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PostPosted: Fri Mar 20, 2015 5:41 am 
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Hi Guys,

I'm new to the forum thing, so please forgive me if this is posted in the wrong area or break with etiquette. I've been searching the forum the past couple of days and while I have found lots of great information, I couldn't really find much specific to my situation, so please forgive me if this has been covered elsewhere. You all seem like a compassionate group that genuinely want to help others and do so in a gentle manner, so I worked up the courage to go ahead and post.


So to the point, I have been on legitimately prescribed cloanazepam (Klonopin) for a little over four years now. To be clear, I have never abused the medication in any way; it never did anything for me that way and was initially effective for the purpose it was intended. I was on 4mg a day for about three years, and a little less than a year or so ago I decided I no longer had need for the medication as I found other non-chemical means of dealing with my at the time very severe anxiety/panic attack issues. I also felt like the side effects were becoming counter-productive to the treatment of my depression. I spoke with my psychiatrist (who unfortunately due to a move a couple hours away and more importantly insurance reasons I can no longer see) and we agreed I could begin tapering down my dosage.

Over the past ten to twelve months, I've tapered down my dosage from the original 4mgs/day to 1mg/day without any issues at all and I plan to continue tapering until I am completely off. As my taper has been completely at my own discretion and of my own recognizance, I plan to be free of the medication within six months, possibly less. My new psychiatrist may want to have more of a structured taper, though, I'm not sure. Regardless, it's basically a non-issue for me and I look forward to not having to worry about taking or getting prescribed the medicine any more.

That leads me to my current dilemma. I have an appointment in five days with a doctor for the specific purpose of suboxone treatment. I've been an opiate addict for about ten years now, a chronic relapser and it's basically destroyed my life. I'll spare you the gory details, but you know the story; either high or thinking about being high even in brief stints of sobriety. I was wary of going on another maintenance med upon which I would be dependent, but this really is my last resort. I am completely at my wit's end. I don't use any other drugs or take any other medications (I successfully weaned off of my antidepressant), barely drink aside from the occasional craft beer or two.

As a brief aside, in an attempt to stay clean, I cut myself off from all my connections about four months back, but I couldn't handle the withdrawals and got myself hooked on poppy seed tea. Up until that point a few months ago, I had never even tried poppy tea in any form. It's a dirty high that's dangerous due to lack of consistency in seeds and I feel even more pathetic than when I was using pills or patches.

But more directly, how much of an issue do you think the fact that I'm currently tapering off of the clonazepam will be with getting treatment for this carnivorous monkey on my back? I'm really feeling desperate; I've tried tapering off the tea but we all know how tapering goes for most of us addicts. Also, what should I expect at the initial visit?


Thank you to all of you that read this and even if you don't have any specific answers, encouragement is also much appreciated.

Jonny


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PostPosted: Fri Mar 20, 2015 6:28 am 
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Hi Johnny

Every doctor is different but i am on xanax for severe panic & anxiety attacks and i am on bupe. My sub doc called my prescribing doctor and i was able to start treatment. My sub doc won't write a xanax script for me but has no problem with treating me. I wasn't on a high dose and i never abused the xanax so i think that had something to do with it. I have also been able to taper down since i began sub treatment.

IMO, my sub doc feels like he is mostly off the hook by not writing the xanax but every doctor is different. If your prescribing doc will talk to the sub doc and confirm you have tapered that would be a plus.

I hope things go well for you also.


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PostPosted: Fri Mar 20, 2015 12:42 pm 
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JohnnyB,
to answer your question: maybe. Some sub providers will, some won't. The guidelines from SAMSA recommend that they not be combined. Be upfront with your history. It would be unfortunate (to put it mildly) to have started Bupe and then have the benzo in your system 2 months later on a UA and be accused of "violating" the agreement and then discharged from the program. If I recall correctly there are threads about this happening in the Damn Doctors section.
I do not. I will start a patient on sub if we have a fixed plan in place to be off benzo's and other sedatives soon. In our state we have a database we can check to ensure that a patient is not getting scripts from other doctors and we do UA's to check that it is out of your system.
You are on a low dose. I have had patients stabilize their Bupe dose then wean off that dosage of Klonapin over the next month. They haven't looked back and are still with me. Admittedly my N is small (2).

Tiki - your sub doctor is not 'off the hook' by letting someone else write for a controlled substance. In this era both would be held accountable for anything that would happen. On rare occasion I have written for a few doses of Xanax or Ativan a month for PRN use for panic, but not for regular dosing.
Dr. J has some excellent blog posts regarding use of Suboxone and Benzodiazepines over at the Talk Zone.
PAX


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PostPosted: Fri Mar 20, 2015 2:13 pm 
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Hey Johnny,

Since you are already in the process of tapering, and are open to following a schedule from a doctor, I think you should be fine. As docm said above, be sure your sub provider knows exactly what you are on and tell him about your plans to taper. I'm pretty sure most doctors will be open to starting you off with the subs as long as you are actively working a taper plan and are willing to work within their recommendations for discontinuing it's use. Especially given the fact that discontinuing the use of any benzo abruptly after long term use can be very dangerous.

This subject can definitely be tricky though, and we can't guarantee your doctor will agree with us. Every doctor has different ways of handling this issue, and most tend to lean toward caution. I hope yours will work with you!

Welcome to the forum! Be sure to let us know how it goes.

Q

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PostPosted: Sat Mar 21, 2015 10:20 pm 
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Thank you guys for your considered responses. The awareness that people care is relieving in and of itself.

Part of the issue is that since I have moved and am now on different insurance, I have to reestablish care in my new county of residence. So I met with my new psychologist yesterday and was open with all of my issues with him, but he is concerned that I won't be able to see a doc at the mental health clinic for a while (they are currently loosing two of their doctors), so I almost certainly will run out of my script anyway. We tried to come up with a plan, and the best we could do was hope that the other doc will be understanding of my situation. We also decided I should speed up the rate of taper in order to stretch out the script and make the withdrawals hopefully less intense if it does come to that. We also decided that in the event of my getting my script refilled, I could probably taper off of the clonazepam completely in a month to six weeks, so I have some semblance of a set regimen in place and at least some measure of support in the event that I have to go through withdrawal.

I definitely plan on being completely honest with sub doc when I see him in a few days. My biggest fear, honestly, is that he won't trust me. I'm really counting on him to offer me some kind of help, god knows I need it, and I hope that me showing the initiative to get in to counseling and therapy as well as diligently taper off of my medication will give me some credibility (by the time I see him, I'll be on .75mgs/day). I just dread the idea of being shuffled through and treated like so much livestock that I'm not given a chance or taken seriously (that has happened a few times to me recently, and it is very demoralizing). So I guess all I can do at this point is hope and pray that the doctor is a compassionate sort that will listen and help me as best he can.

Thanks again for your replies and encouragement. I'll definitely keep perusing the forum and will certainly keep you posted.

Jonny


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PostPosted: Sun Mar 22, 2015 12:57 am 
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Definitely come back to us and let us know how your appointment goes! I also hope you won't be treated like a head of cattle. Will you be able to provide the sub doctor with your former physician's information if he needs to verify what you're reporting about your clonazepam taper? You might need to provide your former doctor with a release so he can share that part of your history with the sub doc.

I don't have experience with tapering off a benzo, although I'm prescribed about 30 xanax every 3-6 months. But I'm sure there are plenty of people here who have. So as you continue your taper or if you have to dramatically stop (which would be stupid from a medical standpoint), there will be people here who can help you through it.

Keep us updated, Jonny, and good luck!

Amy

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PostPosted: Wed Mar 25, 2015 9:09 pm 
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Hey guys!

Just thought I'd update this thread with progress thus far.
So, excellent news. Saw the sub doc today and he was very gracious and compassionate, as was the nurse. He discussed with me the issues of being on a benzodiazepine, but wasn't very concerned. I was grateful that he took me seriously and trusted that I was being sincere. So I go in for induction on Friday morning. The next day and a half or so will be unpleasant, but certainly worth it. And I'm not too concerned as I know there will be relief and the withdrawal will be brief.

Thank you for your encouragement, I'm looking forward to finally dealing with this issue head on, and grateful for the opportunity to do so. I was so extremely anxious about this visit, terrified that I would be rejected. Rationally, I knew that I was over-thinking it, but I've been pretty desperate. I can't describe how much more positive I feel about getting clean and the weight that has already begun to lift.

I'll certainly be on the forum here, and am very glad for it's existence. Thanks again!

Jonny


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PostPosted: Wed Mar 25, 2015 9:59 pm 
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Jonny

Thats Wonderful!!! I am also glad you put in the first line it was good news :D We just never know how a sub doc will react so it's hard to give a definitive answer. He sounds like a good sub doc, to sit and explain why it's not good but still allowing you to get help while you continue the benzo taper. I went down on my benzo after starting sub, it was weird because i just didn't need it.

Just do as he said and you will be able to stop the madness. 24 hours is not all that bad when you know there is an end in site.

I am really HAPPY for you!


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PostPosted: Wed Mar 25, 2015 10:44 pm 
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@Tiki

Thanks! I agree, 24 hours is much easier. The light at the end of the tunnel is very bright and close! I also am sure this will make finishing my taper off of the benzo much more tolerable. I decided I didn't need it a long time ago and if I could have just stopped taking it, I would have, but the taper is definitely necessary.
Also, a good doctor is worth their weight in gold, imo. And the nurse was great, too. I told her how embarrassed I was about the whole thing and she couldn't have been more compassionate. I felt relieved immediately, even though it had been about 24 hours since I'd had any opiates. All in all, I left the office feeling incredibly more positive about the future than I have in a long time. I also felt confident and affirmed in my decision to go this route for treatment.
So Friday first thing in the morning I'll begin induction. I'm a little anxious about it and not looking forward to the mean time, but having seen firsthand that the doctor and his staff are kind and caring takes a lot of the jitters out of it. I'll let you know how it goes.
Thanks!!

Jonny


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PostPosted: Fri Mar 27, 2015 4:33 pm 
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My psychiatrist prescribes both my bupenorphine and my lorazepam. My opiate addiction and my anxiety are two separate issues. I try to take them as far apart as possible as I notice when I take them within a couple hours of each other, the benzo seems much less effective for treating anxiety. I have severe panic attacks that hinder my ability to drive and do other basic activities. I did have to sign paperwork acknowledging that mixing the two drugs can be dangerous, and the pharmacist lectures me every single time I pick them up, but I'm ok with both of those conditions for the here and now. I feel at this point going off the bupe would lead to relapse, and the anxiety interferes with my ability to live my life. I've got two different doctors and a therapist saying that yes, the pros outweigh the cons for me right now, so for now, this is what I'm doing. I have been trying to find if combining the two really does reduce the effectiveness of either or both, but haven't really found anything.
Best wishes!

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PostPosted: Sat Mar 28, 2015 12:14 am 
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Hi Jonny! I'm so happy to hear your good news!

Sometimes it seems like nothing but a craps shoot as to whether one gets a good sub doctor or a bad one. The fact that the nurse put you at such ease says a lot, because the doctor usually sets the tone for the practice.

Let us know how your induction went this morning! I hope you're still feeling well!

Amy

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PostPosted: Sun Mar 29, 2015 12:31 pm 
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Hey Jonny,

I was just wondering how your induction went. I am hoping to hear nothing but good news from you when you come back to report! Everything sounded good from your first visit, I'm really happy you found a doctor who would listen to you.

Q

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