The news article below was published by THE
JAPAN TIMES on March 13, 2012. This copy
includes some clarifying comments from meshown in text boxes. You can click here to see
the original news article online.

The Japan Times Feature Article
Tuesday, March 13, 2012
THE ZEIT GIST

New Zealander loses legal fight overcrippling med addiction
Former Japan resident seeks to spread word about thedangers of benzodiazepines
By SIMON SCOTT

When Wayne Douglas arrived
home in New Zealand from Japanin early 2001, his own mother
didn't recognize him at the airport.
"She said that I looked like ahalf-dead zombie," Douglas recalls.
"My mother had to drive me to thedoctors' rooms, which were only
about 100 meters down the road,(because) I was unable to walk that
far at the time."
Douglas' departure from Japan wasa sudden and painful one, and was
precipitated by a severe addiction
to benzodiazepines, a type of
tranquilizer he had been
unwittingly prescribed by aJapanese doctor.

A changed man: Wayne Douglas took his fight for justiceand compensation over a debilitating addiction to
benzodiazepines as far as the Supreme Court of Japan,
which refused to hear his case. Douglas was prescribedthe drugs for seven months as part of what the doctor
allegedly called a "radical" course of treatment.
SIMON SCOTT

"In one of the train stations along the way I took off all of my work clothes and threw
them straight in the rubbish bin, shoes and all," he remembers. "I felt so disgusted anddirty within myself from the effects of addiction, and also because I didn't want to keep
anything that reminded me of the suffering I had to endure at the time, I ended up
throwing all of my belongings away." In addition, his addiction to prescription drugs
weakened his body to such a degree that even carrying a light load was too much forhim.
Douglas first came to Japan in 1992 on a two-week scholarship for outstanding
students of Japanese, and has spent over 10 years in total in Japan working as both an
English teacher and CIR (coordinator for international relations) in local government
at various locations.
In March 2000 he started working at the Saitama International Association as a CIR.
Everything had been going smoothly at work and at home until the early morning of
May 11.
"At 2 a.m. I was awoken by a sudden attack of vertigo," says Douglas. "It felt as if myenvironment was spinning around, with the room appearing to turn in a clockwise
rotation."
He called his boss, who arranged a taxi to Omiya Red Cross Hospital, where heunderwent a range of examinations. Tests turned up one negative result after another,while in the meantime the strange, scary symptoms continued: ongoing dizziness, hotflushes, staggering, nausea, vomiting, a sense of the environment rocking from side toside, a feeling of being drunk, his head and body swaying.
"I tended to veer off to the left when walking and it felt like someone was pushing me tothe left," explains Douglas. "It seemed as though I was viewing my environment
through a camcorder when walking."
As the disturbing, debilitating symptoms persisted, Douglas fell further into despair.
Finally, a month later, Douglas happened to watch a television documentary thatfeatured a doctor who was introduced as an international authority in dizziness. Seeing
hope for a cure, Douglas went to see him at his clinic in Tokyo.
The doctor diagnosed Douglas as having Sylvian aqueduct syndrome, a rare condition
caused by a narrowing of the midbrain canal that results in abnormal eye movement
and other symptoms. Douglas says the doctor told him that in order to treat his
condition it would be necessary to "change the constitution of his organic makeup" withthe use of drugs. According to Douglas, the doctor called the prescriptions in question a"drug cocktail" and added that he was going to take "a radical approach" to histreatment.
Wayne was prescribed five different drugs — three benzodiazepine tranquilizers(Contol, Rivotril and Grandaxin), a tricyclic antidepressant called Tofranil(imipramine) and a type of anti-inflammatory (ibudilast) marketed as Ketas. Douglas
says he received no explanation from the doctor about the nature of the drugs.
"I decided to take the liberty of asking if they had any side-effects, as a precautionary
measure. (The doctor) answered by saying, 'All drugs have some side-effects, but these
are nonaddictive drugs in small doses with little side-effects, so you needn't worry
about taking them over long periods of time.' "Douglas knew nothing about benzodiazepines at the time, and as the doctor was an
respected expert on balance disorders, he accepted his judgment in good faith.
After the first couple of weeks of treatment, Douglas
experienced a noticeable improvement in his
condition※1 and a settling of the more severe
symptoms he had been experiencing, so hecontinued taking the prescriptions.
Unfortunately for Douglas, this progress was
short-lived, and by late August — less than twomonths after beginning treatment — his condition
had begun to deteriorate again. By the four-monthmark — the point when the doctor said he should
expect to have fully recovered — his dizziness wasmarkedly worse than before treatment. ※2"I was left in a state where I was constantly
staggering, like being quite drunk." Anddisturbingly, he also began experiencing new
symptoms.

[Comments]※1 This sentence was taken fromStatement 1 of the plaintiff, article
4.3 where it says ‘symptoms had
settled a little’.
However, in the news article it says
“Douglas experienced a noticeable
improvement in his condition”.
The fact is the symptoms had
settled a little.
※2 This sentence was taken fromStatement 1 of the plaintiff, article
4.7 – A where it says “my condition
continued to deteriorate rapidly”.
However, in the news article it says
“his dizziness was markedly
worse”.
Although my general condition was
worse, “markedly” is anoverstatement for the dizziness.

"I began to suffer from severe emotional instability including panic attacks, anxiety,mood swings, aggression, and feelings that I was going mad.
"This is the first time I had ever experienced anything like this, and it still remains
with me.※3 I felt afraid of being diagnosed as mentally unwell and sent off to an
institution in a country different from my own, never to come out again."By November 2000, Douglas had begun to losefaith in the doctor and his treatment and decided
to stop taking the prescribed drugs. However, hefound he was unable to go without a single dose
— unwittingly, he had become addicted tobenzodiazepines.
Douglas began to find it increasingly difficult tocarry out his job, and his boss put him on lightduties with breaks every hour. Douglas was at an
all-time low, and entertained thoughts of suicide
for the first time.

[Comments]※3 This sentence was taken fromStatement 1 of the plaintiff, article
4.7 – A where it makes reference tothe panic attacks only.
However, in the news article itappears to suggest that many
symptoms still remain with me.
The “still remains with me” part
relates to the residual panic attacks
only as at January 2008 – the time
Statement 1 was submitted to thecourt, not the time of the newspaper
article (March 13, 2012).

"If one can imagine what it must feel like to be drunk 24 hours a day, seven days aweek, week after week, month after month, and suffering from numerous other ongoing
debilitating symptoms, including panic attacks, and feeling like you are going mad allat the same time for over one year, whilst trying to function normally within society ina country different from your own without any support — then you might understandwhat I meant when I said to my mother in that November phone call, 'Mum, I feel likeI'm in hell.' "Unable to cope on his own in Japan, Douglas eventually made the decision to return to
New Zealand in March 2001. It was only when he visited his local doctor back homethat Douglas learned for the first time that the drugs he had been given in Japan werehighly addictive, and he was diagnosed as a benzodiazepine addict.
Douglas' doctor also referred him to the Alcohol &Drug Service at Taranaki Base Hospital, whoentered him into a detoxification program in April.
Within two months, Douglas was
benzodiazepine-free.
Yet his life was far from back to normal. It took
another year before he was cleared by his doctor towork again, and even to this day — over a decade
later — he says he is still suffering from some of theresidual emotional effects of his addiction, such as
depression, chronic anxiety and panic attacks. ※4"I found thereafter that, because of these panic
attacks, my ability to carry out normal employment[Comments]※4 This sentence was taken fromStatement 1 of the plaintiff, article
6.3 where reference was mainly
being made to the time whenclearance was given to return towork in 2002~2003.
However, in the news article itappears to suggest that many
symptoms still remained at thetime of publication (March 13,2012) about a decade later, which
is not so.
(See article 3.1 of Dr. Judson’s
third report on recovery).

had diminished considerably, and subsequently I was unable to apply for jobs thatmatched my qualifications and experience," he explains. "So I ended up having to apply
for low-paying jobs, and even then, on occasion I would end up unemployed again, as I
often became easily fatigued."
Bitterly aware of the long-term negative impact his benzodiazepine addiction had on
his earning potential and quality of life, and wanting to understand why all this had
happened to him, in 2003 Douglas began conducting research into the Japanese
doctor's diagnosis and drug treatment.
"I needed answers to ensure that it never happens again, and I also felt a desperateneed to put the pieces together in order to get some closure on this ordeal," he says.
The more he learned about his case, the more he began to believe he had been thevictim of medical malpractice. With that realization, Douglas embarked on an almost
decade-long journey to seek compensation and justice, a journey that took him finallyto the door of the Supreme Court of Japan.
The first thing he discovered after consulting with neurologists and other specialists in
New Zealand and later in Japan was that all the experts were in agreement: The
doctor's original diagnosis of Sylvian aqueduct syndrome was completely wrong, andthat even if it had been correct, benzodiazepines are an entirely unsuitable means oftreatment for the condition.
Dr. David Hutchinson, a neurologist from Auckland Hospital who examined Douglaswhen he returned to New Zealand, determined that his original problem of vertigo anddizziness was most likely caused by an "episode of acute vestibulopathy," not Sylvian
aqueduct syndrome. This was the same diagnosis that doctors at Saitama Hospital hadoriginally made.
Vestibulopathy is inflammation of the vestibular nerve, a sensory nerve that carries
information from the inner ear to the brain. Such an inflammation can cause vertigo,
nausea and imbalance.
In a 2008 letter included in reports submitted to the Japanese courts, Hutchinson
wrote that Douglas did not show any of the constellation of neurological signs ofSylvian aqueduct syndrome, "but more importantly his brain MRI scan did not showhydrocephalus or any other disorder which can produce the Sylvian aqueductsyndrome."
In addition, Sylvian aqueduct syndrome is regarded by most neurologists as a fairly
quaint clinical concept that is rarely used in contemporary practice, the letter said.

More shocking than the alleged misdiagnosis was the fact that the treatmentprescribed for Douglas was completely unsuited to both the actual condition he had andthe condition he was incorrectly diagnosed as having, Hutchinson wrote.
"I do not know of any reason, theoretical or otherwise, why benzodiazepine medication
would have had a role in the treatment of Mr. Douglas in 2000. Benzodiazepine drugs
do not have useful antiemetic (antivomiting) or antivertiginous properties and have noclear role in the treatment of acute unilateral peripheral vestibulopathy.
"Further, benzodiazepine drugs would not be effective in treating hydrocephalus (waterin the brain) or any of the other conditions which may produce the Sylvian aqueductsyndrome," Hutchinson said.
As Douglas began to better understand what he had gone through and how his
prolonged suffering through benzodiazepine addiction had been largely avoidable, hebecame increasingly determined to seek justice and compensation.
In 2005, despite much apprehension and fear, he returned to Japan and began putting
together his case against the doctor. In 2006 he entered into mediation with the doctor
and the clinic where he practiced, but after numerous failed attempts to reach asettlement, Douglas took his case to the Tokyo District Court in early 2007.
In court, the issue of diagnosis was not central to the case. Instead, the basis for
Douglas' claim for damages was that he had become addicted to benzodiazepines
because he was prescribed them repeatedly over a long period of time, without
informed consent, and that the doctor neglected to properly monitor his condition whileon the medication.
The doctor's defense argued that Douglas was never addicted to benzodiazepines in thefirst place. If there was no addiction, the argument ran, the doctor could not have failed
to "properly monitor" his patient's reaction to the drugs, because the drugs were notcausing the adverse symptoms.
Douglas lost his case in the district court but was unwilling to give up the fight. In 2009,
he took his case to the Tokyo High Court, which eventually sided with the lower courtin rejecting Douglas' appeal, ruling in February 2011 that the "appellant's claim has no
grounds of reason."
The basis for the high court's conclusion was that it could not be proven that Douglas
was benzodiazepine-dependent because the symptoms he claimed were attributable totolerance, withdrawal and/or side-effects from the drugs could also be "symptoms ofautonomic nervous disorder." In other words, Douglas had an underlying anxiety
disorder and this, not the drugs, was the cause of his symptoms.
Yet according to Heather Ashton, emeritus professor of psychopharmacology at
Newcastle University in England and a leading expert on benzodiazepine addiction,
who studied Douglas' case, the drugs themselves were the cause.
"Benzodiazepines affect the whole nervous system, both the central nervous systemand the autonomic nervous system," says Ashton.
The autonomic nervous system regulates and controls involuntary bodily processes,
such as the widening or narrowing of blood vessels or the beating of the heart. In thecontext of a frightening event, for example, the autonomic nervous system would be
responsible for causing a person's hands to shake or heart rate to increase.
"The autonomic nervous system responds to anxiety and stress from any cause.
Benzodiazepine tolerance, dependence and withdrawal all cause stress and anxiety, so
the response of the autonomic nervous system is the same as its response to any othertype of anxiety," she says.
In addition, the court concluded that because the dosage of benzodiazepines Douglas
was prescribed remained the same throughout the time he was seeing the doctor, thisshowed that he had not developed tolerance and was therefore not addicted.
However, Dr. Graeme Judson, the clinical service director of Alcohol & Drug Service
Taranaki, who treated Douglas when he returned to New Zealand, said in a report hesubmitted to the Japanese courts: "I would like to clarify that it is also possible for apatient to get 'withdrawal' symptoms during treatment simply due to tolerance alone,even on long-acting agents. This is because once a patient has developed tolerance thesame dose of benzodiazepine may not exert the same effect, even if it produces the same
plasma levels."
Here Judson is referring to a common phenomenon in benzodiazepine addiction called"tolerance withdrawal." The normal pattern of addiction is that an addict gradually
increases their dose of the drug over time in order to continue to get the desired
psychological effect and to avoid withdrawal symptoms.
But in some cases, such as Douglas', this does not occur and the addict takes exactly
the same dose over time, and thus withdrawal symptoms occur even while they are stillusing the drug.

Another issue of contention in the case was whether the daily dosage ofbenzodiazepines Douglas was prescribed was high enough to result in dependency.
Most surprising of all, the high court relied on the packaging produced by thepharmaceutical company to determine the dosage at which benzodiazepines could be
deemed addictive.
To quote from the high court judgement: "The only written information contained in
the package insert of the benzodiazepine-type drugs that were prescribed to theappellant — Rivotril (Clonazepam) and Contol (Chlordiazepoxide) — is that it ispossible for drug dependency to form on high doses, and there is no written information
relating to the possibility of developing drug dependency on clinical doses. Therefore,
as ruled in the original verdict, the development of dependency to prescription doses ofbenzodiazepine-type drugs cannot be recognized as established medical knowledge inour country."
Yet evidence exists that at least some Japanese medical professionals have been awareof the issue of benzodiazepine addiction from clinical doses for some time.
As far back as 1996, for example, professor Mitsukuni Murazaki of Kitasato University
published a journal article called "Benzodiazepine Dependency on Clinical Doses.""We need to be prepared to see a greater than 50-percent dependency rate in those whotake clinical doses of benzodiazepines for more than 4-6 months," Murazaki wrote in
the article. "It is important to put measures in place to avoid heading towards
long-term prescribing of any more than six months, and essentially, benzodiazepines
should be brought to a controlled end before falling into a state of dependency."
Amongst medical professionals in Western countries it is common knowledge andwidely accepted that addiction can, and frequently does, develop on clinical doses ofbenzodiazepines.
According to Ashton, tolerance and dependence can develop if benzodiazepines are used
regularly for longer than 2-4 weeks. "There is no minimum dose," she adds. "For
example, tolerance and dependence have been observed after the regular use of 2.5-5
mg of diazepam." Douglas was prescribed a diazepam equivalent of 21-31 mg for almosta seven-month period in Japan.
Douglas also attempted to take his case to the Supreme Court, but the appeal was
dismissed in October 2011 before it reached the court because it was deemed not tohave met the requirements for "constitutional infringement."
Despite losing the case Douglas is still upbeat.

"I don't feel like I lost, I feel like I won and the court failed," he says. "It feels like they
were protecting the doctors and failed to protect society.
"What I want to do is use my experience and the material generated through my case toprovide a resource to others who are dependent or may become dependent."
Questions relating to the Douglas case and a request for comment were sent to thedoctor who treated Douglas in Japan, and their receipt was confirmed in a phone call,but he failed to reply in time for publication.
Benzodiazepine use is on the rise in Japan, andalthough per capita use is lower than in many
European countries, it is still the highest in Asia. ※5
According to a 2010 United Nations report, the highconsumption levels are in part due to Japan's large
elderly population, but also might reflect"inappropriate prescribing patterns and associatedabuse."
Dr. Hirokuni Beppu, a neurologist and expert on
medication in Japan, believes high rates ofbenzodiazepine use in Japan are part of a wider
trend towards a more "medicalized society" driven bypharmaceutical companies and the media.

[Comments]※5 A United Nationsorganization, the International
Narcotics Control Board,
indicated in their 2010 Reportthat Japan has the highest
average consumption rate of“anxiolytic” benzodiazepines in
Asia with the only exception
being Iran (See Figure 20 on page35), and although use for thisindication is lower than in many
European countries, Japan has
the highest average consumption
rate of “sedative-hypnotic”(sleeping pills) benzodiazepines
in the world with the only
exception being Belgium (SeeFigure 26 on page 39).

"Nowadays, people are pushed more and more to go to the hospital or the doctor's," heexplains. "In traditional Japanese culture people looked after the neighbors, took time
to listen to their stories and gave support. But today in Japan each person is separated
and the family is smaller — all people can do is talk to professionals. Such kinds ofchanges in society, has caused an increase in anxiety."
Beppu also advocates increased regulation and says maximum prescription periods
should be reduced to one week from the current 30 days for most benzodiazepines. The
period is even longer — 90 days — for benzodiazepines used for the treatment of
epilepsy, such as Clonazepam (Rivotril), one of the drugs Douglas was prescribed.
However, he thinks improving medical education in Japan is the most importantsafeguard against addiction to these drugs.
"We need to re-educate GPs (general practitioners) or hospital doctors and improvetheir knowledge about medication through drug bulletins or journals," he says. He adds

that the government is strongly influenced by the pharmaceutical industry and sees
increasing drug exports as a money earner for Japan.
"To tell people too much about the risk of certain drugs is bad for the pharmaceuticalcompanies — the focus is on making Japanese pharmaceutical companies become
stronger."
Information about benzodiazepine addiction and how to safely come off the drugs canbe found at professor Ashton's website:www.benzo.org.uk/manual/index.htm. Send all your comments and story ideas tocommunity@japantimes.co.jp[Closing Comment]
As mentioned in the story, I was having great difficulty in walking
following my vertigo attack (before taking benzodiazepines). Manyexpert neurologists have provided expert verifications saying thatmy initial illness was due to vestibular neuronitis which is what I
believe too. As I understand it, many people with this condition havea severe balance problem which usually improves gradually overtime due to the natural process of “compensation”. This is where thebrain readjusts itself to compensate for the distorted balance signals
being sent from the nerve in the affected ear to the brain.
However, in my case, because I was being prescribed a multitude ofdrugs that affect the entire nervous system, I believe that thisnatural healing process of “compensation” was being inhibited. This
together with being in a state of benzodiazepine dependence is thereason why I believe it took so long for my balance mechanisms to
restore themselves. In fact it wasn’t until after the drugs had been
removed that I actually began to make a recovery from my balance
related problems. Eventually I made a full recovery but only in theabsence of the drugs.