Phenazepam can cause addiction. Now it will be more difficult to buy it - and no, this is not necessarily good news

Since March 22, 2021, phenazepam refers to potent substances and its sale without a recipe becomes criminally punishable. In addition, the phenazepam is now “subject to objective-in-quality accounting”, due to which it will need to be written out according to a more complex procedure. Usually, due to such changes, the drug begins to be prescribed much less often. And this is how this will affect patients.

Phenazepam is a Soviet drug that is considered dangerous in many countries. People really abuse them

Phenazepam is benzodiazepine, that is, a drug that suppresses the work of the central nervous system, as a result of which a sedative effect is manifested. Other benzodiazepines include, for example, lorazepam, diazepam, clonazepam.

Benzodiazepines are used for various mental disorders (in particular, with anxious disorders and cancellation syndrome due to alcohol dependence), with epilepsy and insomnia. But the Mental Health Center psychiatrist Natalya Stepanova clarifies that phenazepam should never become the main drug in treatment. It should be used as an auxiliary tool, and assigned a short course.

The problem is that benzodiazepines are increasingly using people without medical problems. Moreover, it happens that patients abuse them. “I think that a lot of elderly patients are dependent on phenazepam, they use it as sleeping pills,” the epileptologist of the Epineiro Center, the author of the blog about neurology Anna Ratovitova, writes in response to the question “Medusa”. - There are those who use it for 20 or more years in a row. Previously, it was often appointed for this purpose, although this is wrong. ”

Epileptologist of the Center for Epileptology and Neurology. A. A. Genomed and the Genomed Center Artem Sharkov talks about the stories of dependence from his practice: “I observed several cases when the patient simulated [convulsive] attack to get phenazepam, or when the patient took the phenazepam for a long time, and ultimately developed dependence, up to severe panic attacks and psychosis on cancellation.”

“Dependence on phenazepam is a fairly frequent phenomenon,” says psychiatrist Natalya Stepanova. - Often, patients are already coming with a formed dependence, and you will find out that they take this drug for several years, uncontrollably, in high dosages, use as a saving tablet that facilitates falling asleep, quickly relieves anxiety. And, of course, they refuse him with difficulty. It takes a lot of effort and time to slowly “remove” the phenazepam.

Fenazepam is Soviet development , and it is mainly used in Russia. In many other countries, it is not registered, it gets there illegally , and people there also abuse them. The International Drug Control Committee attributed fenazepam to psychotropic substances under international control (like many other benzodiazepines).

The Ministry of Health changed the rules for the discharge and sale of phenazepam. Previously, it could easily be obtained even without a recipe

Fenazepam is one of two benzodiazepines , which used to be sold in Russia according to a simple recipe. All other drugs of this group have long been in the list of potent substances , and then psychotropic , the circulation of which is limited and in respect of which some control measures are allowed. Accordingly, it is quite difficult to appoint them for many years.

In the case of phenazepam, if desired, you could easily find a pharmacy that sold the medicine without a prescription. True, the experts with whom Medusa spoke, noticed that in the last two or three years the recipe began to demand more often and the ability to buy phenazepam without it. Nevertheless, as the psychiatrist says Natalya Stepanova, patients still manage to purchase a drug without prescribing a doctor, including without a prescription.

Since March 22, 2021, phenazepam refers to potent substances (although mainly benzodiazepines - in the list of psychotropic substances, the turnover of which is limited and in respect of which it is allowed to exclude some control measures). This means that now its sale without a recipe is criminally punishable .

In addition, the Pharmaceutical Bulletin reports , the Ministry of Health insists that the drug is subject to objective-quality accounting (despite the fact that it is still not officially included in the list of appropriate drugs). From pharmacies and hospitals, this requires taking into account such drugs in a special journal. The magazine must be kept in a safe, the keys to which are stored by a special authorized person.

In turn, doctors must write a prescription in a special form in which you need to indicate a large amount of information and put several seals - otherwise the pharmacy cannot accept the recipe. Special journals keep records of recipe forms, the forms themselves are stored in a lockable metal cabinet or in a metal box. The recipe is valid for 15 days.

Now, according to experts surveyed by Medusa, the drug will be prescribed much less often (due to the bureaucraticization of the process). In particular, not all clinics have forms of such recipes.

Even with a prescription, explains the psychotherapist Pavel Besvonov, it will be quite difficult to buy such a drug. Firstly, pharmacies that work with drugs subject to subject-in-quality accounting are much less than those where you could buy phenazepam earlier. Secondly, as the expert says, practice shows that due to the fall of demand for benzodiazepines (which will be less common), pharmacies will not be interested in the purchase of such drugs.

Theoretically, if it is impossible to find the necessary drug in a pharmacy, it can be obtained during hospitalization. Unless, of course, hospitalization is justified for the patient. But in hospitals, doctors and nurses are faced with a large bureaucracy and a risk of criminal liability for incorrectly completed documents.

Doctors fear that tightening the rules can hit patients who really need a medicine. Among them are many older people

Due to the changes, several problems may occur at once, says Anna Rubbitova. Patients who have taken phenazepam for years run the risk of encountering the abolition syndrome and other unpleasant consequences of dependence. Often these are older people - and they need the help of a narcologist.

Another problem is expected just in hospitals. “Now in covid hospitals there are many elderly who have sleep disturbances, panic disorders, they do not give rest to themselves, nor to doctors, sisters, nor neighbors in the ward ...” writes Rubbitova. “Transquilizers are good for a short period.” Phenazepam refers to them.

Artem Sharkov, although he himself does not prescribe this drug, understands why he is appreciated in hospitals: “He (was) the only affordable, without storage under his seven locks and two accounting magazines (and in the hospital, simplicity decides simplicity). It quickly acts [if it is a tablet that dissolves in the mouth], it is generally difficult to overdose, almost does not give inhibition of breathing with intravenous administration. That is, it was possible to reassure the agitated and super -lane patient faster. ”

But even those patients who are not placed in hospitals, benzodiazepines are also quite necessary. “There are a number of states in which other anti -aircraft drugs cannot cope, and the alarm is so strong and pronounced that we cannot completely abandon benzodiazepine,” says Natalya Stepanova, psychiatrist, Mental Health Center. - And if you inform the patient about the risk of dependence, limit the time for taking two weeks, the benefits outweigh the risks. But, of course, each case is individual, and we initially avoid the prescriptions of such drugs to patients with a history of dependencies, suicidal risk, etc. ”

Judging by the words of the experts, it made sense to appoint specifically to phenazepam only because it was very difficult or completely impossible to find an alternative. Otherwise, the choice would be made in favor of other, safer and more effective benzodiazepines. But they have long been under strict control. Now it will be difficult to appoint phenazepam.

How it will be in practice

If the clinic does not have forms for recipes for the established form, then the doctor does not have the opportunity to prescribe such a drug. In this case, the only thing he remains is to send the patient to another clinic. “And there they can be refused [in the appointment of such a drug] without considering it necessary,” writes Anna Rleztova, an epileptologist. “Moreover, getting to an appointment with a narrow specialist in the clinic is not so fast now.”

It is important that many additional information is included in the recipe.

“It will be an unconditional disadvantage that a strict accounting eats an already short time for an appointment with a doctor, turning a clinical reception into discharge of pieces of paper,” writes the epileptologist Artem Sharkov.

“Formally, the drug will not be prohibited, but the issuance and accounting is so complex, and the risks of troubles with the inspection organs are so great that the doctors will simply stop writing it out,” says psychotherapist Pavel Besvonov. - These are additional reports, additional checks, special unpleasant people can come, ask why the doctor prescribed such a drug, whether there are evidence for this in the medical history. Exactly the same happened with Pregabalin, an alprazolam and some others. In principle, the recipe can be obtained, but it is very difficult. ”

“There will be people to live without benzodiazepines,” Pavel Besvynov sums up. -Benzodiazepines began to be used in the 1960s. Humanity somehow coped with them. ”

Daria Sargsyan