"Take a holiday from reality whenever you like, and come back without so much as a headache . . ." -- Aldous Huxley, "Brave New World," 1932
Even outside the heavy double doors, the roar is deafening as the tiny yellow tablets of tranquility rush down stainless steel spouts into large cardboard cartons below.
Three of the four-tablet-stamping machines are operating, spitting out 400 pills a second, 24,000 a minute, 1,440,000 an hour, not shutting down until more than 15 hours later when they have produced two lots -- 30 million tablets -- or enough Valium to supply America for only about five days.
Valium is the most frequently prescribed drug in the United States and the world, used by more persons than penicillin.
In 1978, retail pharmacies alone filled 44.9 million prescriptions in this country for an estimated 2.3 billion doses of the drug. And that is in the face of about a 20 percent decline in its use since 1975, a decline that has paralleled sales of other prescription drugs.
Valium has become such a widely accepted part of the American culture that it is joked about in the comic strips and a one-liner about it in the recent movie "Starting Over" regularly brings down the house.
If Valium is used properly -- and that term is interpreted in many different ways -- it indeed is a wonder drug.
It is a muscle relaxant. It is a treatment for alcohol withdrawal. It helps control seizures. It helps control anxiety. It can be used as a daytime sedative and a nighttime sleeping pill.
It comes perhaps as close as any drug can to being all things to all people. And that may be its biggest problem.
Its critics contend that because Valium is viewed as being so safe, it is treated much too casually by physcians.
Many doctors prescribe Valium particularly for female patients who constitute two-thirds of the drug's users, rather than listen to a patient's problems and provide counseling. It is sometimes far easier in a busy office to dash off a prescription than it is to take 45 minutes for a patient with vague complaints.
And perhaps because many physicans prescribe it so casually, the drug is often passed around among family members and friends, many of whom never get a prescription for Valium and never have a doctor aware that they are taking it.
Surveys show that most Americans distruct tranquilizers and that in 60 percent of the cases, Valium is prescribed for persons who need it for a purely medical benefit, such as muscle relaxation, or for physical problems associated with anxiety.
Yet there are people who misuse and abuse Valium.
There are no hard numbers to show how many, although estimates of misuse run as high as 30 percent of those who take it. Prescription data suggest that Valium is taken by about 20 million Americans, and even if only 1 percent of them are abusers, that's still 200,000 Americans with a Valium problem.
According to the federal Drug Alert Warning Network, in a one-year period between 1976 and 1977, 54,400 people sought emergency room treatment for problems caused by taking too much Valium -- compared with only 17,600 persons who had taken too much aspirin, and 21,500 heroin, methodone or morphine abusers.
In a two-month period in 1978, 208 persons were admitted to Washington area emergency rooms, saying they had taken too much Valium or had mixed it with other drugs or alcohol. This compared with 174 persons admitted with alcohol problems and 58 herion, morphine and methadone users.
Officials of Hoffman-LaRoche, the giant Swiss-based firm that manufactures the drug at its sprawling complex here, argue that the drug is safe, non-addictive and cannot kill, unless mixed with alcohol or other drugs.
All that is true if the drug is taken for short periods of time. But studies have shown that a person who takes two to three times the recommended daily dose of Valium may become hooked on it.
Some argue that the symptoms of Valium withdrawal, such as irritability, nervousness and insomnia, simply mark the reappearance of the problems for which the drug was taken. But taken in larger doses for long periods of time, Valium can cause withdrawal reactions similar to those experienced with herion or alcohol, including life-threatening seizures.
For most persons, however, Valium is a kind of psychic aspirin, taken occasionally to ease them over life's rough spots. How people view their use of the drug seems to depend on their views of drugs generally. These persons include:
The professional woman who says she takes Valium "about once a month. If you break up with a boyfriend, for instance, it's required. It's like oxygen."
A woman who went to a doctor in upper Marlboro for the first time complaining of severe headaches that aspirin didn't help. She was given a cursory examination, then asked if she was unhappy or having problems. "I said. 'No, as a matter of fact, things are going really well now.'"
The doctor then took out his pad, wrote something down and handed the prescription to the woman, telling her to "try these." "These" were 5-milligram Valium tablets. "When I saw what it was," said the woman, "I threw away the prescription."
Dr. Michael Halberstam, a local internist and author and a self-described "true believer" in Valium, tells of a man who simply "cannot stand the man his daughter is living with. He tells me, 'Every time they come to visit, I want to kill the son of a bitch.'
"For the two weeks a year that they come to visit he takes Valium," said Halberstam. "That's a perfectly appropriate use of the drug. My patients [who use Valium] don't want to be something more than they are, they want to be themselves."
The woman who can't remember why her gynecologist first prescribed Valium, but eventually built up a 40-milligram-a-day habit, fed by prescriptions from three doctors she visited every three weeks. Finally her druggist refused to fill them.
She tried to kill herself by taking five times the maximum daily dose and discovered one of the medical profession's great open secrets: Valium virtually never kills, unless it's mixed with alcohol or other drugs. She "walked into walls," however, one day when she mixed a Sinutab with a Valium.
A writer who became "psychologically" addicted to Valium by taking a single 5-milligram tablet each night to go to sleep. "I cut it back to a half [tablet] myself," he said, "and I sleep just as well. But I can't sleep without it." He has been taking the drug for four years now, one a night. For 60 days, he alternated the Valium with a placeo -- sugar pill -- without knowing which was which. He slept just as well.
A herion addict called a WRC Radio talk show on Valium and said the tranquilizer is "like a drug addict's delight. It's a dollar a piece [on the street] for the blue [10 milligram] ones and 50 cents for the yellows [5 milligrams]. Women sell Valiums.
"If it's fresh, one's enough to relax you," he told the talk show's guest host, Dr. Robert Dupont, former director of the National Institute of Drug Abuse. "It's a relaxing drug and people do need things to make them relax. What I really crave is heroin, but that's illegal."
"I had been given Valium about 10 years ago by my internist," a woman caller told Dupont, "and I take it when I need it."
"Said another caller, "I feel very guilty when I have to help myself with this pill."
The last two users best raise the major questions asked about Valium specificlly and tranquilizers generally: When does a person truly need a drug to control anxiety, and how does society view such drug use?
According to Dr. Dorothy Starr, a psychiatrist in private practice and president-elect of the Medical Society of the District of Columbia, "The only trouble with the benzodiazepines [the chemical family that includes Valium] is they work too well.
"Anxiety is a normal condition of living," she said. "People should learn to deal with anxiety and learn to avoid anxiety, rather than always blot it out. But certainly, there are lots of times when there is not point in allowing a person to be in pain, and anxiety, for no reason, if painful."
Starr and many other psychiatrists agree that there are different degrees of anxiety. Valium is appropriate therapy, along with counseling, these professionals agree, for persons who get sweaty palms, heart palpitations, dry mouth, and are so anxious they simply cannot function in certain situations.
A perfect example, said Starr, might be the person with a morbid fear of medical procedures who needs some kind of test in a doctor's office, but is so tense that the exam is almost impossible to perform. A Valium, in such a situation, would be entirely appropriate, she said.
Another example, said Starr, might be the case of a student who is pushed hard by his parents to get into medical school. He may have finally come to the point of taking his once-in-a-lifetime entrance exam, but is too tense to concentrate.
The danger with Valium, she said, "is that it works. You don't want to set up a positive reinforcement cycle in which . . . every time you feel bad you reach for something. You don't want to set up a cycle in which, instead of coming to grips with the fact that you do have to study for [mid-semester or final] exams," you take a pill.
"Anxiety makes you do what you've just got to do. It makes you study for your exams, anxiety make you do what your mother and father raised you to do. Anxiety makes you obey the law because if you don't the cop will catch you.
"Anxiety about doing things we're not supposed to do, about goofing off when we're supposed to be doing something, is what keeps a whole lot of people in line," said Dorothy Starr, "like the whole human race."
According to Dr. Frederick Goodwin of the National Institute of Mental Health, an internationally known expert on depression, the issue of abusing a drug like Valium generally focuses on "the question of whether a person was using a drug to blunt symptons which would be otherwise useful to them in their lives."
Anxiety, Goodwin said, helps tell people when they are in a situation that "perhaps they ought to reevaluate ." If the person "loses that signaling function, then the drug is not serving them well and they are more in an 'abuse' than a 'use' situation."
Studies show, he said, that up to a certain point anxiety improves a person's performance. But after that point, which varies among individuals, a person becomes overwhelmed by his anxiety.
It would be counterproductive, Goodwin said, for a person to take a Valium when he hasn't reached that point yet. "But in the highly anxious person, trapped by his anxiety, preoccupied by it," a drug such as Valium could help bring the anxiety under control.
As a specialist in depression, Goodwin is concerned that many patients suffering from depression are given Valium by their general practitioners for what appear to be symptoms of anxiety. The doctors, he said, never look for the underlyng cause of the anxiety. And when the anziety disappears, the patient's depression is left untreated.
There are some defenders of Valium who argue that if it were not available, many of those who use it as a crutch would just switch to alcohol and more dangerous, addictive drugs like the barbiturates and narcotics. Thus Valium, these people argue, is a social safety value something societies have needed from ancient times to Aldous Huxley's fictionalized "Brave New World."
Dr. Sidney Wolfe, director of the Ralph Nader-financed Health Research Group, who believes Valium is prescribed far too often, said that argument misses a major point.
"The difference between Valium and opium, or cocoa leaves, or Soma [Huxley's mythical drug] and alcohol is that the other drugs aren't prescribed by a doctor to improve your health. One hundred percent of the Valium prescriptions come from physicians to improve health. That's how it's distinguishable from the other drugs in society, and that's an important difference."