Anxiety while a suboxone patient?!

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DanOhioAwesome
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Anxiety while a suboxone patient?!

Post by DanOhioAwesome » Sun Sep 15, 2019 11:14 am

Hello all,

Just a couple thoughts that I've been wondering about so I figured I'd write them down here.

So years ago before I was ever addicted to percs/oxys my doctor briefly touched on that I may have mild anxiety. This was when I was like 23/24. I'm 37 now. I started abusing pain killers from about the age of 25 until I finally admitted my problem at 33. I never followed up with the anxiety with the doc nor took benzos when I was abusing pills. They just weren't my thing. Well now that I'm older the last few year's ill have random panic attacks out of the blue. I've probably had like 6 or 7 in the last 3 years. So my question is it possible to be diagnosed and prescribed some sort of anti-anxiety medicine while also being on suboxone? I realize that benzos are highly abused as well, but I never naturally gravitated to Xanax or anything similar during my illegal drug use days. I honestly can say the only drugs I've taken were opiods pills. No heroin, no cocaine, no meth etc. So are their patients that take suboxone and responsibly take Xanax or their equal if they do indeed have anxiety?

Thanks

Dan

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Re: Anxiety while a suboxone patient?!

Post by docm2 » Sun Sep 15, 2019 11:33 am

More and more guidelines (APA, VA etc.) are now recommending CBT; cognitive behavior therapy, an 8-10 week therapy that is designed for the type of anxiety you are describing. I am not aware of any guidelines that recommend daily use of a benzodiazepine except for a couple of rare seizure disorders and a couple of other non-psychiatry indications.
If, after a course, and I'm confident other things have been adequately addressed then I do prescribe Xanax or similar for panic attacks. Limited # per month so there is no risk of daily use nor dependency. If the 7 tabs are gone in 9 days then we reevaluate the treatment and return to therapy, add an SSRI but early refills do not happen. Not that common, 4 of my current 99 patients.
When patients call for an appointment I review the PMP (state database for controlled substances) there are a number of providers in my state that provide BZOs with Suboxone, or opiates for that matter.

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Re: Anxiety while a suboxone patient?!

Post by DanOhioAwesome » Sun Sep 15, 2019 12:21 pm

Thanks that was really helpful. Like I said I rarely have the panic attacks so would that low number even justify taking a Xanax daily? Heck, most of the time I don't even realize I'm having any anxiety problems until my wife points it out.

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Re: Anxiety while a suboxone patient?!

Post by DanOhioAwesome » Sun Sep 15, 2019 12:22 pm

I'm sure the course you suggested is what would dictate needing the meds at all.

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Re: Anxiety while a suboxone patient?!

Post by Amy-Work In Progress » Sun Oct 06, 2019 1:43 pm

I have a prescription for .5mg xanax for panic attacks. The prescription is for 30 tablets and is written "Take one tablet by mouth 1 to 2 times daily as needed rarely". In other words, I am not to take them on a daily basis! Taking benzodiazepines daily only results in rebound anxiety.

I have occasional panic attacks as well and the xanax does a good job of knocking them down quickly. My prescription for 30 .5mg tablets is dated 10/5/18 and there are still 7.5 tabs left. I am using them "rarely" just as they were prescribed.

If you can take them like this and can avoid taking them as sleep aids or for less intense situations, you could be a good candidate for them.

If, however, you are looking for more ways to "feel" something or to avoid feeling normal, you need to stay away from them.

Of course, finding a prescriber for xanax is getting very difficult.

Amy
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Re: Anxiety while a suboxone patient?!

Post by DanOhioAwesome » Sun Oct 06, 2019 6:14 pm

Amy,

Yeah I really dont want to be on any daily anti depresant medicine. 1 - because every body I know that takes those types of meds turn into zombies. Well not everyone but a good amount. 2- I don't want to take something that has high-risk of killing my sex drive anymore than mother nature and suboxone has. (I use to be amazing) now it's a struggle but we make it work.

I don't want to take any thing else if I can help it. I don't need to "feel" any thing. Truthfully at the very begining of my addiction now that I'm talking about it. I tried Xanax once and it wasn't for me. Not something I got pleasure from and never touched it again.

From what I've read it does seem like something like Xanax like your situation would be ideal for me but I'm def not going to ask because I don't wanna come across as I'm drug seaking behavior.

Thanks
Dan

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Re: Anxiety while a suboxone patient?!

Post by suboxdoc » Sun Oct 06, 2019 7:42 pm

Such an interesting thread, because I have this discussion every day I'm at the office.

The discussion always ends this way, with one side explaining the medical reasons (very well presented by Amy), and the other feeling dismissed, ignored, and a little angry. Dan, I hope you'll stick around.

Let me help explain what a prescriber is thinking in this situation. Panic attacks almost always end before 20 minutes - even though it seems longer to the patient. So I think... how long will it take for the person to get a tab of Xanax in his/her hand? Even if the pill is in the purse or pocket, alprazolam STARTS to be absorbed at about 20 minutes (most benzos take twice that long). The peak is at about 60 minutes - slower if there is food in the stomach. So why would anyone prescribe or use Xanax for panic attack? The symptoms will be gone long before the drug has any effect.

That's always half of my argument. Then about SSRis I explain that the right SSRI will not be something you will notice. It won't make you numb (I sometimes say "I've taken Lexapro for 20 years - do you think I'M numb?!!!)

Seriously, I don't know what 'me' would be like off the SSRI. But I believe that it helps me move beyond conflicts and let things go. I KNOW, from my experience prescribing the medication, that it usually ends and prevents panic attacks.
..
I say these things over and over - only because they are the truth that I know. But I've heard the arguments enough times that start to wonder if I'm missing something.

People should feel free to comment. Please be nice to each other.

How does Xanax help so much, since it takes so long to work?

Are your 'panic attacks' different than standard panic attacks?

Does alprazolam do something else for you? (sorry - don't know a fair balance to that question)

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Re: Anxiety while a suboxone patient?!

Post by DanOhioAwesome » Mon Oct 07, 2019 1:44 pm

Not a problem I'm definitely sticking around. When I do get panic attacks and they're very very seldom and that's part of the reason why I never addressed it with the doctor because I felt like it's so seldom that it didn't warrant being prescribed anything.

But you are right if it does take almost an hour for it to even start working I'll have missed the panic attack by 40 minutes or so so it does no good for the one that I may have five months from then.

But when I do get them it's definitely the worst feeling in the world. I literally feel like I'm about to die and I need to go to ER immediately. I would say they definitely started though once I stopped taking Percocet and I've gotten on Suboxone.

The very first night that I had it about 5 years ago I was by myself and thought I was having a heart attack and I literally got in my car and started driving to ER. Nothing happened and I was fine.

Since then if I do feel one coming on I normally will just get up and walk around and some fresh air kind of raise my hands in the air and kind of just walk around as if I'm pacing or something and that usually helps quite a bit.

However with anxiety I do have that quite frequently. It's not crippling it doesn't prevent me from doing my job Etc but it's annoying having to "think" through things often.

I have my paxil rx but I just don't know if I need something like that. So I havent started taking it yet.


Dan

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