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Being forced off of meds due to my age


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Just found out today when I called my pdoc to discuss adding an anti-anxiety med to my regime, that due to my age being 62, benzos are prohibited.  I have been on Klonopin since 1998.  I am totally freaking out. 

 

He's giving me nothing to replace this, he is refusing SSRI's, SNRI's, antipsychotics, TCA's.  There's nothing he will prescribe for my mood. 

 

I am taking Lithium but that is subject to how my liver blood work comes out.  That can also be taken away from me. 

 

Currently I am in the US and under a Kaiser plan.  This doctor has been at this medical facility 20+ years and is highly thought of, so if I appeal his decisions, it will be likely that this will be over-ruled. 

 

I had no idea that by turning 60 most of the mood meds that I need to exist would be taken away from me.

 

What do I do, crawl under a rock?

 

De

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This is unbelievable.  I am  not quite your age, but almost....  I am also being tapered off my clonazepam (Klonopin) by July (a six month taper) after being on this medication for ten (10) years.

 

My story is more complicated, and I was not told that it had anything to do with my age.    The bottom line is this:

 

THERE IS NO PROHIBITION by the DEA (Drug Enforcement Administration) or by any medical body (i.e. the American Psychiatric Association, the American Medical Association that states that after a certain age, you can no longer have the medications you mention.    NONE.  There is no basis in law for your doctor declining to prescribe this medication.  There may be a basis in their PRACTICE, but it is not prohibited by any higher authority.  

 

I can't speak to the Lithium issue;  that seems dependent more on your blood work than anything else. I do know that people > 60 are on lithium .... as long as they have periodic lab tests to check their levels.  Someone who has been on the medication (I have not) may add to this reply.  

 

If I were to make an educated guess, I would say this is either a KAISER policy or some new policy of the psychiatric group within Kaiser.

 

Why would doctors limit benzos for people over 60?  

 

Well, one important quality statistic that is measured in healthcare is the number of people who fall - fall and break hips, hit their headz, etc.... it is known that taking a benzodiazepine may increase the risk of falling, especially in older people.     Someone may have had the bright idea that to reduce the number of falls, reduce the benzodiazepines prescribed to people who might be most likely to fall:  older people. 

 

BUT!  by "older people", I generally feel that applies to the "frail elderly" not to me (and not to you).  There are people on this board over 60 years of age who are most certainly not "FRAIL". 

 

This makes me so angry.  It is dangerous, as you may know, to go off Klonopin quickly without a taper.  So make sure the doctor (or SOME doctor) allows for a reasonable tapering schedule if you are not going to be taking this medication any longer.

 

So ... there is no federal or state law that prohibits prescribing of benzodiazepines (like Klonopin) to an entire class of people (over 60 years of age).    I am quite certain about this.

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Thanks FlamelessCandle, I will be looking this up and calling the FDA and reporting Kaiser.  You might want to ask your pdoc why he is reducing yours.  It would be interesting to know if it's also age related.

 

My proc did mention the "fall" issue and also early dementia, confusion. I don't think that Klonopin is all that expensive if I were to pay for it out of pocket and I could go back to my former pdoc and he said he would gladly prescribe it to me, but he would want to reduce it significantly over a long period of time, but not to take me off of it completely.  He felt the 2 mg was to high for me.  Of course both pdocs did prescribe the 2 mg to me recently. 

 

Then there is the other issue, I have sleep apnea and combining Seroquel (prm) with Klonopin and Lithium all three can reduce my oxygen intake.  But all this is new news to me.  If it's such a hot issue, why did my proc prescribe me a 3 month supply just last week of Klonopin?

 

De

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You are being fed bullshit. Find another pdoc.

 

In Kaiser, at least here, your pdoc has to approve you changing to another pdoc. This is unlike the rest of Kaiser where you can just set up an appointment with another PCP. Talk about double standard. It is a major hassle and the new pdoc comes with attitude because you had the nerve to take issue with the old one. That's my history with them, at least. So glad I have different insurance now.

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As far as paying out of pocket, generic Klonopin (clonazepam) is not very expensive.  I've never actually had the brand name kind, so I can't say about that, but generic (clonazepam) has always been effective.

 

Re: oxygen intake or respiration issues, I don't know about interactions between Seroquel, Klonopin and Lithium.     I might ask your pharmacist  about this - given the dose you take of each med, should you be concerned about oxygen intake?    Pharmacists know a LOT about meds and about interactions. IMO,  maybe more than most doctors ...  that's the entirety of what pharmacists study.

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I didn't come home in time to call the FDA about the position Kaiser is taking with me, but will tomorrow.  Kaiser, for me, is a plan that Medicare introduced.  I can opt out of Kaiser at any time and go straight Medicare, but I have to pay the 20% out of pocket.  I don't need Kaiser's permission to opt out and opt out means I will still be with Kaiser, I am just choosing to use my Medicare benefits. 

 

This doctor said to me "someone has to own your prescription with Klonopin, going forward".  Just the wording "someone has to own" shouted at me he doesn't want to take responsibility or cross over a Kaiser rule, which I also will be looking up. 

 

The thing is, I have been on Klonopin for 16 years, daily, and to take me off of this medication is frightening me.  I don't have anyone in my life on a consistent basis to help me when I go into any withdrawals or have any serious side effects which may become fatal, as the research I have been doing is stating.  I know when I needed to have an ENT test conducted on me, I was asked to stop taking Klonopin cold turkey for 3 days.  By the 3rd day I was deep into the DT's and thought I was having a heart attack, called my pdoc who told me to take my Klonopin and what a dramatic difference shortly after that.  So, I know better than to ever do that again.

 

I have been going through a very destabilizing period in my life.  I'm just recovering from cancer, I had to move to an undisclosed location due to domestic violence in my life and am just now adjusting to my new life.  It's been alot over the past 12 months. To take me off of Klonopin right now would put me at significant risk and the Kaiser pdoc knows this.  Plus I don't have any idea how I will be off of Klonopin.  Each time I change pdocs, I get a different diagnosis. 

 

So, I have an option.  I can do back to my pdoc that I have been seeing for the past 16 years and have him help me with all this and pay the 20% out of pocket and do the generic of Klonopin, but even he says that he might refer me on to a geriatric pdoc who does nothing but this type of medicine.  He agreed that after 60 is the model his colleagues follow as well, but it's case by case and not across the board as Kaiser is doing.   I wanted to go with Kaiser because my pdoc of 15 years is getting ready to retire soon and wanted to establish myself with a new pdoc. 

 

I need to check out what this pdoc at Kaiser is telling me and also thank you for suggesting I seek out a pharmacists opinion FlamlessCandle.  And thank you to all who have responded trying to help me tease out what information I was given by this Kaiser doctor.

 

I'll let you know what info I get tomorrow from the FDA and a local pharmacists.  The Kaiser pdoc made an appointment with a neurologist who specializes in sleep medicine and seizures/migraine for me in two weeks.  I think he wants to prove I am dissociating and not having absence seizures.  I was put on Klonopin in 1998 to control seizures by a former neurologist when all the other seizure meds I tried, I could not tolerate. The Kaiser pdoc said he will forward all my psychiatric records over to the neurologist :-(  So, are the cards stacked against me already before I go? I am getting a feeling one doctor at Kaiser may not differ from another Kaiser doctor's opinion (the good ole boy network).  I just may have to go outside of Kaiser for my mental health treatment. 

 

De

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I would suspect your doc simply does not want to say no and is hiding behind this made up FDA "rule". It could be your insurance, but you should be able to get a prior auth to get around this. If your doc supports you continuing to use this med.

Edited by notfred
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This doctor said to me "someone has to own your prescription with Klonopin, going forward".  Just the wording "someone has to own" shouted at me he doesn't want to take responsibility or cross over a Kaiser rule, which I also will be looking up. 

 

I think you have a good instinct about this statement. I realize that psychiatrists have different positions on prescribing benzos in general and also for older patients as well. But the way he put it just strikes me that his motivation is more self-interest than your best interest - and - really - why bother establishing yourself with a pdoc like that? One thing I'm wondering is - if he really thought you should be off the klonopin - did he suggest a taper schedule and would he have been willing to prescribe for that? Or was he just "it's not my problem?"

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I am thinking the same thing you are kateislate.... "why establish myself with a pdoc like that".  Unfortunately, he is the head of the whole dept in psychiatry at this location and he supervises everyone underneath him.  I selected him for his tenure there.  I have only seen him three times in the past year.  I also agree with you that he is more self interest than my best interest.  He's taking a hard line with me on this and is not being flexible.

 

So, while I am looking into all this on various levels, without confronting him directly about all this, I will check out what the neurologist has to say about staying on Klonopin for my seizure disorder since I cannot tolerate any of the anti-seizure meds currently out there.   If the neurologist will keep me on Klonopin, then I am safe and my pdoc can go jump in the lake.  I will at that point, ask to be assigned a new pdoc and not challenge him at all.  I can't take on anymore challenges in my life.  If all else fails and the neurologist is against Klonopin, then I will go to my former pdoc and let him treat me. 

 

When I was recovering from breast cancer, I fought my way all the way up to the top at Kaiser to get a bilateral mammogram and one done within 6 months of radiation.  Obama care mandated only the side of the cancer would be tested and I would have to wait another year.  When I asked for all this in writing, I finally got my bilateral mammogram conducted within the 6 months.  

 

Kaiser is beginning to scare me.

 

De

 

This doctor said to me "someone has to own your prescription with Klonopin, going forward".  Just the wording "someone has to own" shouted at me he doesn't want to take responsibility or cross over a Kaiser rule, which I also will be looking up. 

 

I think you have a good instinct about this statement. I realize that psychiatrists have different positions on prescribing benzos in general and also for older patients as well. But the way he put it just strikes me that his motivation is more self-interest than your best interest - and - really - why bother establishing yourself with a pdoc like that? One thing I'm wondering is - if he really thought you should be off the klonopin - did he suggest a taper schedule and would he have been willing to prescribe for that? Or was he just "it's not my problem?"

 



Interesting, notfred, thank you for sharing this with me.  I feel better now knowing this.  I might just give Medicare a jingle and see what their fix is on this.

 

De 

 

Mom gets Ativan every month and she is in her 80's. Medicare pays for it.



Thank you for sharing this notfred.  I feel soo much better knowing this.  Will check with Medicare on this as well.

 

De

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Have been doing some online research on geriatric medicine.  I will call my state licensing bureau tomorrow to see if they require licensing in the state I am living in to treat a geriatric patient for mental health concerns.  According to what I am reading online, a psychiatrist has to have special training to treat and prescribe a geriatric patient.  This is what my former pdoc was trying to explain to me. 

 

So, I sent off a very polite email to my Kaiser pdoc asking him for names of geriatric psychiatrists I can transfer to, within Kaiser, "so I could make an informed decision".  If Kaiser does not have this specialist, I may be able to get them to pay for services outside of Kaiser, that is if my state licensing requires special training for a psychiatrist.

 

So, will see what my Kaiser pdoc has to say when he responds tomorrow.  I don't want to make an enemy out of him, I just want him to know that I am not accepting his position on this, in an indirect way.  He knows how I feel directly, so now I am trying a soft approach with him.

 

De 

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It sounds like you are taking a very thorough and informed approach to this issue.  It's distressing, so it's all the more impressive that you are able to do the research, make the phone calls, and be assertive.

 

Good luck and keep us posted.   I'll do the same on my end.   Interesting about geriatric psych patients in regard to providers needing special licensure or training to treat them.  Therapy/psych services are regulated and licensed state by state (for the most part).  So it could be, if this is indeed true, that it applies to one state and not another.    

 

In parts of the country where there is a shortage of psych providers, I'm surprised that geriatric patients are treated differently.  Not that they don't have some special consideration... they do.  

 

Anecdotally, my dad, who passed away last summer at 84, had (untreated) anxiety and panic disorder/s for most of his life.   We finally got him to seek treatment;  neither the psychiatrist nor the therapist mentioned anything about being "trained" or licensed to treat geriatric patients.  Their waiting rooms were diverse in terms of age, from teens to the elderly. 

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FlamelessCandle ~  Thank you for your compliment and the pat on the back :) Your encouraging words were inspiring to me. I'm sorry your dad had to suffer so long into his life span.  Was he ever able to receive treatment that helped reduce his suffering?

 

Yes, I am prepared that my state does not require special licensing, but may require special training, fingers crossed.

 

I just checked under my online state licensing dept. of health and found a notice on the front page that is interesting, and so the research begins:

 

Geriatric Resources
The Joint Commission on Health Care has noted a significant shortage of geriatricians in xxxx. To obtain information specific to the treatment of elderly patients, please access these and other resources for practitioners who provide geriatric care:

http://www.americangeriatrics.org – Website for the American Geriatrics Society
www.Geriatricsatyourfingertips.org - Manual on geriatric care
www.Eperc.mcw.edu/EPERC/FastFactsandConcepts - end of life and palliative medicine
www.pogoe.org - The Portal of Geriatric Online Education (POGOe) is a free public repository of a growing collection of geriatric educational materials

 

De

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@ Dewey - thanks for asking about my dad.  

 

He did get some relief from his anxiety, sort of.... he was on Paxil for a few years.   What complicated the matter was my mom died as he was starting to get treatment and medication.  He was devastated by the loss, so he had a "good reason" to be depressed and anxious.

 

Also, he was diagnosed with Alzheimers after he'd been on Paxil for those 2-3 years.... (not that it was related or anything). So it was hard to sort out what symptoms were arising from what!

 

I wish he'd gotten treatment many years before he finally did; it just wasn't "done" with men of his generation (that's what my mom said about it.)

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FlamelessCandle ~  I'm really sorry to hear of your dad's suffering and wishing geriatric medicine was there for him.  I had thought by the time the baby boomers reached a certain age that our medical infrastructure would have this all figured out, but apparently not and now with Obama care (forgive me for bringing up a political topic) it seems that senior care is diminishing.

 

There is so much unknown about the brain, that it's scary and as we age some of us are subject to all this.  At least he had you by his side comforting him and helping guide him through the maze of medical care :)  which I am sure was very difficult for you.  And yes, there is the generational issue that plagues seniors of a certain age that is still continuing today. 

 

De

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