Doc­tor who helped peo­ple quit drugs dies

Antelope Valley Press (Sunday) - - Weather/obituaries - By KNVUL SHEIKH

When re­searchers be­gan tin­ker­ing with a class of tran­quil­izer drugs called ben­zo­di­azepines in the 1950s, they felt they had un­cov­ered a so­lu­tion to mod­ern anx­i­ety and in­som­nia. Ben­zo­di­azepines worked quickly and ef­fec­tively to quell rac­ing heart­beats and dis­miss spin­ning thoughts. The dozen or so dif­fer­ent types — in­clud­ing Xanax, Val­ium, Ati­van and Klonopin — be­came the most fre­quently pre­scribed drugs around the arose world, about even their as con­cerns po­ten­tial side ef­fects and ad­dic­tive prop­er­ties.

“Pa­tients them­selves, and not the med­i­cal pro­fes­sion, were the first to re­al­ize that long-term use of ben­zo­di­azepines can cause prob­lems,” wrote Dr. Heather Ash­ton, a Bri­tish psy­chophar­ma­col­o­gist.

She said that pa­tients who had been on the med­i­ca­tions for months or years would come to her with fears that the drugs were mak­ing them more ill. Some con­tin­ued to have symp­toms of de­pres­sion or anx­i­ety. Oth­ers had de­vel­oped mus­cle weak­ness, mem­ory lapses, or heart or di­ges­tive is­sues.

Ash­ton would dedicate much of her ca­reer to lis­ten­ing to hun­dreds of pa­tients’ ex­pe­ri­ences and rig­or­ously col­lect­ing data.

The re­sult of her work, in 1999, was “Ben­zo­di­azepines: How They Work And How

To With­draw.”

Now known sim­ply as “The Ash­ton Man­ual,” it has be­come a cor­ner­stone for those look­ing to quit the drugs safely. Ad­dic­tion re­searchers world­wide still cite it in stud­ies on ben­zo­di­azepines. And pa­tient sup­port groups have trans­lated and dis­trib­uted it in about a dozen lan­guages.

Ash­ton died on Sept. 15, 2019, at her home in New­cas­tle upon Tyne, Eng­land. She was 90.

Her death, which had not been widely re­ported, was con­firmed by her son John.

“Heather was a re­mark­able per­son,” Ni­col Fer­rier, an emer­i­tus pro­fes­sor of psy­chi­a­try at New­cas­tle Univer­sity who worked closely with Ash­ton, said in an in­ter­view. “She was very up­set by this prob­lem of ben­zo­di­azepine de­pen­dence that was es­sen­tially caused by doc­tors over­pre­scrib­ing the med­i­ca­tions, and she took it upon her­self to help pa­tients strug­gling to with­draw from them.”

From 1982 to 1994, Ash­ton ran a ben­zo­di­azepine with­drawal clinic at the Royal

Vic­to­ria In­fir­mary in New­cas­tle, tai­lor­ing her ta­per­ing sched­ules for each pa­tient. She ac­knowl­edged that ben­zo­di­azepines could be use­ful in the short term, but said that they should not be taken for longer than two to four weeks. Long-term use, she found, of­ten led to phys­i­cal de­pen­dence. The brain adapted to the seda­tive ef­fect of the drugs to the point where pa­tients would pop a calm­ing pill just to treat the symp­toms of with­drawal since the pre­vi­ous dose. Pa­tients who tried to quit cold turkey faced ex­treme rest­less­ness, ir­ri­tabil­ity, in­som­nia, mus­cle ten­sion, rac­ing heart­beats and other de­bil­i­tat­ing symp­toms.

Ash­ton con­cluded that peo­ple needed to slowly re­duce the dose of their med­i­ca­tion, some­times over the course of six months or more. She ex­plained this strat­egy in her man­ual, us­ing ex­am­ples from pa­tients she had treated her­self.

“Her work both hon­ored her pa­tients and turned out to be more help­ful than any ran­dom­ized, con­trolled trial,” said Dr. Anna Lem­bke, an as­so­ciate pro­fes­sor of psy­chi­a­try and be­hav­ioral sciences at Stan­ford Univer­sity, where she leads the school’s Stan­ford Ad­dic­tion Medicine Dual Di­ag­no­sis Clinic.

Ash­ton’s work was also timely. Sci­en­tists were start­ing to re­al­ize that pa­tients who be­came de­pen­dent on ben­zo­di­azepines of­ten mis­used opi­oids as well. One study found that the over­dose death rate among pa­tients tak­ing both ben­zo­di­azepines and opi­oids was 10 times higher than among those who only took opi­oids.

But un­like opi­oid pre­scrip­tions, which started de­clin­ing af­ter 2012, ben­zo­di­azepine pre­scrip­tions con­tin­ued to rise. Doc­tors still had lim­ited aware­ness of ben­zo­di­azepines’ ad­dic­tive po­ten­tial and some pa­tients could con­tinue on the same steady dose for years with­out ex­hibit­ing any symp­toms or ob­vi­ous changes in be­hav­ior.

“If pa­tients take them only as pre­scribed by their doc­tor, then they don’t meet cri­te­ria for ad­dic­tion, be­cause ad­dic­tion in­volves be­hav­iors that cor­re­spond to com­pul­sive drug-seek­ing,” Lem­bke said. “But re­ally, if you look at what’s hap­pen­ing in the brain, it’s prob­a­bly not that dif­fer­ent.”

In 2013, the Bri­tish Na­tional For­mu­lary, which ad­vises doc­tors on pre­scrib­ing prac­tices, up­dated its guide­lines to rec­om­mend ben­zo­di­azepines for short­term use only and to sug­gest a with­drawal sched­ule based on Ash­ton’s man­ual. In 2018, it re­vised its rec­om­men­da­tions again to sug­gest an even slower with­drawal, based on ev­i­dence that Ash­ton and other re­searchers had col­lected.

The United States fol­lowed suit, with the Food and Drug Ad­min­is­tra­tion re­quir­ing that all ben­zo­di­azepines carry a so-called black-box warn­ing about the drugs’ side ef­fects, and that doc­tors check their state’s pre­scrip­tion drug mon­i­tor­ing pro­gram to see whether a pa­tient had been given any fed­er­ally con­trolled and ad­dic­tive med­i­ca­tions in the past 12 months.

“Ba­si­cally, we now rec­om­mend us­ing the same kind of in­ter­ven­tions that are used to ad­dress the opi­oid cri­sis to ad­dress the ben­zo­di­azepine over­pre­scrib­ing cri­sis,” Lem­bke said. “Dr. Ash­ton was the van­guard of that change.”

Chrys­tal Heather Cham­pion was born on July 11, 1929, in Dehradun, In­dia, to Harry Cham­pion, a forester, and Chrys­tal (Par­sons)

Cham­pion. Her par­ents sent her to board­ing school in Eng­land when she was 6, but in 1939, dur­ing World War II, she and her older brother, Jim, were among mil­lions of chil­dren evac­u­ated from Bri­tain to live with rel­a­tives and foster fam­i­lies over­seas.

The two ended up in the care of John and Obi Mar­shall in West Ch­ester, Penn­syl­va­nia. They be­came a sec­ond fam­ily, and Heather re­mained in close touch with the Mar­shalls for the rest of her life.

She re­turned to Eng­land in 1945 and went on to study medicine at the Univer­sity of Ox­ford. Af­ter grad­u­at­ing, she mar­ried John Ash­ton and moved to Lon­don, where he worked as an econ­o­mist for the Min­istry of Agri­cul­ture. They moved to New­cas­tle in 1964, when John was ap­pointed a pro­fes­sor of agri­cul­tural eco­nom­ics at New­cas­tle Univer­sity. Heather Ash­ton was hired by the univer­sity’s depart­ment of phar­ma­co­log­i­cal sciences, where she de­vel­oped her ex­per­tise in psy­choac­tive drugs.

In ad­di­tion to ben­zo­di­azepines, she con­ducted sev­eral stud­ies on the ef­fects of nico­tine and cannabis in the brain, and was among the ear­li­est re­searchers to use elec­troen­cephalog­ra­phy to un­der­stand changes in neu­ral ac­tiv­ity.

She took great pains to avoid any con­flict of in­ter­est that might un­der­mine peo­ple’s trust in her work or pro­fes­sion. She scrupu­lously de­clined sup­port of any kind from the phar­ma­ceu­ti­cal in­dus­try.

Even af­ter she re­tired, Ash­ton con­tin­ued pub­lish­ing orig­i­nal re­search, see­ing pa­tients and teach­ing med­i­cal stu­dents. She also re­mained ac­tive on the ex­ec­u­tive com­mit­tee of the North East Coun­cil on Ad­dic­tion and would an­swer re­quests for ad­vice on ben­zo­di­azepine de­pen­dence that poured in from around the world.

As she aged, she re­lied on her son John to help her type re­sponses to emails.

“She al­ways put the in­ter­ests of pa­tients be­fore ev­ery­thing else,” he said.

In ad­di­tion to John, she is sur­vived by two other sons, Jim and An­drew; a daugh­ter, Caroline Ostler; and six grand­chil­dren. Her hus­band died in 1986.

ASH­TON

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