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Doctors unprescribing Benzos


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How did it go?  "The only thing we have to fear.  Is fear itself!"  So a small piece of my history.  I was DXed with Anxiety and my doc suggested Xanax.  As I've had experience with a person who takes Xanax and his apparent vegging out on it I begged off.  I was afriad that whatever happened to him would happen to me.  So we went over a list of other Benzos and the only one I knew about was Valium/Diazapam.   I knew one person that took it and seemed to be perfectly functional on it.  In fact if she had not suddenly stopped taking it I would have had no idea she took it.   *Aburpt stopping a drug your taking daily like Valium can have serious baggage.   Better to taper off or better yet not take it daily - I think

So I tried a half tab and it did nothing.  I tried 2mg and again nothing.  I asked GDoc if we could up the dose to 5 to 10 and after getting an OK I found that 5 or 6mg was where I could tell it was doing something and that was enough for occasional bouts of Anxiety.   I think the buspar helped put up a wall so that anxiety wasn't getting to the curled up on the floor or unable to drive level stuff but the occasional super tense up holding my breath and mouth drying up kind of anxiety that wasn't daily?  It worked pretty good.  Maybe a handfull of times (Finger counting amounts) I took 10 mg.  That was a tad sedating maybe too much unless its the Sky is falling levels of anxiety.

So - the Benzos = dementia stuff started going around and I was called to turn in the unused valium and was put on Xanax (As needed)  Xanax at the 0.5 mg amount ought to have been like 10 mg of Valium from what I've read but it was (at times) underwhelming.  Or perhapes the short lived effect made the interrupted anxiety more noticeable?  Anyway I refilled it on a fairly infrequent basis because I was never in danger of using all the tabs in a month.  Then I signed up for an automated reminder system for my meds and Vitamins.   The Xanax came in monthly and for the last 4 or 5 months I just texted back "1" to refill.   The only other option was press 9 to make the system forget about reminding me about that drug.  So....  I made a complaint about Xanax maybe 0.5 was not effective or maybe I needed Xanax ER or as I put it Diazapam worked pretty well why not just go back?  I think the monthly refilling set off an alarm and I got a major talking to about addiction.  After explaining I wasn't using them all that frequent and how extra crappy things were going I got a new DX of severe Anxiety and was put back on Diazapam.   At the useless 2 mg dose and reminded not to take it everyday.  SIGH...

So I see tdoc this week and PDoc in a week or two to figure this out.  I'm thinking of bringing in the unused tabs of Xanax to show I'm not shoveling it in.  Explain that I think I'm having a short acting or dose problem with Xanax and see if I can't get back to the dose that worked with the Diazapam. 

Are Benzos the new Heroin of meds?  Should they be?  The stuff I read from the UK seem to imply this.  I'm seeing UK law suits against Doctors for "creating" drug addicts etc.  I don't have a dx of paranoia but it seems like the National health care types are finding ways to unprescribe a lot of drugs and therapies.  Or is this just me? 

Whats going on with you guys?  If your taking a benzo is there a sudden signal from your doc that they want you off them?  My impression is that Xanax is far more addictive then Valium.  Or are they just two sides of the same coin?  Do you sign pledges not to misuse them?  Are you doing meds checks where you are doing an inventory of unused pills?   Real problem or?

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The first pmed I was rx'd was clonazepam (klonopin in the US) when I was 17. I've been on benzo's since then, I'm 31 (almost 32) now and have gone up and down in doses, switched around, etc. I've been fortunate to have doctor's that don't think they're a problem. I'm rx'd up to 3mg clonazepam a day, and I usually take 1-1.5mg unless its a bad day. It still helps. My pdoc has never checked on my meds, and my pharmacy will refill 7 days early (I had one pharmacy that would refill clonazepam and vyvanse only on exactly 30 days after being prescribed) and they're in my pdoc's building. I bring leftovers, or I keep stuff "just in case". 

I screwed up big time and went through 15 days of elavil in 9 days and freaked, my pharmacist was kinda pissed, but then I started crying, and he calmed me down. Then I called my pdoc's receptionist going "he's going to dump me as a patient, I screwed up" and she reassured me, she was very kind. I got the elavil a couple hours later. First time I've done that with any med.. but I was so anxious.

I've never had any doc mention taking me off benzos. Hell, I've had a few tell me to take more, but I listen to my prescriber, period. If another doc wants to change a dose, they can get my signed consent and fax him. He knows I've been on clonazepam since I was 17, and has never mentioned d/c'ing it. He did, however, when I was referred to him after my old (asshole) pdoc retired, switch me from Xanax to clonazepam because clonazepam is longer lasting. I found the switch incredibly easy, as I was taking less Xanax than the clonazepam.

I do have a history of drug abuse, its in my records, but my pdoc knows I haven't even as much as smoked pot since 2010 (I was big on club drugs) and he's never tested me, except for the usual IP drug test when I went IP a couple years ago. He doesn't mention abuse at all. I've never come up short on any controlled med (clonazepam and vyvanse) and I quit drugs 3 years before I saw him, but the pdoc before him (retired) sent my file with "SUBSTANCE ABUSE - ECSTASY" on it. (I did it once, crashed, ended up in the ER... I mostly did ketamine in 2008-2009... I did E.... once... fuck) My pdoc doesn't even ask me if I smoke cigarettes, or if I've been drinking. He's very kind, good to me, and seems to trust me, which I like. Pdoc before him was always accusing me of "smoking dope" even though I've done it once since I was 16... he was, well, a douchebag, but rx'd the benzos.. 

A good rapport between you and the pharmacy and the pdoc and the pharmacy is always a good thing. It makes things run better. 

IMO, xanax has the shorter half life, so is harder to get off of that valium. Addictive means abuse. Dependence is generally what happens, it'll poop out, or you need it more to work the same - but you aren't abusing it. BIG difference.

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I was put on Ativan while inpatient seven years ago at the same hospital that runs my current PHP (my most recent inpatient stay was unfortunately not at the same hospital).  When I've been in PHP, there's been talk of having me come off the ativan eventually, when they found out it's been seven years.  It stopped them in their tracks a bit, though, when I said that they were the ones who prescribed it first and monitored it for the first six weeks (I was in a PHP seven years ago also).  Seems like they can't make heads or tails of it.  There was some talk about having gabapentin as a substitute, but it's currently helping me fall asleep, so I don't see how it could be a replacement for a morning dose.  I understand it can help with anxiety, but it can't help if it puts me to sleep.  So I'm not sure how far they'll push it.  Initially there was talk of switching from ativan to klonopin because of the long-acting nature, which makes it a better daily medication.  That made a lot more sense than me because the few times I've had it it hasn't made me fall asleep. 

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I am not good with prn meds. I had ativan and I popped it like candy because i am always anxious. I almost had to have my meds dispensed for me.(pain meds I don't take soon enough). Then, my pdoc put me on klonopin on a schedule and it worked better for me. But, I was hospitalized and the hospital pdoc took me off it all at once (I felt sea sick) because he didn't like patients on benzos.

I take lexapro now, which helps a little. I have some coping skills. Everything helps a little.

My pdoc isn't big on benzos. It came up on intake when I told him I don't do good with prn meds in general.

I used to be almost a recluse and now I do some public speaking and work with people so I have worked on developing social skills, overcoming anxiety, 

I never took xanax. From my experience with ativan, I think it would wear off too soon for me. I would rather take something like klonopin. 

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I think as barbiturates 'had to go' (the maxim is untrue but the generalization applies in most of cases), same thing will eventually happen with benzodiazepines.

At least here, where the the standards are different, over past decade, considering different benzodiazepines, I saw some changes on official pharmaceuticals therapeutic recommendations to something more tolerant.

It extended the length of treatment and made more 'loose' the interactions over those years;

Those changes didn't make an experienced PDOC more flexible but made 'general doctors' prescribe it more.

Since I started taking this class of med, it never had a long term treatment approved and it usually had a window of treatment.

The most positive thing wrote by those pharmaceutical companies were something like:

"The treatment should be as short on length as possible".

I think the pressure in this case is over abuse, dependence and addiction because to be honest, I think they are for most of people not easy to intoxicate and overdose.

I personally think the tolerance is built too fast but is the best thing around.

 

Edited by uncomfortable thoughts
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3 hours ago, HAL9000 said:

Whats going on with you guys?  If your taking a benzo is there a sudden signal from your doc that they want you off them?  My impression is that Xanax is far more addictive then Valium.  Or are they just two sides of the same coin?  Do you sign pledges not to misuse them?  Are you doing meds checks where you are doing an inventory of unused pills?   Real problem or?

There has never been a time when pdoc said he would stop prescribing benzos for me.

I have never signed a pledge not to misuse them.

I've never had to do a med check involving anything. 

32 minutes ago, notloki said:

I've seen a psychiatrist continuously since 1985, several over the years. I've never had one refuse benzos.

^^THIS for me too.

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I have taken benzos off and on all my life and have never had a problem with a doctor refusing to prescribe them. However, I have not needed one in the last five years or so, and I don't know if it would be a problem now since there does seem to be an anti-benzo culture developing.

I think it would be flat out wrong to say that benzos are the heroin of meds. Heroin is incredibly addicting and open to abuse, but most of all, it is fatal in overdose. Benzos by themselves are very safe even in overdose,

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1 hour ago, uncomfortable thoughts said:

I think as barbiturates 'had to go' (the maxim is untrue but the generalization applies in most of cases), same thing will eventually happen with benzodiazepines.

 

 

Big difference between the 2. Barbiturates are deady alone or with a small amount of alcohol. Benzos are not. The LD50 for benzos is so sky high that you would be asleep way before they become deadly. 

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42 minutes ago, notloki said:

Big difference between the 2. Barbiturates are deady alone or with a small amount of alcohol. Benzos are not. The LD50 for benzos is so sky high that you would be asleep way before they become deadly. 

Oh Really?

Is barbiturates that toxic?

I think I talk to the undead because I know barbiturate prescribed people that not only used to drink regularly but also abused alcohol.

About the benzo, I told, is safe, so I agree, the only population that could be in danger besides the mentioned issues are senior without tolerance or with a health condition, most related to heart, respiratory or dementia.

Barbiturates are still in use here, specially for convulsion related issues and flunitrazepam this year was reduced by half per pill.

Not everybody will hold a +40 2mg pills of flunitrazepam in the middle of Italy, but still, like I mentioned, at least for me, the problem is the quickly built up tolerance.

Edited by uncomfortable thoughts
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12 minutes ago, uncomfortable thoughts said:

Oh Really?

Is barbiturates that toxic?

I think I talk to the undead because I know barbiturate prescribed people that not only used to drink regularly but also abused alcohol.

About the benzo, I told, is safe, so I agree, the only population that could be in danger besides the mentioned issues are senior without tolerance or with a health condition, most related to heart, respiratory or dementia.

Barbiturates are still in use here, specially for convulsion related issues and flunitrazepam this year was reduced by half per pill.

Not everybody will hold a +40 2mg pills of flunitrazepam in the middle of Italy, but still, like I mentioned, at least for me, the problem is the quickly built up tolerance.

It is well known as to their toxicity. Benzos were developed and became popular do to this important fact ie the toxicity of barbs vs the much less toxicity of benzos.

http://emedicine.medscape.com/article/813155-overview

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17 minutes ago, notloki said:

It is well known as to their toxicity. Benzos were developed and became popular do to this important fact ie the toxicity of barbs vs the much less toxicity of benzos.

http://emedicine.medscape.com/article/813155-overview

I agree.

I told barbiturates are toxic and I told benzos are less toxic and a lot safer, but barbiturates aren't as toxic as 'can't tolerate a small amount of alcohol', not meaning that it would be a safe interaction.

Give half a century and you'll get the same reaction from medical literature community but this time about benzos potential of abuse and easily built up tolerance.

I would like to see more progress related to pharma. 

I think it's pointless to keep this discussion since in some degree what I think it's important I'm agreeing with you.

Edited by uncomfortable thoughts
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Belsomra is a unique med, unrelated to anything else and is an attempt to create a non-benzo hypnotic by "big pharma" due to complaints about existing hypnotics, which often have the same drawbacks as benzos. Some are true benzos and most all work through GABA, s the benzos do. It does not work through GABA pathways or any of the pathways used by other hypnotics on the market.  It is not even really sedating and certainly does not work through sedation.

Tolerance is overrated. There are many on lists like this one who have been on benzos for decades without developing significant tolerance. In my decades of experience with benzos I have found I get tolerant to one thing, sedation. Keep in mind hypnotic effects and sedation are different things, they work through GABA but on different GABA receptors. This kind of tolerance is beneficial when you take a benzo for issues not related to sleep. I also think there is a big misunderstanding of what tolerance, dependence, and addiction mean. They are very different in that dependence and tolerence do not have negative health effects while addiction is full of them.

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2 hours ago, notloki said:

Tolerance is overrated. [...] [...] dependence and tolerence do not have negative health effects while addiction is full of them.

Well, you are probably trolling this topic.

If you achieve a certain level of tolerance, the med just become useless or the med just fulfill some dependency need. 

If your main concern about barbiturates are toxicity, you're just naive because this shows that, besides reference on your initial basic reference, you lack empirical and clinical evidence.

Toxicity, wasn't the main concern related to barbiturates, instead the fast dependence and tolerance were the main reason that barbiturates were exchanged to benzos.

We achieved something less toxic that created an open and safe window to create dependence and tolerance.

If you had some experience in abusing anything in your life you would create a sort of empathy for this kind of problem and not posting them out as something trivial.

Edited by uncomfortable thoughts
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31 minutes ago, uncomfortable thoughts said:

If you achieve a certain level of tolerance, the med just become useless or the med just fulfill some dependency need.

I agree. I took 3 mg of Klonopin for three years and in the end it just became useless. That was when I decided it was time to withdraw.

32 minutes ago, uncomfortable thoughts said:

Toxicity, wasn't the main concern related to barbiturates, instead the fast dependence and tolerance were the main reason that barbiturates were exchanged to benzos.

I disagree. The main issue was toxicity because people were committing suicide by overdosing on barbiturates. The people most likely to be prescribed barbiturates are the mentally ill which is the same group most likely to overdose.

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41 minutes ago, jt07 said:

I disagree. The main issue was toxicity because people were committing suicide by overdosing on barbiturates. The people most likely to be prescribed barbiturates are the mentally ill which is the same group most likely to overdose.

I agree that MI population are prone to OD and in this population addiction comorbidity ratio is often higher, creating a separate condition by itself but, barbiturates were revolutionary in treating MI, some consider it as the first effective drug.

I disagree that toxicity was the main reason that took it out of a market.

I'm basing on my knowledge and considering the rate of suicidal population.

Most barbiturates users woulden't reach the point of toxicity without first having created addiction, tolerance and/or dependency.

Those type of profiles are built quicker on barbiturates compared to benzos and in my opinion should be considered.

From what I know, the fast habit formation, proceed by tolerance and it's intensity would exacerbate or provoke an intoxication.

Meaning that in 'modern' days, the traits of use would be better classified as a 'narcotic'.

That's probably why it's still prescribed on some countries for some condition.

Edited by uncomfortable thoughts
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14 minutes ago, uncomfortable thoughts said:

I'm basing on my knowledge and considering the rate of suicidal population.

And I'm basing my argument on an article I read about the genesis of the benzodiazepines. Unfortunately, I cannot find that article so we are just going to have to agree to disagree.

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So take this in consideration:

18 minutes ago, uncomfortable thoughts said:

Most barbiturates users woulden't reach the point of toxicity without first having created addiction, tolerance and/or dependency.

Those type of profiles are built quicker on barbiturates compared to benzos and in my opinion should be considered.

 

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Ok, and UT, you take this into consideration.

http://www.ncbi.nlm.nih.gov/pubmed/24007886

I think this is a debate about nothing. I think there were more than one or two reasons why the benzodiazepines replaced the barbiturates. There is probably a difference between countries as well, and I can only speak about the history of benzodiazepines in the United States, and toxicity was a main reason, though perhaps not the only one.

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24 minutes ago, jt07 said:

Ok, and UT, you take this into consideration.

http://www.ncbi.nlm.nih.gov/pubmed/24007886

I think this is a debate about nothing. I think there were more than one or two reasons why the benzodiazepines replaced the barbiturates. There is probably a difference between countries as well, and I can only speak about the history of benzodiazepines in the United States, and toxicity was a main reason, though perhaps not the only one.

[...] Roche's competitors also began looking for analogues. Initially, benzodiazepines appeared to be less toxic and less likely to cause dependence than older drugs. [...]

I think the article forgot to mention the potencial of abuse and addiction, but it only mentioned the dependence.

The american propaganda related to anti-barbiturate is out there and those were strong on addiction.

On the same article but about benzodiazepines: 

[...] By the 1980s, clinicians' earlier enthusiasm and propensity to prescribe created a new concern: the specter of abuse and dependence. [...]

 

I'm taking those things in consideration.

On those barbiturates days you could easily have access to something far more toxic if you intended a suicide.

I think there were more than one reason why barbiturates were discontinued.

I mentioned the toxicity but I also mentioned the dependence and addiction that were public pushed.

I agree, this debate is pointless but it brought up some useful points.

 

I hope this anti benzo pushes the development of something better.

I'm not trying to bring barbiturates back but there are medical movements to put it back on use based on the benefits it had specially used on controlled population.

I just think history is just repeating itself and I can't see the toxicity of barbiturates brought up as often to public as the addiction were.

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