Written Request to Japanese Government




Written request regarding benzodiazepine type drugs (Submitted: 28th October 2015)

On 28th October 2015, Medwatcher Japan submitted a written request, regarding benzodiazepine type drugs, to related corporations, the Ministry of Health, Labour and Welfare, the Ministry of Education, Culture, Sports, Science and Technology, and related academies.  

Benzodiazepine type drugs exert the following actions: anxiolytic, hypnotic, myorelaxant, and anticonvulsant. Most of these drugs sold in Japan are used as anxiolytics and hypnotics.

Although benzodiazepine type drugs exert the above actions, within just a few weeks or months of regular use, even on therapeutic doses, tolerance develops, which can then lead to physiological and psychological dependence. The forming of physiological and psychological dependence can cause many problems including: memory impairment, cognitive dysfunction, confusion, hallucinations, paranoia / delusions, seizures, emotional detachment / depersonalization, motor sensory disturbances etc. Also, cases where these withdrawal symptoms become so severe that they impact significantly on people’s daily lives are not uncommon.

Considering the risks of tolerance and dependence, European countries and the United States have adopted controls; whereby it is basically recommended that these drugs are not be prescribed for any more than 2~4 weeks. However, in contrast to this, Japan has no such controls over the duration of continual prescribing, and there are many cases where benzodiazepines are co-prescribed in large amounts. Subsequently, it seems sufficient to say that Japan likely has the highest prescription number per unit of population in the world. It has also been pointed out that behind the current state of prescribing exists a general lack of awareness, regarding benzodiazepine type drugs and associated risks, on the part of medical workers in Japan including psychiatrists.

In recognition of this, our organization proposes to improve prescribing practices and the level of awareness shown by medical workers in Japan with regards to dependency on benzodiazepine type drugs and withdrawal symptoms. For this purpose, we have carried out investigations and inquiries while engaging in talks with psychiatrists and patients; leading to the following points being raised in this written request.

Matters Pertinent to Request:

1. Revision of package inserts to include:
1.1 Clearly listing the risks of dependency on therapeutic doses, withdrawal symptoms, and polypharmacy in the warning column.
1.2. Stating diazepam potency equivalents.
1.3. Placing limitations on duration of prescribing
2. Compiling, distributing and publicizing on the internet information for patients to maintain the right of informed consent.
3. Ensuring benzodiazepine type drug dependency is noted on dispensary forms.
4. Establishing and developing specialised benzodiazepine type drug dependency treatment facilities.
5. Providing training for all medical workers involved in the treatment of benzodiazepine type drug dependency.
6. Providing further educational training in all medical schools and pharmaceutical faculties regarding benzodiazepine type drug dependency.

NB: To patients currently on benzodiazepine type drugs and families.
Regarding reduction and withdrawal, you will need to work closely with your physician, as caution must be exercised when making decisions. For this purpose, it is advisable to use The Ashton Manual referred to in this written request as a point of reference.
Contrary to intentions, it can be dangerous for patients to reduce, or withdrawal, using their own judgement; therefore, it is advisable to refrain from this.
Please be advised that our organization is unable to accommodate individual enquiries or assist with the introduction of treatment facilities.

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28 October 2015

Related Corporations (see attachment)
Minister of Health, Labour and Welfare: Hon Yasuhisa Shiozaki
Minister of Education, Culture, Sports, Science and Technology: Hon Hiroshi Hase
Japan Society of Sleep Research Director: Mr. Hiroshi Ito
The Japanese Society of Psychiatry and Neurology President: Mr. Masatoshi Takeda

Medwatcher Japan
Chair: Toshihiro Suzuki
160-0022 Tokyo Shinjuku Ward Shinjuku 1-14-4 AM building
TEL.03-3350-0607 FAX.03-5363-7080

Written request regarding benzodiazepine type drugs

Matters per request

Our organization herby requests the following matters regarding benzodiazepine type drugs.

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1. Request to Relevant Corporations

(1) ベンゾジアゼピン系薬物について、以下の点について添付文書を改訂すること
ア 常用量依存症と離脱症状、ベンゾジアゼピン系薬物同士の多剤併用の有害性を警告欄に明記すること
イ ジアゼパムの力価との等価換算値を記載すること
ウ 処方期間の継続に制限を設けること

(2) 患者の自己決定権を保障するため、当該薬剤がベンゾジアゼピン系薬物であること、ベンゾジアゼピン系薬物の依存性や離脱症状、適切な離脱方法を明記した患者向け説明文書を作成して、医療機関でベンゾジアゼピン系薬物を処方された全ての患者に交付させるとともに、同説明文書をインターネット上に公開すること

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2. Request to Ministry of Health, Labour and Welfare

(1) 関係各企業に対し、上記1(1)のとおり添付文書を改訂するよう指導すること
(2) 関連各企業に対し、上記1(2)のとおり、患者の自己決定権を保障するための情報を積極的に告知するよう指導すること
(3) 薬剤情報提供文書にベンゾジアゼピン系薬物の依存症が必ず記載されるための適切な施策を講ずること
(4) 平成26年度「依存症治療拠点機関設置運営事業」において指定された全国拠点機関及び5つの依存症治療拠点機関に、ベンゾジアゼピン系薬物依存症に特化した部門を設置して専門的な治療や研究を実施させるとともに、少なくとも各県に1医療機関をベンゾジアゼピン系薬物依存の専門的治療を実施できる治療拠点機関として指定すること

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3. Request to Academies


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4. Request to Ministry of Education, Culture, Sports, Science and Technology


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Reason for Request

1. Outline of benzodiazepine type drugs

1.1. Description



(2) ベンゾジアゼピン系薬物の薬理作用など

ア 薬理作用



イ 力価と代謝・排泄について



ウ 耐性の発現


[1] 本要望書においては、エチゾラム(商品名デパス)、ゾルピデム(商品名マイスリー)、ゾピクロン(商品名アモバン)、エスゾピクロン(商品名ルネスタ)についても、ベンゾジアゼピン受容体に結合して作用する点において同様の問題を抱えているため、広義のベンゾジアゼピン系薬物として扱うこととする。
[2] COMMITTEE ON THE REVIEW OF MEDICINES;Systematic review of the benzodiazepines,Bri.Med.J. 29 MARCH.910-913 1980)

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2. Clinical dose dependency on benzodiazepine type drugs and withdrawal

2 ベンゾジアゼピン系薬物の常用量依存症と離脱症状

(1) ベンゾジアゼピン系薬物による常用量依存



(2) ベンゾジアゼピン系薬物の離脱症候群




[4] 長田健一ら「抗不安薬の適切な使用方法」ModernPhysician 34巻6号719-723頁(2014年)
[5] WHO Programme on Substance Abuse(1999-11)(pdf).Rational use of benzodiazepines-Document no.WHO,PSA,1996
[6] 大倉隆介他「精神科病床を持たない二次救急医療施設の救急外来における向精神薬過量服用患者の臨床的検討」日本救急医学会誌19巻901‐913頁(2008年)

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3. State of prescription benzodiazepine type drugs in Japan

(1) 単位人口あたりの消費量は世界最多の可能性



なお、2010年に実施された「全国の精神科医療施設における薬物関連精神疾患の実態調査」において、対象となった薬物関連障害症例671例のうち、鎮静剤(主としてベンゾジアゼピン系薬物)関連障害症例は119例(17.7%)存在し、1987年の調査開始以来ほぼ一貫して覚せい剤に次ぐ第2位であった有機溶剤(シンナー)を抜き、薬物関連障害の原因薬剤として第2位の位置にあることが明らかとなった[9] [10]。

(2) 継続処方制限がないため長期連用されている



(3) ベンゾジアゼピン系薬物同士の多剤併用の問題点


(4) 大量消費及び長期連用の背景―医療関係者の認識の低さ

上記のような諸外国と比較した場合の日本における突出した消費量、長期連用、多剤併用の背景に、ベンゾジアゼピン系薬物の副作用や常用量依存に対する医療関係者の認識の低さがあると、複数の医学文献において指摘されている[13] [14] [15]。



[7] 村崎光邦:わが国における向精神薬の現状と展望―21世紀をめざして―.臨床精神薬理,4; 3-27,2001
[8] 戸田克広「ベンゾジアゼピンによる副作用と常用量依存」臨牀精神薬理16巻6号867-878頁(2013年)
[9] http://www.ncnp.go.jp/nimh/yakubutsu/drug-top/data/researchJHS2010.pdf
[10] 松本俊彦他「我が国における最近の鎮静剤(主としてベンゾジアゼピン系薬物)関連障害の実態と臨床的特徴―覚せい剤関連障害との比較―」精神神経学雑誌113巻12号1184‐1198頁(2011年)
[11] 内村直尚ら「睡眠薬の臨床用量依存をどうみる」臨牀精神薬理9巻10号(2003年)
[12] 田島治「抗不安薬併用の問題」Modern physician24巻1027-1030頁(2004年)
[13] 前掲戸田克広「ベンゾジアゼピンによる副作用と常用量依存」臨牀精神薬理16巻6号867-878頁(2013年)
[14] 松本俊彦「不安障害の薬物療法と新たな治療薬依存」精神科治療学28巻4号463-470頁(2013年)
[15] 田島治「ベンゾジアゼピン系薬物の処方を再考する」臨牀精神医学30巻9号1005-1009頁(2001年)
[16] 中島正人ら「ベンゾジアゼピン系薬剤の処方実態調査」医療薬学36巻12号863-867(2010年)
[17] 別府宏圀「アシュトン・マニュアル日本語版の誕生」TIP正しい治療と薬の情報26巻12号177-180頁(2011年)

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4. Matters pertinent to request

(1) 医療関係者の認識を改善する必要性


ア 添付文書の改訂(要望の趣旨1(1)、要望の趣旨2(1))






イ 関連学会主導の研修の必要性(要望の趣旨3)


ウ 医学部及び薬学部教育強化の必要性(要望の趣旨4)



(2) 患者に対する説明充実の必要性

ア 患者向け説明文書の必要性(要望の趣旨1(2)、要望の趣旨2(2))



イ 薬剤服用歴管理指導の必要性(要望の趣旨2(3))




(3) 専門医療機関整備の必要性(要望の趣旨2(4))





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NB: To patients currently on benzodiazepine type drugs and families.
Regarding reduction and withdrawal, you will need to work closely with your physician, as caution must be exercised when making decisions. For this purpose, it is advisable to use The Ashton Manual referred to in this written request as a point of reference.
Contrary to intentions, it can be dangerous for patients to reduce, or withdrawal, using their own judgement; therefore, it is advisable to refrain from this.
Please be advised that our organization is unable to accommodate individual enquiries or assist with the introduction of treatment facilities.

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My thoughts on Article 3-1 of “Reason for Request”

Article 3-1 of “Reason for Request” makes reference to a survey conducted on drug related impairments at all hospitals with psychiatry departments nationwide. This survey was also reported in an Asahi Newspaper article on 22 July 2014 (which my story also appeared in).

However, as outlined below, I believe this survey consists of many shortfalls, failing to expose the true scale of the situation.


  1. The aforementioned survey is limited to hospitals with psychiatry departments, but benzos are vastly prescribed in all hospitals, across all departments and in most clinics, including the vast number of those that don’t have psychiatry departments (these weren’t included in the survey).
  2. Most doctors are ignorant about benzo dependency and do not have the knowledge or skills needed to be able to diagnose it, so it is likely the majority of cases aren’t being reported.
  3. Almost all patients aren’t aware that their prescriptions are in fact benzodiazepines, and they aren’t aware they’re suffering from dependency (they know something is wrong, but they don’t know what’s happening to them or why, and in many / most cases doctors are misdiagnosing dependency), so once again, it is likely the majority of cases are going unreported.

Also consider:

Experts say BZs can be more addictive than heroin, and Japan has the highest prescription numbers in the world, as outlined above.

If a comprehensive and thorough survey (along with proper diagnosing and testing of the entire population taking these drugs) was conducted, I feel absolutely certain that the incidences of doctor induced dependency on prescription drugs, such as benzodiazepines, would far exceed that of any illegal drug.

Also see:

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Byrne Quote


for benzodiazepine use

Dr Andrew Byrne
Redfern NSW Australia
Benzodiazepine Dependence, 1997

Marsden Quote

“If any drug over time is going to just rob you of your identity [leading to] long, long term disaster, it has to be benzodiazepines.”

Dr John Marsden,
Institute of Psychiatry, London
November 1, 2007

Woolas Quote

“Benzos are responsible for more pain, unhappiness and damage than anything else in our society.”

Phil Woolas MP,
Deputy Leader of the House of Commons,
Oldham Chronicle, February 12, 2004

Coleman Quote

“The benzodiazepines are probably the most addictive drugs ever created and the vast army of enthusiastic doctors who prescribed these drugs by the tonne have created the world's largest drug addiction problem.”

Dr Vernon Coleman,

The Drugs Myth, 1992

Blunkett Quote



David Blunkett, British MP
February 24, 1994

Laurance Quote

“If there's a pill, then pharmaceutical companies will find a disease for it.”

Jeremy Laurance,
The Independent, April 17, 2002.

Angell Quote

“To rely on the drug companies for unbiased evaluations of their products makes about as much sense as relying on beer companies to teach us about alcoholism.”

Marcia Angell MD
(Former) Executive Editor New England Journal of Medicine

Lader Quote

“It is more difficult to withdraw people from benzodiazepines than it is from heroin.”

Professor Malcolm H Lader
Institute of Psychiatry London
BBC Radio 4, Face The Facts
March 16, 1999

Ashton Quote

“Withdrawal symptoms can last months or years in 15% of long-term users. In some people, chronic use has resulted in long-term, possibly permanent disability.”

Professor C Heather Ashton
Good Housekeeping, 2003

Stevie Nicks Quote

“Klonopin (Clonazepam) is a horrible, dangerous drug.”

Stevie Nicks

Boeteng Quote

“Clearly, the aim of all involved in this sorry affair is the provision of justice for the victims of tranquillisers.”

Paul Boeteng, British MP, 1994

Slysz Quote

“The website 'benzo.org.uk' is really outstanding.”

Marcin Slysz,
Product Manager,
Roche Polska

The Ashton Manual

The Ashton Manual contains expert advice on benzodiazepines and how to withdrawal written by world renowned expert Prof. Heather Ashton.

The withdrawal schedules provided in the manual are only intended as "general guides". Each person's experience of withdrawal is unique and the course of withdrawal depends on many factors.

Read The Manual

Diazepam Conversions

Ever wonder why the diazepam conversion rates differ from source to source?

Addictive Medicine Specialist, Dr. Graeme Judson explains as follows:

“The rate used for converting Diazepam equivalents tends to differ from source to source. This is because individual variation in clinical responses to “equivalent” doses can vary so close monitoring of patient response to substitution is necessary when converting from one Benzodiazepine to another.”


See a variety of benzodiazepine related documentaries that may be of interest.

See this Section

The purpose of this site does not include any form of retribution.
Also, for privacy reasons the defendants’ names along with certain other names have been omitted from all public documentation contained herein.
©2012 Benzo Case Japan Programming by Butter

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