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PostPosted: Tue Feb 12, 2013 2:32 pm 
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I'm new to the forum and relatively new to the whole subject matter. Like the tread topic says, I'm interested in commonly accepted practices and things to absolutely avoid. It is my 30 year old step-son Jeff that is going through this. Here are the basics:

He is/was taking Zoloft and Suboxone while under the care of a doc. (He was previously on methadone due to black market prescription drug abuse and had taken himself of that. However, he still didn't feel right and began seeing the doc.) He then began self-medicating w/Xanax after a friend suggested he try one. He said the one pill made him felt "normal". He steadily progressed to the point where he was taking up to 9 pills a day. I believe that the Sub was 8 mg 2x/day and I think the Zoloft was 100 (again, not really sure). Anyway, on January 28 he decided he had enough of all the meds and being treated like a guinea pig and checked into a detox. They stopped everything except for demarol(?) for seizures, a muscle relaxer and something else I don't recall. After four days he felt great and checked out AMA. He came home and within a day or two was, basically, bedridden. With tremors and/or shivering, had to be coerced into eating and drinking, could barely talk and very little sleep. He had an appointment with his doc last Thursday but was physically unable to go. His mother took him to the doctor yesterday and he thought blood work, EKG etc were in order and suggested going to the ER because if he wrote the orders it would take a few days to get everything done and get the results back. The doc did not have admitting privileges. Off to the ER where I met his mother and him.

The ER doc said that the withdrawal symptoms should have passed by now and suggested 1 mg of Atavan as a diagnostic tool. Surprising to me, the doc said that Atavan is out of your system quickly and the Suboxone even faster. Maybe the drug is gone but my understanding was that withdrawal could go on for weeks and months. Maybe the really acute symptoms pass in a week or so? At this point Jeff was almost unresponsive and you would have to ask him questions multiple times to get one word answers. He had tremors and could barely get from a wheelchair to a gurney. Bloodwork, CAT scan, urine and EKG were within normal ranges. He got the Atavan IV (1mg I think) and about 30 minutes later was a little better but not much. I had to go home at this point but eventually the doc came back and said that he didn't have a basis to admit him (which would have made a transfer to a detox/rehab much easier). My wife said that this news seemed to snap Jeff out of his stupor and he got agitated and angry as he wanted to go somewhere, anywhere to get help. The bed at the detox isn't available until Friday. The doc then gave him Klonopin. Apparently, Jeff secretly spat half of it out since he doesn't want to take ANY drugs but he got the other half. When they got home 45 minutes later Jeff was moving around no problem, seemed completely lucid but was pissed that he couldn't get in to a facility and that he had ingested the Klonopin and that they gave him the Atavan. He believes that that will negate all he went through the previous 12 days. About six hours later my wife checked on him and he had regressed. While he was speaking pretty clearly, the answers were inappropriate to the questions being asked. She described him as "psychotic". Initially, she thought he was just messing with her but it became apparent that he was not. When I left for work this morning he was still speaking but agitated. He had little or no sleep overnight, as has been the case since he came home.

My questions are many. 1) Does anybody stop these drugs cold and succeed, especially in this combination? 2) How long after stopping a benzo does the seizure danger last? 3)How much of a setback were the single doses of Atavan and Klonopin? WERE the 12 days wasted? 3) What is the risk of permanent brain damage of some sort? 4)If one is to be stepped down on the medications would they do both at once or individually? 5)Would any detox/rehab center even consider a cold turkey approach with medical monitoring? My guess is that he is looking at 6 months in-patient treatment and going back on the meds (which he is vehemently opposed to) and then stepping down. His staying at home is not an option. Two weeks have maxed out our ability to care for him, especially his mother. Is recommending specific detox/rehabs permitted on this forum? We are in NJ.


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PostPosted: Tue Feb 12, 2013 3:05 pm 
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I just wanted to say how sorry I am that this is happening to you all.

Now. It sounds to me that he left the detox and the sub withdrawal really took hold because he was on such a high dose to nothing.

The xanax and benzos are extremely dangerous at such high doses with suboxone. I've had a friend die that way. But the benzo withdrawal ive HEARD is harder than opiates.

It is POSSIBLE to stay off these substances and live a decent life...it just takes a lot of effort and changes to life. But without recovery tools after detox...it is bleak. Just being honest. Look up relapse rates for.yourself. the cards are definitely stacked in the addicts favor....no matter who they are.


Keep your heads up and don't give up!!


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PostPosted: Tue Feb 12, 2013 4:08 pm 
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Wow sounds like he really wants to stop though if he is spitting out klonopin while in opiate AND benzo withdrawal!!

You probably know this but I will post to be sure: Xanax, klonopin, Ativan, also Valium are all brand names of benzodiazepines or 'benzos' for short. Stopping these drugs can lead to seizure and death. It is recommended to taper. Usually a dr. will switch to Valium (diazepam) because of its long half life and do a long taper down to nothing. I have done this after years and years of benzo abuse. It's not THAT bad but not fun. Cold turkey effects can last and the main one for me was EXTREME ANXIETY whenever I would go into withdrawal over my years of abuse. It can take a long while to go away.

Like moviemaker said its not recommended to take sub and benzos but if there is a tolerance to one or both, chances of respitory depression are lowered drastically from my understanding.

If you are sending him to an inpatient rehab, they should know what to do for you guys. Just make sure to tell them everything. They might stop everything and monitor him to detox giving mild medication like clonidine (blood pressure med used for detox) I don't think that klonopin he took will "erase his progress". He has a long way to go either way unfortunately. If he really wants to be clean he can make it but needs meetings or counseling or both in and after rehab and will have to stay vigilant with a recovery plan for the rest of his life. As for brain damage? I don't really know opiate w/d is generally considered safe but the benzos as you know are tricky...


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PostPosted: Wed Feb 13, 2013 4:27 pm 
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Wow I can’t imagine what you and your step son are going through. The physical w/ds stopping 16mg of suboxone a day cold turkey will be extremely rough for 2-3 weeks, followed by slow improvement the following months. The success rate stopping subs cold turkey from that dose are probably less than 1% AND that’s the just the suboxone. Xanax withdrawal is a whole different animal(9pills a day could be as much as 18mg/day which can kill someone who stops cold turkey). I’m not surprised the combination of withdrawls are making him seem “psychotic”…I’m no doctor but he’s in a real tough spot.

In my opinion:
1)Yes, I believe it is possible to stop both drugs cold turkey, but it would extremely difficult(nearly impossible) to stop from a combination of such high doses.
2)I don’t know. I’m sure it depends on the dose he was taking and length of use. Ask a doctor. Careful, this is probably his greatest immediate danger.
3)I doubt it was much of a set back and was probably needed at the time due to risk of seizure. 12days are not wasted there will be more discomfort to come.
4)That probably depends on the treatment plan, but I believe many people choose to step down one at a time.
5)I would think a detox center would medically supervise him the first few days. My guess is his symptoms will require additional probably milder benzo’s and opiates for a few weeks while he gets his tolerance down.

Good Luck – Post back if you can.


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PostPosted: Thu Feb 14, 2013 3:02 pm 
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Well, when I got home from work he was finishing packing for the airplane trip to detox/rehab. He and mom had been clothes shopping and he was just wolfing down a burrito or something. He was in pretty good shape, overall. This was about 5:00 PM. I stopped to pick up some sub that had been called in by his doc. It was supposed to hold him over til he got to the rehab at midnight or so. As we neared the airport he said that he was felling nauseous. He was looking pale and pretty out of it but seemed to get a little better over the 20-3o minutes. His best friend (also in recovery) came and accompanied him to the gate. (They would let only one non-ticketed person in w/him) I had a feeling that we should stay until the plane took off but we left anyway. His friend called and said that Jeff seemed pretty good as he boarded the plane. The friend also left at that time.

About 45 minutes later we got a call from the airport. Jeff had vomited just as the plane was backing away from the gate. (Fortunately, he made it to the restroom). The plane returned to the gate and he had to get off. By the time we got back there he was seated in a wheelchair with medics and looking very pale and out of it. He told me that as he got on the plane things seemed to close in and it got much worse once he was seated in the packed plane. He tried to hold it together but just couldn't.

As we were putting him into the car he had a kind of seizure or something. More like a really bad cramp in his arm but he was pretty unresponsive. The medics came back and took him to the ER (different hospital). He vomited again in the rig. At the ER they hung an IV and pumped him full of fluid. They also gave him some Atavan. He puked again after about two hours and for some reason this seemed to bring him out of his stupor and he began talking again. EKG, bloodwork and other vitals all normal. He must have been dehydrated because after 1 1/2 bags of IV he could urinate only a little and it was dark. More IV fluid and some anti-nausea med. More puking and more anti nausea med and some more Atavan. There were interesting revelations about past drug use while all this was going on. The previous night I had heard him using terminology I was familiar from my days as a narc. His mom didn't have a clue when I mentioned it to her. She thought a "bundle of dope and Xanax every day" just meant a lot of drugs. When I told her this was 10 bags of heroin a day plus the Xanax she couldn't believe it. The only good news was that he claimed that he never used IV so the chances of transmitting disease was lessened. Jeff was pretty forthcoming about what he had done and when. Apparently, he hasn't touched heroin in years, preferring the Xanax.

Anyway, by 3:00 AM he seemed ok, just tired. He was lucid and making perfect sense. The doc said we could stay there until the next flight at 7:00 AM and he would monitor him. He said that he would give him a little more Atavan just before we left in the hopes it would get him through the 3 hour flight. Jeff agreed to give it a shot. His mom stayed with him until he boarded and this time we stayed until the plane actually took off. I was praying he didn't have a problem with the plane being forced to land along the way. One of us should have accompanied him but the flight was booked. Mom spoke one of the ground crew who recognized what was going on. He assured her he would let the flight crew know on the QT and that it would be fine.

He made it but lost his I-Phone along the way so the rehab called to say "we have him" but not much more. We have no idea how the actual flight went. Seven hours later they called again to say he was in the ER again. This makes three nights in a row. Somehow, the reports from the other hospitals didn't make into the right hands and the ER doc didn't know the history, making treatment a little more difficult. Mom got on the phone and gave the whole rundown to an ER nurse. About ten minutes later she called back to add something only to find that the nurse had ended her shift w/o passing the info on! That got straightened out and the last we heard, Jeff was stable and would likely be returning to the detox/rehab. Barring any more medical emergencies we will not hear anything/much for two weeks. We're keeping our fingers crossed.

What a nightmare. I can't imagine what Jeff is going through and what lies ahead in the coming weeks and months.


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PostPosted: Thu Feb 14, 2013 3:37 pm 
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Thanks for posting this update! It sounds like this guy is in for a tough few weeks/months. Make sure if he calls and begs you or mom to get him that you do not, no matter what. We addicts are a manipulative bunch and know just what to say to get you to do what we want. He will thank you after, when he can think straight, for NOT getting him out.

Best of luck and please update us


Gb


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PostPosted: Fri Feb 15, 2013 11:49 am 
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I have a question about procedures at these in-patient detox/rehabs. I guess I will direct this at the center but thought I'd ask here as well. When an adult enters a treatment center but becomes unable to participate in decision making about his own medical treatment, what do they do? Consult with the prior doc if there is one? Just use their best judgement? There are horror stories about what goes on in some of these place. I assume they can't seek input from the family due to privacy issues. We are going to get Jeff to sign a release allowing the staff to discuss his treatment with us but we would be better of getting a power-of attorney drawn up? Telling us what they are doing is different than asking. My wife, who was a RN in a psych ward, is fearful that treatments may be ordered while Jeff is incapacitated that she (and he) would strongly oppose. I'm talking specifically about the medical end of things - what drugs and how much, etc.


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PostPosted: Fri Feb 15, 2013 11:51 am 
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I have a question about procedures at these in-patient detox/rehabs. I guess I will direct this at the center but thought I'd ask here as well. When an adult enters a treatment center but becomes unable to participate in decision making about his own medical treatment, what do they do? Consult with the prior doc if there is one? Just use their best judgement? There are horror stories about what goes on in some of these place. I assume they can't seek input from the family due to privacy issues. We are going to get Jeff to sign a release allowing the staff to discuss his treatment with us but we would be better of getting a power-of attorney drawn up? Telling us what they are doing is different than asking. My wife, who was a RN in a psych ward, is fearful that treatments may be ordered while Jeff is incapacitated that she (and he) would strongly oppose. I'm talking specifically about the medical end of things - what drugs and how much, etc.


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