Medical dominance
Phil Brown in Mental Health Care and Social Policy, 1985
In the case of the anti-anxiety drugs, the picture is still less positive. The case of meprobamate is instructive. This drug, known as Miltown, was introduced in the late 1950s as an anti-anxiety tranquilizer. After many years and millions of prescriptions, it became clear in controlled studies that the drug could not be shown to have any more effect than placebos, and clinical experience indicated that the drug was addictive (see Greenblatt and Shader, 1971). For these reasons, meprobamate has been quietly withdrawn from use. In its place have come a number of other anti-anxiety tranquilizers, the best-known of which are Valium and Librium. Once again, however, history may be repeating itself — it now seems possible that Valium and Librium cannot be shown to have any effect greater than a placebo, and that they can be addictive.4Nyswander (1975: 152-153) a psychiatrist well known for her studies of addiction, has warned that sustained use of Valium in large doses brings about ‘a far worse addiction than heroin, morphine, or demerol.’
The Psychopharmacological Revolution
Petteri Pietikainen in Madness, 2015
In 1955, meprobamate was put on the market first as Miltown, and then (by another company) as Equanil. They were marketed as tranquillizers and, to a lesser extent, as muscle relaxants, and the target audience was as wide as possible: anybody with troubled nerves was a potential customer. This marketing strategy worked better than Berger or anyone had dreamed of: the net profit of the first-year sales was $100 million (in today’s money, $8.6 billion). With the help of marketing campaigns and nationwide media coverage, Miltown was turned into an emotional aspirin that belonged in the medicine cabinet of each and every American. Meprobamate became the best-selling drug ever marketed in the United States. It was not devoid of side effects and it could also be mildly addictive. But the overall reactions from physicians were positive: meprobamate was a relatively safe drug, and there was no doubt that it worked for many people (Shorter 2009, 44–5; Tone 2009, 84–5).
Psychoactive Drugs, Psychotechnology, and the New Biologism
Phil Brown in The Transfer of Care, 1985
Miltown (meprobamate), introduced in the late 1950s as an anti-anxiety medication, had no more effect than placebos. In 1957 FDA investigator Dr. Barbara Moulton told FDA medical director Dr. Albert H. Holland, Jr. about meprobamate’s addictive qualities, and he responded by telling her to do nothing, because ‘I will not have my policy of friendliness with industry interfered with’. Two years later Holland resigned and began working for American Home Products Corporation, whose Wyeth Laboratories division manufactured meprobamate under the trade name Equanil. Shortly, however, meprobamate was withdrawn and replaced largely by Valium and Librium, which have come to approach addictive levels (Mintz, 1967: 193-195; Scheff, 1976). Valium was long considered to be free from most soporific and addictive effects which had been common in earlier minor tranquilizers. Yet recent research has shown a high degree of addiction, as well as dangerous withdrawal symptoms, including psychotic breaks (Koumjian, 1981). Barbara Gordon’s autobiographical I’m Dancing As Fast As I Can (1979) popularized this problem of psychotic breaks upon withdrawal. When the film version was produced, Roche Laboratories (1982) mailed a letter to all physicians in the nation, arguing that Gordon’s personal misuse of Valium was the problem. Roche believed that ‘The film may generate serious, unjustified concern and disrupt doctor/patient relationships’. Gordon in fact sought without success a psychiatrist who would provide a positive relationship, but was continually confronted with psychiatrists who relied on drugs, often switching inappropriately from one to another.
Phenprobamate use disorder: a case report
Published in Journal of Substance Use, 2021
Harun Olcay Sonkurt, Melis Danisman Sonkurt
Tolerance and dependence of centrally acting muscle relaxants have been reported in the medical literature for nearly 50 years (Elder, 1991). Meprobamate, one of the best-known examples, had been a controlled substance after studies indicating its addictive effects, shortly after its introduction in the 1950 s. Fifty years after its launch, it was withdrawn from the European Union and Canada market, with the statement: “its harms outweigh the benefits.” (Lane et al., 2018). Following the increasing reports of tolerance and dependence about carisoprodol, another frequently used centrally acting muscle relaxant, it has been taken under the controlled substance status by the Food and Drug Administration and withdrawn from the market due to the risk of addiction in several countries (Reeves et al., 2012). Similarly, cases of dependence related to drugs such as cyclobenzaprine, butabarbital, triazolam have been reported (Zawertailo et al., 2003). In addition to these, phenprobamate, which has been reported to be similar to meprobamate in terms of effects, side effects, and toxicity, is not a controlled substance and is frequently used as a centrally acting muscle relaxant (Emet et al., 2009).
Fomepizole to treat disulfiram-ethanol reaction: a case series
Published in Clinical Toxicology, 2020
Azzurra Schicchi, Hélène Besson, Riana Rasamison, Marie-Pierre Berleur, Bruno Mégarbane
Here, DER mainly resulted in neurological and circulatory impairment. Gastrointestinal symptoms, flushing and ECG abnormalities were observed. We do not believe that co-ingestions significantly contributed to some of the clinical findings in the three patients with positive benzodiazepine screening despite the absence of quantification. Benzodiazepines can be responsible for drowsiness and consciousness impairment but less probably for tachycardia, vomiting, flushing and hypotension. Meprobamate, the other co-ingested drug, is able to induce inebriation with dose-dependent hypotension and thus mimic DER. However, the rapid improvement following fomepizole administration clearly supported the DER-related origin of the observed features.
Trends in carisoprodol abuse and misuse after regulatory scheduling: a retrospective review of California poison control calls from 2008 to 2015
Published in Clinical Toxicology, 2018
Christie Sun, Kathryn A. Hollenbach, F. L. Cantrell
As the use of skeletal muscle relaxants increased beyond certain guidelines [4], concerns regarding abuse potential increased [5]. Sometimes, it was self-initiated as a substitute for other drugs of abuse, to modify effects from other drugs, or for opioid withdrawal symptoms [6–9], but was recognized to have a distinct effect with its own potential for abuse. While deaths from carisoprodol alone are not common, the rapid rise in the number and severity of carisoprodol intoxications was alarming [10]. Its active metabolite, meprobamate, is already classified as a Schedule IV substance, which likely contributed to the federal scheduling of carisoprodol [11].
Related Knowledge Centers
- Anxiolytic
- Central Nervous System
- Electroconvulsive Therapy
- Hydrotherapy
- Benzodiazepine
- Carbamate
- Therapeutic Index
- Mephenesin
- Sedative
- Federal Food, Drug, & Cosmetic Act