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PostPosted: Tue Oct 29, 2013 7:33 pm 
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I recently started Suboxone treatment, 6 mgs daily, about 3 weeks ago. I've been on Xanax for several years at a dose of 2-3mgs daily (my doctor knows this.) I've searched the Internet, several forums, including this one, and can't find any definitive studies showing how these two drugs interact with each other when used on a LONG term basis. So far, I haven't had any issues.

I was wondering if anyone on here has had PERSONAL experience, or knows someone who has had personal experience, taking Suboxone with Xanax on a long term basis. If so, any details or help would be great!


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PostPosted: Thu Oct 31, 2013 8:36 pm 
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I guess no one has any long term experience with Xanax and Sub here. Most, if not all doctors will not prescribe Xanax and Suboxone together. Both are CNS depressants and RB strongly recommends not mixing them.

In reality, you know and I know that they can be taken together if not abused. But again, it's not likely you'll find someone like yourself here. But now that I've bumped this topic back on top again, let's see if a member can answer your question.

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PostPosted: Fri Nov 01, 2013 12:19 am 
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Agreed, Rule....

A person who has been on buprenorphine long enough to develop full tolerance (a week or two) no longer has significant respiratory depression from the drug. A person who has been on alprazolam, at a stable dose, long enough for tolerance to develop (a few weeks) no longer has significant respiratory depression from that drug.

It is hard to die from buprenorphine overdose. Deaths most commonly occur in people who do not have tolerance to opioids. And even in those cases, the 'ceiling effect' limits respiratory depression to a level that prevents death. But the addition of a second respiratory depressant can cause fatal respiratory depression. MOST deaths on buprenorphine have occurred in the presence of other respiratory depressants-- usually benzodiazepines. These deaths have led to strong warnings against combining benzos with buprenorphine.

**********NOTE******** Deaths DO occur, though, in some cases even in people tolerant to opioids and benzos. NOTHING said here should be taken to imply that it is safe to combine benzos and buprenorphine. People must talk to their own physician about the issue! With that important safety reminder, I'll continue with a general discussion of the issue....

In general, tolerance to medications including benzos and buprenorphine reduce the respiratory depression that those medications cause. So overdose is not common in cases where a person is fully tolerant to a benzo and carefully adds buprenorphine, or fully tolerant to buprenorphine and then slowly adds a benzo.

BUT... benzos are a common source of cross-addiction with people addicted to opioids. Benzos also are counter to the whole point of buprenorphine treatment-- the idea of teaching a person to break the conditioning of taking something in order to tolerate life. The idea with buprenorphine is to get the person to learn to live 'life on life's terms'. Taking alprazolam only causes the person to continually 'look inward' and evaluate how he/she 'feels'. The goal with buprenorphine is to stop looking so hard at how things 'feel', and to instead just tolerate life.

Panic attacks are very uncomfortable-- but I believe, strongly, that most people who take benzos make their panic attacks worse for the reasons I discuss here: http://www.suboxonetalkzone.com/the-pro ... iazepines/
I have seen many, many cases where people with horrible panic attacks-- people who couldn't shop or drive without taking alprazolam-- broke the cycle of 'withdrawal anxiety' and got on the right SSRI, and stopped having panic attacks altogether.

Finally, doctors are guided and bound by the 'standard of care'. For the reasons described above, doctors who give benzos to patients with histories of opioid dependence are generally viewed as 'bad doctors' by their colleagues, medical boards, pharmacists, etc. I have had patients have their buprenorphine coverage cancelled, permanently, by their insurer, after I prescribed benzos or even a sleeper like Ambien for the patient. The insurer in those cases argued that 'the person must not really have addiction if you are willing to treat the person with a benzo.' I tried to fight that argument with the state insurance commission, but had no success in doing so.

Is it 'fair' to stop the benzo in this case? I don't know-- but fairness is not the only issue. In the real world, we must also respond to practicalities. Prescribing benzos in such a situation puts the doctor at risk-- probably more than it does the patient! But doctors pay dearly, and work hard, for their licenses.... and in my own opinion a doctor shouldn't have to risk his/her livelihood in order to treat a patient-- especially to treat a patient with a medication that only causes tolerance in the long run.


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PostPosted: Fri Nov 01, 2013 3:29 pm 
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Thank you rule for the insight and the "bump." Although no one with first hand experience posted in this thread, I believe I received a much more informative answer from Suboxdoc than I would've gotten from someone with a more narrow point of view.

Thanks so much for taking the time and effort to answer my question, and then some. I have a much better general understanding of the doctor/patient relationship when it comes to combing these two medications now, plus an overall better perspective on the actual combination of the two drugs.

I couldn't have asked for a better answer!

Thanks so much for your help!


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PostPosted: Fri Nov 01, 2013 5:25 pm 
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Emilio , I'm not a big dose taker but I been taking 1- Alprazolam .5mg ER along with 2 mgs of Suboxone daily for 2 yrs now .... I take the Alprazolam ER at bedtime so I can sleep , can't sleep without it . Be resourceful about this , Mike


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PostPosted: Tue Nov 05, 2013 4:10 pm 
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Thank you, Painter. I don't want to seem like I'm intentionally bumping this thread but I have another question and I think it's best that posters know as much about my history as possible.

I've had suboxone treatment before, for about a year, with no issues or interactions with Alprazolam. Within a couple months of stopping suboxone treatment, I relapsed.

I saw my sub doctor for the second time today and thankfully we are on the same page when it comes to an effective sub dosage as well as weaning down my Xanax dosage and keeping it there during sub maintenance. My question to him was, even though everyone is different, HOW LONG does he generally keep patients on sub maintenance and what are my options when it comes to length of treatment. After the obvious "disclaimer" (which I understand) he said that since I relapsed shortly after treatment last time, it would be at least a year and that indefinite treatment is an option. Ultimately, we would work together to determine the duration of sub maintenance.

I'm wondering what forum member's opinions are on indefinite suboxone treatment. Good idea or bad?

Keep in mind that I'm paying out of pocket, not using an insurance company, so there are no bureaucratic issues to deal with...which comes at a cost...literally.


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PostPosted: Tue Nov 05, 2013 4:56 pm 
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Emilio,

You'll find mixed reviews on long term sub maintenance, here, but mostly "pro." It's a very personal choice, but most members here have been on suboxone for at least a year or two, and longer. When your first year passes, I'd tell you to take a look at your surroundings to determine if anything has changed. Are you still in the same exact position, needing shielding from possible (and probable) relapse? Are you still hanging out with the same people? Same job? Same location? Same "triggers"? If the answers are yes, then I think longer maintenance is wise. Anything that can help you from falling into old traps, and can help you focus on making positive changes to your life. Sometimes we can't get that done in a year, sometimes it takes a few, and sometimes it's a 'work in progress' indefinitely.

Looks like you've found a good doctor who's understanding about the position you're in. That's great! Keep us posted on your maintenance and how it works for you.


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PostPosted: Tue Nov 05, 2013 8:21 pm 
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Hi Tinydancer,

I'm sure I will find mixed reviews. Honestly, I asked my doctor about the duration of treatment just to see if he was willing to maintain me on suboxone for a lengthy period of time...if not indefinitely. Luckily, he is very open and understanding. To answer your question, I'm still in the same position, same people, same everything.

Suboxone works great for me and makes me feel as if I'm in control of my life again, but on the other side of the coin, I don't want to use a "crutch" just to get through life. Unfortunately, relapse is inevitable for me. At this point anyway. Seeing a psychiatrist or behavioral therapist would help, but not cure. I'm an addict. That NEVER goes away. I'm questioning.....is maybe using a "crutch" permanently, better than constantly fighting cravings, arranging your life around withdrawals, and fighting hitting rock bottom to exhaustion?

My doctor actually said that if we DO go the "permanent" route, that I should just look at it as taking a daily vitamin. Perhaps it is for someone like me...for a lot if people like me.

I look forward to any more input!


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PostPosted: Wed Nov 13, 2013 8:25 pm 
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Sorry I didn't read all of the responses, but I take Klonopin and Suboxone. I've been on Klonopin for 10 years, and suboxone about 3. I'm trying to taper my suboxone down to 0 right now.


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PostPosted: Thu Nov 14, 2013 1:03 am 
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Emilio, I like your doctor. I have about 2/3 of my original 100 patients, all on buprenorphine or Suboxone for as long as 7 years. I should add that they all are doing great in life; they have the 'daily vitamin' (or daily blood pressure pill) idea down, and most would say that the only problem is that every now and then they forget to take it-- sometimes for a day or two! One guy had 'the flu' for three days before he remembered that he forget to take the Suboxone (he takes a number of general medical pills for cholesterol, heart disease, etc--- and just forgot to load his pill planner with Suboxone).

I have long term patients who work as attorneys, CEOs, even a cop. Nobody would ever consider they were impaired in any way; in fact, I think because of how they value life, they all are doing very well.

I wish more people understood that doctors don't try to keep people on Suboxone. If my part of the world is like yours, there are PLENTY of people wanting Suboxone treatment. Long-term patients who do perfectly earn the right, over time, to be seen less often... so the way to make money with Suboxone is to have a high turnover. I find it ignorant, and even evil, to force people off buprenorphine at some arbitrary length of time. Tell me one other illness where successful treatment, that does not have significant safety problems with long-term use, is pulled from patients--- particularly from patients who go back to using in measured rates of 90% and higher.

Those docs make me angry-- I'm glad yours 'sees the light'. Many don't.


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