to produce the same response. So that leads to misuse, abuse, tolerance, dependance and the most problematic phase is the addictive properties that it can cause.
Dr. Denise Millstine: And the first medication you were taking, Melissa, if we haven't said yet, was lorazepam, which also comes as the brand name, Ativan, very commonly used medication from this class. This next section of your book you called “The Lost Year,” an excellent title for what you experienced. Will you tell our listeners what that was like.
Melissa Bond: Yeah. So let me see, I was prescribed the medication and then within the next six months, had the medication upped by two milligrams until I was up to six milligrams of Ativan, to be taken nightly by prescription from my doctor. And so I did that, never did more. And
after I had gotten up to six milligrams … the doctor also was not in town a lot, so I all of sudden, when I had felt vaporous with taking the Ambien, I was truly like a ghost. I remember my husband and I moved into a new house because we were going to have two kids. I was losing my balance. I was constantly walking through rooms and running into things. I would be falling. I would hold my daughter in the yard and would like walk, take a step and fall. I couldn't remember anything from one day to the next, which was very disturbing for me because I had been narrative journalist, and so tracking stories and tracking details was very important and very much a part of what my profession was and required.
So not knowing that someone had come to the door, a friend had come and said, “Hey, you know, let's hang out tomorrow, we'll get the kids.” And me, having no recollection whatsoever, was very odd. And so this went on for a number of months, where I really was just sort of a ghost, trying to make sure I was taking care of the kids, not remember what I needed to get at the grocery store. Did I make sure that my son wasn't at the ge has Down's syndrome and autism. And so we had to have a gate in the front because he loved running down the center of a street straight towards the car when he was younger. And so we had to make sure the gate was closed. There was always this constant panic of, did I lock the gate? Did I lock the doors? What have I forgotten?
And on top of that, I started feeling a tremendous amount of pain in my body. My joints would ache. My eyes started sort of shivering. I ended up not being able to read very well. I felt like I had the flu 24/7 and I think it's remarkable. I think probably anyone that has had sort of a long-term illness will know that, denial is huge. And also when you don't understand, trying to fit the narrative of your life into some kind of bucket that makes sense to you. So I kept saying, boy, parenting is the hardest thing I've ever experienced. I'm exhausted all the time and I feel sick.
And then the moment where everything changed was a night when I was picking up my daughter out of the bath and was taking a step outside of the bath to go to her bedroom and put on her little pajamas. And I took a step, and I literally fell like a dead body from a bridge. My muscles just completely went liquid, almost rammed her head into a corner wall until I, like, flipped over and shoved my shoulder into the wall and I lay there and I thought, I must have MS. I must have some kind of neurological condition because this is how it starts. There's cognitive impairment. There are balance issues. I'm not tracking with my eyes. All of these things and then 45 seconds later, my legs came back on. And then I thought, wait a minute, that medication by Dr. Amazing, how much do I really know about it? And I started to do the research.
Dr. Denise Millstine: Michael, when I prescribe these medications to patients, which I do sometimes, I will often give the warning that these medications can be a trap. Nobody starts taking these medications wanting to be dependent on them. But, as you get into this cycle of, you know, whatever, if you're taking them for anxiety or for sleep or for muscle spasms, right,
then your body gets accustomed to it and you keep taking them and you keep taking more, and they have side effects. Can you react to that description, that it's a trap? What I often will say is we just have to respect this medication because it's powerful and it's power can be beneficial, but it also can sort of pull you into what Melissa has just described as a terrifying situation that's very hard to get out of.
Dr. Michael Campbell: Yeah, a lot of what Melissa, you've described today is resonating with me as a pharmacist. And one of the things I want to share that we don't oftentimes highlight is that lorazepam or Ativan, specifically, is a drug that we use in critical care ICU units and those are lifesaving and emergency medications. Well, there's no emergency that lasts greater than four weeks. So if we ask any patient who we save in the ICU, we save their life, “Hey, would you like to take this medication for the next four weeks to four years?” All of them would decline doing so. And Ativan is one of those medications in those code carts. And when you take medications like that long term, it is a trap. It puts your body back into the state of trauma that you've just been rescued from. Insomnia can seem very emergent and when you rectify it with that first dose, remember receptors are being downgraded, so there's less of them. They're not meant to be utilized long-term. And I don't think that we tell patients exactly what to expect, what to do if they start to experience those side effects and how to safely use the medicine beyond four weeks, mainly with other medications, therapies, and follow up appointments with therapists, physicians, pharmacists and nurses. It takes a team to manage long-term use of emergent medications.
Dr. Denise Millstine: I want to be clear about these medications because there are some times, there are some clinical situations where they need to be used long-term. And as long as that's the intention and the risk-benefit analysis has been done for the patient. And healthcare professionals have had the conversation around, “What are the risks?” It's not that these medications are never taken long-term. So if listeners are on them and asking that question, please talk to your specific healthcare team about that.
But, Melissa, you really trusted this doctor and trusted the explanation for everything that you were going through. And now you were in this sort of hole that you had to basically find your way out of on your own, or find people to help you and that wasn't easy either. Talk about finally finding a team that could help unwind everything that had happened.
Melissa Bond: Yeah, so one thing to note is that this was when I received my first prescription, this was 2010. So 14 years ago. The awareness, really when I talk about awareness, there was medical literature that really made it clear even back then, I mean, we've known for a long time that benzodiazepines really disrupt the brain and dysregulate it. However, what we know medically and what's in the medical papers can often be really redirected with marketing, with intelligent and clever marketing. And then that becomes part of the cultural milieu and the way people talk about them. You know, like Stephen Colbert would joke about Xanax and there was like a cultural lexicon in a way of talking about them much more back then but it's still true today. That was very casual, very much like, this is your chill pill, you know, it was like, “Oh my gosh, honey, you just need to like, take a chill pill and then you can take care of the rest of your day,” or, you know, the executive that's going in for a crazy board meeting. And so there wasn't an awareness.
And so for me to suddenly realize that I was in that hole — and not only was I in that hole, but I couldn't just stop. And it wasn't because the insomnia would come back. If I stopped cold turkey, I could have a fatal seizure or go psychotic and, you know, rave about the apocalypse in my yard. Neither of which I wanted. But I wanted more than anything to get off these drugs. I'd always been a very like, granola-ish, you know, rock-climbing yoga girl. And suddenly realizing that what I'm seeing in the research is that for me to effectively get off without causing even more trauma or having a fatal seizure, I would have to slowly titrate over months, if not years, to enable my brain to recover functioning. And I thought, I have never heard of a withdrawal that could last years. It’s not just like you're slowly tapering, you're in pain the whole time. And that was something that I was shocked was not communicated to me by my provider.
Dr. Denise Millstine: And oh, by the way, life continues to go on. While you're going through this process.
Melissa Bond: Kids are still asking for milk.
Dr. Denise Millstine: Yeah. And you still need to function, and you know, the next thing can easily happen. Michael, what's the danger in just stopping these medications, particularly if you're on a higher dose?
Dr. Michael Campbell: So the danger is, and commonplace, to experience withdrawal. Now some of that can be managed or mitigated at home if you're simply aware of the withdrawal symptoms, the common ones being dizziness, fatigue, headache, nausea — that can happen with caffeine.
These drugs though, with Ativan or Ambien, they have a more complex, we'll call it, a withdrawal syndrome, that can turn into an urgent, emergent or life-threatening situation if you don't get prompt medical intervention. And those withdrawal symptoms, which do not happen with Benadryl, caffeine, or, you know, other sleep medications like trazodone, chills without fever, night sweats that are unexplained, that you didn't have prior to stopping the medication, electric-like brain zaps or limbs zaps that you have a sensation of. Those could last three months to a year after stopping the medication. Tremor, vivid dreams, muscle pain, nerve pain. Those things, when they happen in conjunction with each other, create this kind of withdrawal syndrome that requires medical intervention and other prescription drugs to actually treat.
Dr. Denise Millstine: I think one of the important comparisons, since now in 2024, I don't know that there's more awareness with benzodiazepines, but certainly there's more awareness with opioid use disorder. And we hear quite a bit, or we see quite a bit of the portrayal of withdrawal from the opioids, whether that's prescription medications or heroin. Most people can picture what that withdrawal syndrome looks like from those medications and yet it's not as life-threatening as the withdrawal that happens with benzodiazepines. And yet we treat these medications, I would say, culturally, as a general statement, a lot more casually.
And so this is where with my patients, I often will say just to be aware of what a trap it can be. Because nobody said to you, “Hey Melissa, take this illicit medication or this illegal medication.” They said, “Here's this wonderful medication that comes from your local pharmacy, and I'm going to write you a prescription and then more prescriptions for it.”
It's just so easy to get into the situation, and of course your example is an extreme one, and I'm sorry that that happened to you. But for even people who are taking lower doses, they have to be very careful when they come off these medications. And I know you realize that. And thankfully, you were able to finally find a doctor who would be slow and conscientious with you. That must have been such a relief to just finally have somebody who would partner with you.
Melissa Bond: Oh my gosh, yeah. So I had worked with a really lovely doctor for, I think, five months prior, and she had said to me, “I've never gotten anyone off this high of a dose. I don't even know how we're supposed to do it.” And we tried for about five months and my withdrawals were so severe, she said, “I'm afraid we're going to kill you. I'm going to look through my entire network and see if I can find someone that's a specialist.” And I thought, this is crazy, that this is a drug that is used so commonly and that people can get it just by saying, I'm not sleeping well and not be informed that this is a radically addictive drug, a very, very strong, powerful, great drug in the arsenal that is needed for emergency care, but for long-term use is really dangerous.
So she looked through her network, didn't find anyone. I finally checked in with several people that I knew in my network and somehow both of them came up with the same person who was one of two addictionologists in Utah, and having someone that really got it was like a bomb, because even my friends were like, “Wait, what? Okay, so you're addicted to something. Oh, no. You're dependent. Okay, so what does that mean and why does it have to take a year?” They've never heard of such a thing. So to also be in a state, where my social support system was in a state of disbelief. Like they were trying to put it into some narrative that they understood, and they were like, “Why don't you just go to one of those rehab centers and sweat it out for a month?” Like we don't get it. So to find someone who really got it, that could also educate me even further and help with the intense withdrawals was just a miracle for me.
Dr. Denise Millstine: I don't think it can be overstated how important it is to have a support system when you navigate something like this. You have several people that you mention in the book who come and help you with childcare. You even have friends who make space for you to live in their home, so that you can have these nights that are so difficult and not have to worry or think about the kids either hearing you or needing you. I mean, I'm not even sure if it would be possible to go through this process without a support system. Do you agree?
Melissa Bond: Oh gosh, I don't know how someone would do it. Because on every level, it wasn't just the physical torture, basically that you went through every day, you know, your support system get smaller. Anyone that's been through any kind of trauma or illness, you find out who your real support system is.
I think also the emotional component. I had never been so emotionally raw, just like a raw nerve.
So like my limbic system felt like it was just all over the place. I used to make jokes about how my amygdala, which is my understanding, the part of the brain where there's a lot of like fear response, felt like it was just on fire. So I would be like the amygdala fire. And if I didn't have a support system … I can't imagine going through something like that and having been successful.
Dr. Denise Millstine: And talking about support, Michael, probably a lot of people think of pharmacists as being the person behind the counter that fills your pill bottles or tells you when drugs interact with one another. But I'm lucky to work on a team where I have someone like you who can partner in caring with patients, and maybe you can tell our listeners what pharmacists can do. For example, if you're taking a medication with side effects or you're trying to taper off a medication, that's really difficult, just give us that concept of what having a pharmacist on your team can mean.
Dr. Michael Campbell: Traditionally, I'd say 6 out of every 10 pharmacists work in your community, so at grocery stores or drug stores, in your neighborhood. But those pharmacists, often times one of them at a time is taking care of the entire community that day. So they may not have time to dive deep into the 5 to 20 medications that each individual may be taking, to go over what to expect, how to take it, what do you do if you miss a dose, what are the common side effects, what do you do if those side effects occur, what kind of conversations you should bring up with your physician if, issues arise. More importantly, when it comes to, I'll say, tolerance or controlled substances or drug interactions with those types of medications, the pharmacist can play a pivotal role in helping strategically develop, like a taper plan or strategy based off of what other medical conditions you have, what other medications you're taking, how long you've been taking the medication in question. Sometimes there's drug-food interactions. Sometimes there's drug-disease interactions.
There's a new emerging study of your genes and how you respond to certain drugs and if a certain drug in a certain class may be better for you based off of how the individual patient metabolizes that medication, I think that pharmacists play a central role on the healthcare team that the clinician has to lead and they can help improve outcomes when patients need to discontinue these medications safely.
Dr. Denise Millstine: Also people should feel empowered to ask their primary care practices if they have a pharmacist, who can be an enormous resource for things like streamlining your medications, but also looking at some of the risks that come with your medications.
So we've been talking today about “Blood Orange Night,” which is the very brave, very important memoir by Melissa Bond about benzodiazepines, which are very common medications that come with huge side effects and potential for dependance and harm. I want to thank both of you, Melissa and Michael, for being here with me to talk about this important topic and invite our listeners to check out the show notes for more information on this topic.
Melissa Bond: Thank you so much.
Dr. Denise Millstine: Thank you for joining us to talk books and health today on “Read. Talk. Grow.” To continue the conversation and send comments, visit the show notes or email us at readtalkgrow@mayo.edu.
“Read. Talk. Grow.” is a production of Mayo Clinic Women’s Health. Our producer is Lisa Speckhard Pasque and our recording engineer is Rick Andresen. This episode was made possible by the generous support of Ken Stevens.
The podcast is for informational purposes only and is not designed to replace a physician's medical assessment and judgment. Information presented is not intended as medical advice. Please contact a health care professional for medical assistance with specific questions pertaining to your own health, if needed. Keep reading everyone.