Overdose Deaths: Opioids and Benzodiazepines

Any opioid, mixed with any benzodiazepine, alcohol, or barbiturate, can be deadly.

Part of our brainstem, the medulla, tells our bodies to breath while we sleep. Opioids inhibit the neurons (individual nerve cells) of this area of the brain, potentially interfering with this automatic breathing. This is how overdose deaths occur. People go to sleep, stop breathing, and die from lack of oxygen to main organs like the brain and the heart. Even a relatively small dose of opioid can kill a person who isn’t accustomed to taking them, and a larger dose can kill even those who are used to opioids. If you are wondering what constitutes a small or larger dose, that’s unanswerable, because of the considerable differences between individuals.

Benzodiazepines, alcohol, and barbiturates all also inhibit this same brain center, and have the potential to slow breathing, just like opioids. We don’t see many doctors prescribing barbiturates any more, with the possible exception of phenobarbital for seizures, and butalbital for headaches. Sometimes carisoprodol (Soma) is prescribed as muscle relaxant, and it gets metabolized to a barbiturate. We do see a great many people prescribed benzodiazepines, which can be dangerous for a person also taking opioids. And of course, alcohol flows freely in the U.S. society.

When a person with addiction mixes opioids with benzos, alcohol, or barbiturates, he often ends up taking more of the drug than he planned, making it easy to have a fatal overdose. Addiction is all about the loss of control. So for example, an addict may decide to take one Xanax with an opioid, but ultimately take three or four Xanax’s with the opioid. Compounding the problem, the effects of the two drugs together is usually more than would be expected, due to synergy. Synergy means that instead of 1+1=2, suddenly 1+1=4. There’s more of an effect than the person expected.

Some people are able to take both opioids and benzodiazepines without complications, but these people usually don’t have the disease of addiction, and are able to take their medication just as prescribed by their doctor. Even for these patients, benzodiazepines are rarely indicated for use for more than three months (fodder for a future blog).

But benzodiazepines can harm patients with addiction. Except for unusual circumstances, it’s a bad idea to mix any benzodiazepines with any opioid in people with addiction, because of the risk of overdose death. Rarely, a situation may arise that warrants use of benzodiazepines in a patient on opioids, but it’s for a short-term situation, and safer long-term treatments for anxiety usually can be found.

When my patients on methadone or buprenorphine (Suboxone) take benzodiazepines for anxiety, I get anxious. I worry those patients will die from an overdose. It’s a dilemma. Often, patients are clearly benefitting from methadone or buprenorphine, because they’re no longer using illicit opioids, but we now have the risk of an overdose death. So, the methadone or buprenorphine are helping them – unless it kills them… in which case it’s no longer helping.

What to do??

Some doctors say if the patient is benefitting even a small amount, because death rates are so high for opioid addicts who leave treatment, that patient should never be dismissed from a methadone clinic for using benzodiazepines.

I don’t agree with that. The first thing doctors learn in medical school is, “First, do no harm.” In other words, please try to kill as few patients as possible.

And yet, many of these patients can stop using benzodiazepines if they get the right kind of help. I ask my patients “Why do you use benzos?” and base my intervention of what they say. If they’re getting medication from a doctor, I’d like to talk to that doctor, and often a better long-term solution can be found. Benzodiazepines have very few indications for long-term use, because patients develop tolerance to the anti-anxiety properties of these medications fairly quickly. However, it’s dangerous to stop benzodiazepines suddenly in a patient who has been taking them for months or years, because of the risk of withdrawal seizures. We have to decide on the best way to handle the situation. If patients take benzos for the high it produces with methadone, they have to decide if it’s worth risking not only their treatment but their lives. If they take benzos for sleep, often I can prescribe a more suitable medication.

As long a patient has a willing spirit, and does not look like an overdose is imminent, I try to work with him or her. In each case, there are risks in stopping methadone treatment, and risks in continuing methadone treatment. The decision should be made by a physician who is well-educated and well-trained in addiction medicine. We make the best decision we can for the patient in front of us. We are the most qualified to make those – literally – life and death decisions.

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106 responses to this post.

  1. Posted by Tom on February 6, 2012 at 7:25 am

    In my city, over 60% of fatal heroin overdoses come about as a result of mixing heroin with benzos & / or alcohol.

    I heard a doctor on the radio claim it’s actually rare for people to die from heroin overdose alone, without other drugs involved. Is that true?

    Reply

    • No. People die from heroin alone all of the time. However, it’s possible the doctor meant that they may not die from heroin, but rather the impurities and additives the heroin is cut with. There’s some debate about what’s more fatal, the heroin or the stuff it’s cut with. Some sources say up to 50% of the deaths seen with heroin alone are actually due to the additives. I don’t know how one could make that determination, though. Plus, people die from pharmaceutical grade opioids alone, too.
      Heroin addicts have a death rate that is seen to be anywhere from 8 times higher in one study to 63 times higher in another study.

      Reply

  2. Posted by Tonya Roberts on February 15, 2012 at 1:30 pm

    Will you tell me what the correct dosing/induction should be for the following example? If you have a patient that is opiate naive or tolerance is unknown, no objective signs of withdrawal, what would be a safe starting dose? How much and when would you titrate dose up assuming patient is healthy otherwise? .

    Reply

    • I don’t understand your question. If the patient is opiate naive, he/she isn’t appropriate for medication-assisted treatment. Are you implying that this patient lied to the doctor in order to be prescribed methadone or buprenorphine? That would be unwise, to say the least…and it’s a felony (in this state) to lie to get controlled substances, not to mention it’s a good way to die from an overdose.
      Or do you mean the patient is being treated for pain with methadone? In that case, methadone still isn’t the first opioid to pick. for such a patient, schedule III opioids would be much more appropriate to start with.

      Reply

      • Posted by Tonya Roberts on February 15, 2012 at 8:24 pm

        If patient has no objective signs of opiate withdrawal in MMT only subjective?

      • No, it’s also evaluated by doing a drug screen, and taking a drug use history. If a patient doesn’t “speak the language” of pain pill addiction (can’t describe the appearance of certain common brands of opioid pills, doesn’t know the street prices of heroin, if that’s the drug of abuse) the the doctor should also check the prescription monitoring database, which will show if any of the opioids the patients says they’ve been taking are prescribed or not.
        A patient who says they use opioids but can’t describe what they use, how much, etc, have no opioid withdrawal signs on exam, have a negative urine drug screen, and no prescriptions on the database…I’d be highly suspicious that person isn’t addicted.

      • Posted by Tonya Roberts on February 15, 2012 at 10:25 pm

        I really appreciate you responding to me. You have got a lot of good information on your blog. I’m still reading…. Is 30mg the standard starting dose for most and how often are patients titrated up?

      • Thank you!
        There are so many factors that influence the starting dose that there’s not one standard dose…things like body weight, age, other medications, prior dosing with methadon…starting doses can range from as little as 10mg to as high as 40mg, if the dose is divided on the first day. Dose increases can be given every day up to every five days, again depending on the clinical situation. If the patient has been dosing at a clinic and gone for ten days or less, the dose can be increased more quickly.
        In our state, around five or six years ago there was a spate of deaths during the induction phase of dosing, so since then, doctors in in this state tend to start at a lower dose and increase more slowly than five or six years ago. I believe that many of those deaths were related to the co-existance of benzodiazepine use/addiction in many opioid addicted patients.

    • Posted by Taylor on December 30, 2015 at 9:32 pm

      Heroin alone kills everyday. The problem with we addicts is that we think we’ve done it all. Lots of us know our dealers well and have never had an issue with overdose. An overdose usually occurs when we are handed a “new batch,” a different kind of dope than we had gotten before. Because we’ve gained tolerance (and confidence) over the heroin, we throw the same amount in the spoon, not knowing how strong it is or what its cut with. Personally, I overdosed just last year. As a longtime user, I had recently decided to do off the streets and get high the legal way through a methadone program. It was originally intended for me to get clean, find a way out. I wanted to be tapered off. My clinic, however, had another idea. They continually denied my requests to be tapered. In turn I became serverley addicted, running at 130 mgs a day. I was also a benzo addict. I had stopped taking my xanax exactly a month before I started at the clinic, but on the day I began at the clinic, my benzo levels, I learned after a urine screen, were too high for them to “safely dose me,” yet I was given methadone just a few hours later. I ended up confined to a hospital on suicide watch. In short, what I’m attempting to say is that these clinics run solely on your money. If you miss a payment, you don’t get dosed. If you miss a dose, it is THE worst feeling you can imagine. Its worse than heroin withdraw. It will make you do unspeakable things. Wish you were dead.
      Thanks to my methadone clinic, my wish was granted. I was dead for four minutes and twelve seconds.

      This is stupid. If you aren’t an addict and don’t know how it works, don’t pretend you do.

      Reply

      • Methadone works for many people. sorry it didn’t work for you.

      • Posted by sue on January 1, 2016 at 11:29 pm

        I agree with Taylor on this one… My son was sent to a Methadone clinic and they dosed him up to a point that he was almost in a stupor. In his years as a heroine addict I never witnessed such a mess. He was being tapered off of benzos at the same time and far too quickly in my opinion. From personal experience I would say a very slow taper is best and using suboxone in lieu of methodone improved patient compliance.

  3. Posted by Tonya Roberts on February 16, 2012 at 5:03 am

    I would like to see the COWS scale and dosing guidelines used across the board. I’ve read a lot on methadone and from what I understand you really can’t base a starting dose on past opiate use. I’ve also read that it’s not a good idea to increase the dose during induction for 5-7 days to allow time for the methadone to reach a steady state. Start Low, Go Slow I also don’t understand why dosing a pain patient vs. addiction should be any difference. They are either opiate tolerant or not. Also what are the procedures at your clinic for increasing a dose during induction? What kind of assessment is done and by whom to decide on dose increase. So if you have patient that talks the talk is positive for opiates , Has few subjective signs but NO Objective signs, How much would you start this patient on and how quickly would you titrate up, Knowing how dangerous this drug is in the 1st two weeks of induction. What are your thoughts?

    Reply

    • I sense that you want more information than I can give in a reply section. The best thing I can do is give you the URL for NIDA’s webiste, which contains all the information you’ll need about dosing, induction, etc.: http://international.drugabuse.gov
      Go down to Part D, and there’s a section on initial dosing.

      You are correct – past tolerance of opioids gives only a general idea of what a patient’s tolerance to methadone will be, because methadone is metabolized differently than many opioids, plus it has a very long half-life. The very feature that makes it ideal for treating withdrawal symptoms with only once-daily dosing is also what makes it dangerous. A dose change today won’t reach a steady blood level for four or five days.

      However, treating addiction is very different than treating pain. Presumably, pain patients aren’t as likely to leave treatment if frustrated by a lack of response, and they are not at such an increased risk of poor outcome if they leave treatment. (Pain medicine physicians may argue that last point.)

      The “best” way to do dose increases is often a point of contention. We know that if the patient isn’t up to at least 60 or 70mg in the first month, the drop-out rate for addiction treatment is incredibly high. Leaving treatment is very bad, because untreated addicts have a high death rate, not just from overdose but also suicide, accidental deaths, homicide, health problems, etc. But if we go up too fast, we put the patient at risk for overdose from the methadone. It’s like walking a tightrope. It is a complex decision best made by a physician with experience and knowledge. Physicians weigh risk versus benefit with every prescription we write, while non-physicians often expect every medication to be 100% safe. This isn’t possible in the real world. Unfortunately, non-physicians (particularly lawyers) try to second-guess our decisions, because they see only the risk of medication, and don’t examine the risk of NOT taking the medicine.

      It’s hard to convince an addict, still in withdrawal after a week of treatment, that they will feel better in the future but for now we have to increase the dose slowly for absolute safety. It’s just too easy to do what is familiar – go back into their addiction.

      Reply

  4. Posted by Tonya Roberts on February 16, 2012 at 9:36 pm

    Thanks for the website. I also got your book. Really good information which is hard to find. One more question…Can you give voice orders for dose increases based on nursing assessments during induction?

    Reply

  5. Posted by Dave M> on February 18, 2012 at 5:38 pm

    In my local area, a couple doctors prescribe Adderall in addition to your Suboxone and benzo, to keep your brain from falling asleep, I guess. Then, when you can’t fall asleep, they add Ambien. Nice 4 drug cocktail, isn’t it? How do we combat this “add another drug onto the pile” mentality?

    Reply

    • I wish I knew…it’s an uphill battle.
      Medical schools and residencies have to do a better job of educating young doctors about addiction…and recovery.

      Some patients do need stimulants for legitamate ADD. But benzodiazepines can make ADD worse.
      I had a patient who was scattered, disorganized, and forgetful. He did appear to have ADD, but he was also taking Xanax 1mg three times a day as prescribed by another doctor. He was agreeable to taper off those, which took months. In his case, once off Xanax he wasn’t scattered or forgetful, and didn’t need stimulants.

      Reply

  6. Dr Burson, I really appreciate your blog. I am an MMT patient (20 months now) @ 130mg (for the last year) and I read your blog every time you post a new entry – I wish we had a doctor like you at my clinic. I wish we had a doctor that actually stayed for more than 5 weeks at a time, but that’s another issue.

    I have a question for you, and it’s basically, how would you approach this situation? A year ago I had a false positive show up on UAs for benzodiazapines. At the time I was taking Valerian Root, which was eventually shown to be the cause of the false positive – but of course by the time that I finally got them to listen to me and halfway believe me enough to do a re-test, they had already dropped my dose 10% a day, down to 60mg. Of course I was sick and the dose was not holding after a few months, so I had some peak & trough tests done (the laboratory that they use must be really cheap – they use a different, better one for staff, my counselor admitted – oddly enough – because they also screwed up a few of these tests – the first came back saying that I had no methadone in my system at all, and the next one came back saying that I had peak serum levels in the 700s and trough in the 500s – well above the therapeutic range stated as 100-400 mcg (I believe it’s mcg/mL or something, I may be wrong but I am going to assume you get the gist!). Of course, that was the test that they “accepted” and have not allowed me to retest since.) So they would not do anything to help my dose – I really would like to try a lower dose, but have it split, which they refuse to even TALK about considering. Anyway. I’m getting to my point, sorry!

    So after continuing to be sick for months and trying to deal with it or hope it would go away, including the cravings and depression etc etc., I went to my GP – at the suggestion of the clinic doc at that time – and got put on an SSRI (which really screwed me up, both that I tried, just made everything hellishly worse!), klonopin (which I had successfully used before, by successfully I mean without feeling like I “needed” it in that addict way of “needing” something), and prazosin, a BP med that is shown to help with nightmares and flashbacks in PTSD patients. I was having horrific nightmares every night for years and finally, this took care of it. After a few months I went off the anti-depressants because they were literally making me go insane. The klonopin is something I take for sleep, every night, and for panic attacks, when they happen. Sometimes they can happen 4 times a week, sometimes only once. I also found that I don’t have to take the prazosin anymore for nightmares – the klonopin inhibits all the nightmares, for some reason – so thankfully I am down to just one medication. Unfortunately, it happens to be a benzodiazepine. My anxiety has gotten so bad through my recovery that I don’t even know what to do with myself anymore. And I’m still getting withdrawal symptoms every night, and bad cravings, and vomiting in the morning – that says to me that my methadone treatment isn’t being handled correctly, and I feel like I have to compensate with other medications from my GP. The past few months, I’ve developed a complete lack of appetite and I’m losing weight again.

    I’m getting the same answer from everyone – my GP, my psychologist, the clinic staff – “We can’t help you. Try to find a specialist or someone who can.” Well, I have tried that, and I gave up, and that’s how I found myself in the middle of a pain-pill-then-heroin addiction in the first place. I don’t want to be on any meds, including methadone, but I also know that I am very unstable without them, and I’m not ready to give up on things that I think can be great TOOLS to aid in my journey to freedom. But they’re not being used correctly, or I’m not on the right ones, or *something*, I just don’t know what. I feel like I am trying to fight for my sobriety, for recovery from drugs and recovery from abuse, yet being on the clonazepam somehow discredits me in their eyes. I swear, every time I go in for a counseling appointment, she spends quite a while trying to get me to admit that I’m using on top. I have even offered to pay for an extra random UA that they could give me whenever they feel like it, but they declined.

    Gah, I know you can’t answer this whole thing, because it’s very….cluttered with details. I apologize for that. I guess what I’m saying is that being on a benzo and methadone carries a huge stigma – understandably, but….what would YOU do if you were my doctor or counselor? Or what would you advise me to do? I have been one of the best patients there as far as paying on time, not missing sessions, never missing a dose, never “losing” a takehome, etc. And yet I still get treated as if my body and my suffering isn’t worthy of their time or effort or care. I am so so willing to work through this, and formulate a decent treatment plan, yet no one seems to want to take me on. I can’t help but feel lost and neglected. I am begging them for help, I am ready to kill myself, and yet….I feel somehow “in trouble” for taking my prescribed medication. I thought that anti-depressants would help with the anxiety and I’d be able to just take those, but the docs decided that since I had such severe and dangerous reactions to the 4 I’ve tried, that we should give that plan a rest for now. What else works for anxiety?? Due to health problems, as well as the depression and fatigue and physical pain that seems to come from nowhere, I do a little meditation but can’t really exercise. For sleep I have tried Ambien, Lunesta, etc. a few years ago but wow, those meds were horrible (amnesia, sleep-walking, sleep-talking gibberish – those drugs made me seem like more of a drug addled fool than anything else in my opinion! Yikes!).

    Any ideas? I know that this is a long one, but I’d really appreciate any feedback.
    To sum up: Any ideas on other meds to help the anxiety, sleep, nightmares, flashbacks, and panic attacks? And please, any suggestions on how to get the clinic to work with me and not against me? Maybe they won’t ever trust me fully (in fact, I’m still waiting for my counselor to learn my name) but I’d just simply like to have a working, professional relationship that can help me help myself through recovery. What should I do? I have considered filing complaints for the multiple things they’ve done/said/lied about/etc., but I don’t want to become someone that they hate.

    Thank you very much for your blog and I hope you have time to read this!

    Reply

    • Oh dear.
      Yes, your case is complicated. I can’t give you medical advice, because obviously your doctor is the most appropriate to do that.

      But I do have some thoughts. First off, “I am ready to kill myself…” That worries me. If you are suicidal, please get help ASAP. That might mean a hospitalization until you don’t feel like harming yourself. However, I realize people sometimes say things like that to get across their meaning that they are extremely frustrated.

      Second, I am so glad your clinic cares enough to be worried about the combination of benzos and methadone. It’s been a fatal mixture for too many people, addicts and non-addicts alike. I’m not saying that benzos and methadone can NEVER be given together…but in most cases, safer medication can be found. Instead of feeling like staff are kind of picking on you, consider that the staff doesn’t want something bad to happen to you. You may vehemently disagree with their decisions, and feel they are misguided, but hopefully it comes from a place of caring what happens to you. It would be far worse to be in a clinic that has the attitude of, “We don’t care. Mix your methadone with some Jack Daniels and burn a fat one on the way home. It won’t bother us.”

      Third, there are no good studies that show benzodiazepines are effective for anxiety disorders in the long-term. In fact, some studies show a worsening of anxiety due to the rapid tolerance to benzos that occurs. So yes, I think better methods can be found to manage anxiety and insomnia for most patients. Some of those methods don’t include medication. For example, cognitive behavioral therapy is very effective for the treatment of anxiety disorders, but it’s not quick or easy. Your clinic counselor may or may not have enough training to provide this for you. If not, ask your clinic to refer you to a good therapist. Most psychiatrists (M.D.s) don’t do therapy; they refer to Master’s level or PhD therapists.

      Fourth, back before the Valerian root, before your dose came down…how were you doing? How was your anxiety? If it was manageable, is it possible that some measure of your anxiety and insomnia are from opioid withdrawal??? Methadone levels help us, but they aren’t perfect either. But then comes the catch-22. They want you to stop your benzo before increasing your methadone dose, but you can’t stop using the benzos because of the anxiety you feel from opioid withdrawal. In such situations, sometimes I do – cautiously – raise the methadone dose, as long as the patient has not come to the clinic impaired. And I’ve asked patients to come back to the clinic 2 or 3 hours after dosing so I can check them to make sure they aren’t drowsy. I feel so much better about my decision after I can see that they look OK on the higher dose.

      As for interactions with methadone clinic staff, I think you’ll get your best results by continuing to be persistent in seeking help, and continuing to do so in a respectful but assertive manner. Asking to be referred to a therapist skilled in treating anxiety disorders with CBT is an excellent way to prove you are determined to get well, and willing to consider options that don’t include medications.

      Reply

      • Dr Burson,
        Sometimes when I am feeling frustrated I will come back and read your reply to my post. I am now 2 years, 15 days clean but still struggling SO badly with the depression and anxiety. I also have been on the same dose of methadone since…well, for about a year and a half I guess (I am still on the 130 mgs I mentioned here, back in March). Unfortunately, I still get “sick” every single day. The clinic staff & doctor just say “hmm” and “well, let’s see what happens” every time I bring it up when they ask how I’ve been feeling. Split dosing is, apparently, not an option.

        I am still taking clonazepam, however, not regularly (I should add that I got approved for medical marijuana, which I have been using instead of the Klonopin – it has helped immensely). I am on my “last bottle”, because I just can’t go back to the doctor I had been seeing. I should have taken her nonchalant attitude towards keeping appointments and making a treatment plan as a red flag, but I let it go…. When I finally did make an appointment, I mentioned that I would like for her to be in contact with my clinic and she LOST it. It was very scary….She actually yelled at me, and went off on a tangent about how I’m an addict, I’ll always be an addict, I’m not clean, I have just traded methadone for heroin and it’s an excuse, etc. She went so far as to say some extremely hurtful things about the abuse I went through as a child…(She had gone on the computer and pulled up information on me – now I know that she can see that I’m on methadone, and also any prescriptions I have filled….but when I asked her HOW she got the information on my childhood and what those papers were, she said she “didn’t remember” and that the papers were “confidential”) That is some seriously weird behavior from a doctor… I ended up leaving her office sobbing and feeling absolutely worthless.

        I’ve visited quite a few psychiatrists, psychologists, and MDs since I first wrote you here in March. I have tried a number of antidepressants, all of which have made it a lot worse. And currently I have a brand new bottle of Wellbutrin on the counter, which I’m supposed to start soon. BUT I’m not so sure – the doctor who prescribed it very explicitly said, DO NOT do ANY research! Don’t you think that’s a big red flag? It is to me….I told her that I always try to educate myself on anything and everything that I am taking, and she immediately cut me off and said no no no don’t ever do that! No research! And of course she made me promise to not look up Wellbutrin when I got home. I did talk to the pharmacist about it, and after that, I did end up researching. I still haven’t taken it yet, though – not because of what I read but because I’m freaked out that the doctor was so adamant about me not knowing too much about it.

        Truth be told, I just don’t know WHAT to do anymore.

        I’m so…sad. I just cannot find a doctor or psychiatrist or anyone who seems to want to take this on. I know it’s complicated, I get it, but I am 100% willing and begging for help. I’m not rude, I’m quite shy and very soft spoken, and I try to be as professional as I can, but I am really getting broken down by the medical community around here. I come to your blog to remind myself that there are truly good people and great doctors out there, I just haven’t found one I guess. I know you don’t want to risk giving someone advice over the internet, and then having it go badly…but I do absolutely appreciate your responses, both to my own questions and others’.

        Oh, and about the suicide thing – I know that the only advice that can be given is to go to the hospital ASAP….and I understand why…But I feel like this all the time. Always. I never experience joy from anything….is that normal, at this point? I constantly am stuck with the feeling that I’m just not going to get better. I have no desire to live, because my life is horrible and I honestly just feel like a drain on the world’s resources. If I were dead, at least it’d be one less person to bother my roommate and take up a seat on the bus and produce pollution. Ugh, that is quite morbid, and I apologize for that, but that really is how I think and feel. I’m SO USELESS. I don’t even have a job, because I just…I’m useless. I don’t even eat….I have no appetite, and I have discussed this so many times with the clinic and doctors and such – the clinic staff/doctor say that it’s a problem I need to see a different doctor for, and the MDs say it’s something I need to see a psych for, and the psychologists/psychiatrists tell me that the appetite problem is caused by the methadone!

        I know that it’s a long, hard road; I know that I got myself on this island and I’ve got to swim my way out. However, I’d like to be successful – and it’s not like these medical professionals are doing this for free….I’m paying them a pretty penny, and I go without a lot of things to support that and this sobriety. Is there something that I’m missing? Is there a certain approach, a certain thing to say, a specific….I don’t know, just SOMEthing I need to do in order to find an MD or psychiatrist who doesn’t just want to deal with very simple, easy cases? I tend to always look for ones who list experience/specialty in substance abuse, PTSD, etc…but should I be looking for something different, i.e. maybe an older doctor instead of a younger one or vice-versa, someone who graduated from a specific school, someone who is in a specific area or associated with a certain hospital/organization/association, certification in an important field….?

        Once again, I wrote a novel! Sorry about that….And thank you in advance for your time. I know you are a busy woman and I also know how confusing and rambling-on I can be! Thank you.

      • The doctor who told you don’t do research…Could it be your doctor thinks you’re a bit of a pessimist, and that you would become anxious about all the possible side effects that the drug company has to list about their medication?
        I can’t give you medical advice, no. But I do wonder if you would feel better off marijuana and clonazepam, tapered with your doctor’s approval, of course. THC causes anxiety in many patients – now there’s some research you SHOULD do – and clonazepam makes depression worse, as it is a depressant.
        My next question is…and I’m just throwing it out there…are you trying to fill an emptiness within yourself with a pill or a potion? I don’t think that all of the malaise we as humans feel is necessarily medical in nature. I’m no believer in woo-woo treatments for physical and mental ailments, but you say you’ve seen a multitude of doctors, taken a multitude of meds, all without help. Could it be something deeper than medication can fix? Some people might call this a spiritual void.
        I don’t know you and cannot by any means diagnose you. Just throwing it out there.

  7. Posted by dbc131832dr12a212aa212333DeF23417993312314 on June 4, 2012 at 4:59 pm

    I AM NOT A DOCTOR, THIS IS NOT MEDICAL ADVICE. CONSULT A DOCTOR FOR MEDICAL ADVICE. THIS IS A QUESTION.

    This is an old post. However, I have been concerned about some people who have, usually through legitimate channels, become dependent on benzos. Now, for opiods, thank goodness there is Suboxone. While it is no cure, it can make tapering a lot easier. Trust me, when you do get off Suboxone, even at 2mg every *other* day, it takes a while to recover. I didn’t sleep for 2 weeks.

    However, for people on high doses of benzos, for whatever reason – and many do have legitimate reasons, though in other cases they just made a mistake and got ‘stuck’. These people often live very stable lives. Many people you’d never expect to be on benzos are. From school teachers, your Aunt and Uncles, plenty of working people.

    After years of being on Benzos, withdrawal can be deadly, as she notes in this blog post. I didn’t realize how deadly until doing research. In the UK there are clincs to taper people off Benzos.

    When carefully monitored, why is this not an option? The current medical literature would say the patient should be submitted to in-patient detox, so they don’t die. And that’s all they make sure of, that they don’t die. The detox would be unbearable, but maybe you’d live if they actually keep an eye on you (these people don’t get paid much, minimum wage).

    After you get out, you then are ‘off’ for God knows how long, depending on your dose and duration. It may be 6 months before you are normal again. Thus, you can’t work, can’t feed your family, etc… You can’t be a productive member of society. They come out clean, but their lives are destroyed.

    Please reference the Ashton Manual for Benzo tapering as used at her clinic in the UK.

    As for Benzos+Buprenorphine. Even though Bupe is an opiod, it being a partial agonist with a ceiling effect, I can tell you that the risk of *any* complication is near 0. I would say if any problem emerges, it would be only the Benzos. That is NOT true of full agonists like Methadone.

    So, I’d say methadone is not an option for these patients. Of course, frankly, after experiencing both, I believe that most should switch to Bupe. IMHO. I know, not a popular opinion with those on methadone, BUT I know that you *can* switch from a full agonist to a partial agonist. It isn’t pleasant, but it is much better for you.

    What do you do with co-dependent individuals on Bupe that also need tapered off benzos? Is there no compassion in this country for them? Many rehabs say Benzo WDs are WORSE than opiod WDs, and perhaps more deadly – something I didn’t know until recently.

    Again, please read the Ashton Manual and let me know what you think, if you get time. You will find it interesting I think.

    Reply

    • It is dangerous to stop benzos suddenly if the patient has been taking even moderate doses for months. If benzos have to be stopped suddenly, it is safest to go to a medical detox unit, with nurses to check vital signs and monitor for withdrawal symptoms.

      Taper can be attempted as an outpatient. Any doctor who starts a patient on benzos should be familiar with the various “recipes” for tapering that patient off benzos. Ideally it takes weeks to month for the taper of even moderate doses, if the patient has been taking them for years.

      But the question is, what to do if patients have an addiction to benzos? By this I mean that not only do they have physical withdrawal when benzos are stopped, which happens to anyone, but do they also have an obsession and compulsion to keep taking benzos even when they want to quit? If the patient has a benzo addiction, he or she may not be able to taper as instructed by their doctor, because the obsession with the drug keeps telling the patient to take more. Even some addicts can taper as an outpatient if they have enough support, but it’s usually difficult. For those who just can’t taper, inpatient treatment is their other option.

      For cost-saving reasons, an outpatient taper is usually attempted. There are several taper protocols, but in general, the patient is switched to a long-acting benzo and the dose decreased by 10% every few weeks or so. I’ll try to take a look at the manual you mention.

      Buprenorphine (Suboxone, Subutex) isn’t safe with benzos. It’s not as dangerous as combining methadone with benzos, but it can still be deadly. Most of the buprenorphine overdose deaths in Europe were combined with xanax, I think I remember reading.

      Reply

      • Posted by dbc131832dr12a212aa212333DeF23417993312314 on June 4, 2012 at 9:22 pm

        Thank you! Your answer is very insightful. You are very wise in your field and I’m glad you publish your thoughts. So many don’t, for fear of criticism or whatever. I apologize I didn’t write more concisely, or have a better composed post.

        You are right about a person being an addict, that is how someone I know got into this position. Of course, I think he just got scared out of it, and has taken steps to ensure he can’t self-dose as he THINKS he needs to.

        Although he’s scared now, the person I am thinking of is in big trouble then, as this person has escalated to EASILY 6mg of Xanax a day, maybe more. How did this person get it? Would you believe SOME doctors prescribe such high doses to patients? This person is a terrible liar though, so he can’t lie to doctors to get that dose, therefore I will tell him to expect hospitalization and do his best to taper. Previously, he ‘jumped’ off 1mg several times over the years without much trouble (depression for a couple weeks, etc.. but then ok).

      • Posted by dbc131832dr12a212aa212333DeF23417993312314 on June 4, 2012 at 9:34 pm

        — in addendum to my last reply to yours — Assuming, as you said, he can afford the in-patient program that is ;o. Even if he can’t, there are few doctors who would take him. As mentioned, I fear the larger issue when he gets out though, and all will be lost as he takes months to ‘right’ himself. He likely won’t have a home, family, or business anymore – if he maintains his very life. He swore he would never let himself get in such a position, but there were absolutely stress factors beyond most people’s ability to handle (seriously, huge). Anyway, I feel for him, and we’ll see what happens, but I suspect it won’t be good. Can’t be good. Sad. It makes me burst into tears.

      • Posted by dbc131832dr12a212aa212333DeF23417993312314 on June 4, 2012 at 9:54 pm

        I talked to him. He will have to talk to his insurer to see if they handle detox places, then prepare to move and ‘be down’ for at least a month. His wife will surely leave him, depending on him mostly for money. His business may survive he says, depending on how long it takes to be productive again. Of course, I reminded him that it is no excuse to take more to be productive and get extra work done ahead of time. It is a shame, because although he is no perfect person, he is one of the good hearted people of the world. Not out to con, swindle, manipulate, defraud, lie, steal, cheat, or do anything else immoral. I do not believe he will survive, given his family history of heart conditions, and his current weak heart. I will pray for him. Like I said, it makes me cry. These things are the devil, and I don’t want to see one of the good guys go out like this.

  8. Posted by sue stilling on August 17, 2012 at 4:10 am

    I have really appreciated reading your posts and recommendations. I have a 21 year old son who has been battling addiction fro several years. His most recent relapse involved moving from oxy insufflation to IV heroin. I was devasted to say the least. I have helped him through withdrawl and we are 6 days out. Now I am looking into long term adjunct Tx. He has tried Methadone and suboxone in the past. He was miserable on the methodone. Sub worked until he tried to get off (2mg/day woked fine). When we went in to get him back into out patient rehab and more suboxone or possibly try Naltrexone they refused on the pretense that he had tested positive last year for benzos while on suboxone. And to attend their program he needed to get on methadone first. Stating they would not prescribe suboxone because it is “not as safe” as a Methadone/benzo combo in the event he does benzos down the road. I don’t think that is true from everything I have read? He has a medical plan and I believe they don’t want to pay for the suboxone but rather farm him out to a methadone clinic. Is there any literature or studies comparing the two? One being more dangerous than the other if benzos might be used in combination? Your knowledge in this matter would help tremendously.—- Also what is your opinion about naltrexone for opioid use?

    Reply

    • There’s no doubt about it – Suboxone is safer than methadone if the patient is using benzos. Methadone is a full, heavy opioid. Buprenorphine (generic for suboxone, subutex) is a partial opioid with a ceiling on its opioid effect. It’s still possible to overdose and die if you mix buprenorphine with benzos, but MUCH more likely with methadone.
      If your son is through the acute withdrawal stage, naloxone is an excellent choice! He would need to start on tablets to make sure he can tolerate them OK, and then you could switch to the once-monthly injectable form, marketed as Vivitrol. The tablets are cheap, but the biggest problem is compliance. If he doesn’t take them daily, if he “forgets,” he can still get high using opioids. With the long=acting shot, he’d have to stop taking injections and wait until it’s out of his system.
      The naltrexone in tablet and injection does nothing for cravings. It only blocks the opioid receptors so he can’t get high from opioids.
      And no medication is ever meant to be used alone. He needs ongoing counseling. I’d prefer inpatient treatment at a 28-day or more residential program. With opioid addiction, outpatient treatment has very high rates of relapse and there’s a high drop out rate, unless it’s paired with medication like methadone or buprenorphine. No so much is known about outpatient treatment paired with vivitrol but the few studies I have read seem promising.

      Of course, he’s 21, so he will make the final decision.

      Reply

      • Posted by sue stilling on August 17, 2012 at 4:35 pm

        Thank you very much… That is what I thought and your confirmation enables me to pursue Tx options further. Methadone works for many but not for my son so I (he) will approach his practioners with a game plan.

      • Posted by ac3c9141724 on August 17, 2012 at 4:54 pm

        The doctor is completely right. From an addict’s perspective, I can also tell you that methadone, as a full agonist, actually has a real high to it, unlike buprenorphine. In fact, methadone maintenance most often begins in excess of the addict’s original opiod or opiate dose. That is the idea, after all, keep them satisfied and content so that they can begin to rebuild their lives and function as otherwise normal members of society. Methadone is extremely potent.

        It would be hard for me to believe any clinic stating such non-sense as methadone being safer than buprenorphine when combined with benzos, but I have been around the block and know that from time to time you do encounter real quacks out there. Whether they are in it for the money, or are just ignorant, or believe you to be ignorant, who knows.

        I can tell you that confronting them with facts isn’t going to work. They’ll get defensive, and are never going to admit they are wrong. If they were half interested in being right, or the truth, they’d not be so wrong to start with ;p.

        After all, it dosen’t take an MD to know that buprenorphine is much safer combined with benzos than is methadone. The comparison is actually more than ‘much safer’.. it is more like ‘somewhat safe vs. completely and utterly dangerous’. Methadone produces such strong CNS depression that it would often put me down for a couple days at a time, back when I was abusing whatever I could get my hands on. To combine that with benzos is very often disasterous. In contrast, buprenorphine has never caused much CNS depression for me, or anyone I’ve ever seen. You just don’t see people ‘nodding out’ on buprenorphine. It just doesn’t happen.

        I can also say, from experience, that I – for one – have tolerated high doses of benzos along with Suboxone and never saw any negative side effects for me. The biggest problem is benzos are yet another physical dependence, and sooner or later you will pay the price. Sadly, when coming off benzos the support infastructure isn’t there as it is with opiods/opiates. So, you end up suffering for however long it takes for your brain and body to repair itself. it can take months to completely recover. As I like to think of things now, there is the obvious fact from physics, “for every action there is an equal and opposite reaction”.

  9. Posted by ac3c9141724 on August 17, 2012 at 5:04 pm

    And the doctor is also right about your son’s age. The chances of him changing right now are actually quite slim in my experience – at least without being incarcerated. And whether or not he changes is completely and totally up to him – no matter what you do. You could let it get worse, or shelter him (for which some would call you an enabler), but in the end it doesn’t matter what you do. There is no being scared straight now.. his youth is over, and now he’s a man in the eyes of society, the law, and .. well .. life.

    I would explore the underlying cause for him seeking out ‘highs’. Also, it is maybe helpful to remember that, at that age, you really don’t have a physical dependency as bad as you might think (try again in 10 years ;o). For me, whenever I see a younger addict, I usually am pretty confident that they are more an addict than physically dependent. This is not to say they aren’t physically dependent, but they simply are nowhere near the level of physical dependence of a lifetime opiate or opiod user.

    Reply

    • Young people can be every bit as physically dependent as older people. But the withdrawal is more difficult to tolerate with age. I admitted a 19 year old patient last week to treatment with buprenorphine – and she had a six-year history of daily use & was quite sick in withdrawal.

      Reply

      • Posted by ac3c9141724 on August 18, 2012 at 12:42 pm

        I agree, they can be, and didn’t mean to speak in absolutes. What I meant to say is that *most* people don’t begin heavy opiod use at 13 (as your patient apparently did). That said, even someone who has only been on opiods for 3 years can be quite physically dependent. I suppose I speak from my own life experiences. There were times I went through withdrawal earlier in my youth, thought I was going through hell, but now compare that to a cake walk to later withdrawals many years later. Regardless, Suboxone is the proper course of treatment at any age, whether they are heavily addicted, or physically dependent. As a side note, I actually eventually grew better at tolerating withdrawal, surprisingly. It was mostly about not letting my mind psyche me out and staying distracted during times of withdrawal. Sitting there starring at the ceiling in some detox clinic makes it worse, for instance ;p.

  10. Posted by sue stilling on August 18, 2012 at 7:04 pm

    Thanks for the insight…. And by the way—I know I am a co-dependent. That being said, I am fighting for his life here. I will be his biggest advocate while at the same time try not to enable his destructive behaviors. I have read all the books, taken all the classes and have a BS in Psychology. Sometimes I know what to do but can’t do it. I really feel he has underlying issues that have never been addressed. At this point it is hard to tell what thoughts and conditions are innate and which have been caused by drug abuse. When I try to get help in regular Psychiatry they give him anti-depresents and farm him back into the group therapy. I think he needs Suboxone and group Therapy as well as a Psych consult. They want to give him in group everything and have him start his day at the Methadone clinic. He almost stopped breathing the last time we went that route and ended up in the hospital with a bowel obstruction, periods of apnea and braycardia. I am either going to try a private doctor or call the Pysician-in-Chief at our HMO for some intervention on our behalf.

    Reply

    • Posted by Eric VT on September 1, 2012 at 7:29 pm

      .I can very much relate to your story. Especially when it came to my mother and the way she handled my addiction at a young age. My mother saved me countless times in my late teens to mid 20’s when my active addiciton was at its worst. She was always there for me any problems be it social.legal,etc.

      As a addict I just loved this and used this to my full advantage time and time again for years. I knew no matter what every night I had a place to rest my head,food to eat and a house to steal from to keep fueling my addiciton. It did not matter how much I hurt her, stole from her or used her for $ she was always there to take me back with open arms and buying the exuse I gave her over and over again that this time I was going to change. But I never did. She was pretty much loving me to death and doing the exact opposite of what she should of been doing. It was not until she got involved in al-anon meetings and then got tough with me that I got better. I knew I had no home to go to and no place to get easy money from. Lawyer or Bail $ was not coming anymore when I called. Yes it took me a good year or so after she finally threw me out before I cleaned up but I did. I contribute her finally saying no to me and not being co-dependent as a main reason why I cleaned up and got my life together. I wish you and your son all the best.

      Reply

  11. Posted by Eric VT on August 31, 2012 at 10:37 pm

    Every single time I overdosed and found my self getting brought back from the Dead from narcan in a New York City hospital or ambulance there was always another drug in play before hand. I overdosed 3 times in my life. The first two were drinking Alchool before using Heroin and the 3rd was using Xanex/Benzo before I went and coped my Heroin and used.

    Reply

    • Posted by dbc910281927681 on September 1, 2012 at 12:24 am

      Dude, you almost sound proud of it. What is your current status? Also note that this is a Bupenorphine topic, which has completely different pharmacological interactions with benzos than do full agonists.

      Reply

      • Posted by Eric VT on September 1, 2012 at 3:06 pm

        You completely Misunderstood my post. Why would I be proud of something so dam shameful now ? My point was just based on this topic about on how the odds go up drastically when mixing Opiates with other downers. All I was doing was saying how true this is and my experience in the days I was a active addict and the times I OD’ed. Thats all

      • Posted by dbc910281927681 on September 1, 2012 at 4:58 pm

        My apologies then. I misunderstood. Sometimes online things ‘come off’ wrong.

  12. Posted by twacked out twiggy on December 9, 2012 at 8:12 am

    When are they going to come out with a magical pill for my meth head friends to use as a crutch in their “recovery”? Opioid addicts have methadone or suboxone, its only fair they help out meth addicts too.

    Reply

    • Posted by dbc913202819276813 on December 11, 2012 at 7:40 pm

      I would wager as soon as such a medication is discovered, if it is patent-able, you will see such a thing. I would also wager there is going to be a backlash against Suboxone in the coming years, justified or not.

      Reply

  13. Posted by natalie on January 23, 2013 at 1:47 pm

    hello i probbly should have read through all the posts and my question would be answered but im extremely frazzled at the moment. i just left my suboxone doctor that i have had over the last 9 months and she told me because im still on the clonazepam.5mg she would no longer prescribe me the suboxone.5 i have been on clonazepam for 5 years on a steady dose of 2 .5mg per day, some days i go without taking them at all. i generally take them when i work or have to be in a public setting. she has been prescibing me suboxone 8mg films for 9 months knowing that i am on the clonazepam but we have always discussed me getting off of it and even set a date in december for me to be completely on of it. but with taking it for years it wasnt as easy as i thought. i ended up with serious serious anxiety, passing out, inability to sleep, blurred vison, and horrible shakes. not to mention not being able to eat bc i am so dizzy at all times so i have lost about 20 lbs in the last month! she told me she would loss her license if she continued to write the rx. i live in ohio and iwasnt sure if this was true and if so why in the heck that would be a law. i have taken both medications and never had any side effects what so ever.i do not and have not ever abused either medication and never plan on it. i have gotten my life to gether in an amazing way over the last nine months and feel like she just completely pulled the rug out from under me. its very frustrating and im so scared to now withdrawl from the suboxone. i guess my question is, is it illegal for a doctor in ohio to prescribe someone suboxone ?

    Reply

    • I don’t know about if it’s legal or illegal. but it is unwise to prescribe suboxone to a patient who is also prescribed benzodiazepines, except under unusual circumstances. What strikes me is…you’ve been seeing her for nine months, and all that time she’s told you to taper off the benzo…set a date for december…and you weren’t able to stop. I don’t understand why you feel like she “pulled the rug out from under me.” I’d say she worked with you much longer than I would have. I’m guessing there’s another doctor who prescribes the clonazepam, and both of your doctors should have talked and agreed on a plan for a taper. Or if you are unable to taper, a stay in a medical detoxification unit may be appropriate since you have terrible withdrawal symptoms. People can die from benzodiazepine withdrawal, so this is serious. Not everyone can stop as an outpatient.

      Benzos are not indicated for use for anxiety disorders for any longer than three months, except under unusual situations like end-of-life care, and some rare neurologic diseases. Many times anxiety disorders actually get worse on long-term (longer than 3 months) benzos.
      Benzos are massively overprescribed in this country, and in other countries. There are prescribing guidelines for best practices for benzos, based on all available data, but few doctors follow them or are even aware of them.

      I think you had a good suboxone doctor who really cared about your health and well-being, and who was trying to do the right thing for you. If you really want to stay with the suboxoone, I’d advise you talk to the doctor prescribing clonazepam, and ask him/her to help you access a way to safely get off these benzos. And ask this doctor for a more appropriate way to treat your anxiety disorder. this may or may not include medication.

      Reply

    • Posted by dbc913202819276813 on January 24, 2013 at 12:24 pm

      The doctor is right. Having struggled with benzos myself, I can tell you that the longer you are on them the less efficacy they have the deeper a hole you’ll be digging. Your doctor forcing you to make tough choices like this is doing you a favor. You simply must abstain from benzos. Whatever you do, don’t read the horror stories on the net, most are extremely exaggerated and/or worst case scenarios.

      Reply

      • Posted by sue stilling on January 24, 2013 at 12:42 pm

        I can understand the doctors point but she should help you gradually taper you while monitoring your blood pressure and using other/safer meds to do so. Never ever stop cold turkey as this can be fatal. Benzos are far more dangerous than opiates to withdrawl from. That being said, mixing the two are very dangerous. Suboxone is only a partail agonist however and mixing benzos with a full agonist/opiate is more dangerous. Get proffessional medical help to get off the bezos. Tackle one at a time and stick to it. Best of luck to you.

  14. Posted by sue stilling on January 24, 2013 at 12:48 pm

    And janabuson is right…. The more of her posts I read the more impressed I am with her addiction expertise. You have come to the right place to seek advice. I am just the frustrated parent of an addict and she has helped me immensely.

    Reply

    • Posted by dbc913202819276813 on January 24, 2013 at 1:03 pm

      Yes, the doctor is very wise in her field, and surprisingly compassionate.

      While you are right that benzo withdrawal *can be* fatal, it usually is not. When I came off cold turkey of a 6mg+ Xanax habit I’d developed over a few years, I didn’t sleep AT ALL for two weeks. I didn’t know if I’d make it, and reading horror stories on the net about people who took years to be normal again didn’t help.

      Benzo withdrawal is a very psychological thing, and it is easy to get stuck in a post-benzo ‘rut’ while you wait to feel that high again (quit waiting ;p).

      So, while you should consult your doctor and not stop benzos cold turkey, you also have to realize that MILLIONS of people have quit using benzos. Only a tiny fraction developed any severe problems. According to reports, a large percentage of people withdraw without even noticing any withdrawal effects. I’m sure they have them, they just attribute them more to the usual psychological fluctuations and not the abscene of the drug. That said, I’m not a doctor, so what do I know. From the most cautious and conservative perspective, withdrawal should always be medically supervised. From a bit more of a ‘man-up’ perspective, just get over it. I can say that now that I have ;p.

      It’s all in one’s head, and you can come off benzos, and you’ll be much better for it. The world, and reality, simply is NOT the dreamy world of a benzo high. That world is false, fake, and will come crashing down all around you.

      Reply

  15. Posted by natalie on January 24, 2013 at 2:55 pm

    i must make one thing clearI I do not get any kind of high from the benzos or the subs they make me normal. i started taking the benzos after the birth of my son when i developed a horrible case of postpartum that made it nearly impossible to be in social setting without having an anxiety attack. i have always been a very outgoing, super social person so to me this was so far from the norm that i got “help” and was placed on benzos not knowing or being informed of how addictive they are. i now know it was a huge mistake and i should have tried other ways to cope so i wouldnt be in this mess now. the scond part was completely my fault in becoming addicted to opiates and getting on subs. my issues is she knew from day one that i was on the subs and she always just casually said we need to get you off of those and then in november she told me i had to be off completely by december 26th which to me was not being reasonable or compassionate at all. 30 days is not long enough to get off of something i have taken for 5 years.if she had made the benzos more of a focus every single month i saw her i would have understood her doing this now. i am no trying to make excuses for myself but when im under such pressure getting my feet back from completely destroying my life with the opiates and now having the subs and getting things back on track and her asking me to stop something that gives me no high no nothing but the ability to be around friends and loved ones or work without having an anxiety attack seems very harsh. i do not take them everyday or a high mg i take a .5 before work or a social situation and mind you i only work three days a week and stay home with my child the rest of the time. and since she has seriously asked me to stop in november i have missed work and many many social events. and a social event for me isnt the bar or a party its something with my family or sober friends doing healthy activities.i tried to stop the benzos a few years ago on my own whenn i was healthy and want ed to have another child and the withdrawls were a nightmare and i though i was sick or something was seriously wrong with me until i talked to my aunt who is a nurse and she told me i was in withdrawls bc of the benzos, i was completely floored an like an idiot i read hundreds of horror stories which have scared me even more. i am angry with her bc she keeps telling me its out of her hands that she will loss her license and too me if it were that serious the first day i walked into her office and was completely honest about my medication she should have said come back when you are off of it bc it is illegal for me to give you suboxone. not give another medication just to take it away after my body and mind have become comfortable and normal again. i have myself a child and my family to worry about, its not just me myself and i. i completely understand again that the subs are my fault and i own that, i and i alone became addicted to opiates and put myself in this situation but i count on a doctor to help me not make things worse. 30 days is not long enough to quit a 5 year benzo habit, if it was about the high i would quit just like i did with the opiates but its not about that its about feeling normal, thats all i want. i guess i should correct my statement about “always discussed getting off the klons” because there was a conversation about it my first meeting with her then she mentioned it in october and november when the cut off date was set. other than that we always talked about how great i was doing and feeling and how her and her partner could not believe how much i have changed and that they couldnt ask for a better patient and i shit you not i was told that almost every appointment. excuse my french.

    Reply

    • Posted by dbc913202819276813 on January 24, 2013 at 3:47 pm

      Subs and benzos don’t get *anyone* high anymore after being on them to the point of dependence? Nope. But they *do* have an effect, even if you’ve become so accustomed to it that you don’t recognize it. You already state that the benzos allow you to function differently than without them. That, in itself, is a high.

      So, quit rationalizing ;p. Saying you aren’t taking them for a high doesn’t really mean anything. The only people taking either for a high are those who have used them for less than 1 month. Everyone else is maintaining, like you.

      Anyway, convincing this small group of posters here that your desires are justified really doesn’t go very far ;p. If you want, you can try to find another doctor, but I can tell you (after visiting several in my lifetime), NONE like patients on benzos, except the more shady doctors, and those doctors will drop you for no reason at all if they feel like it. None of the doctors are obligated to continue to provide you with treatment. They can, and will, drop you and refer you to inpatient treatment if you are non-compliant.

      Good luck. From my perspective, I see myself, an addict, in most of your remarks. I know you won’t take kindly to that though, but recognizing this is important.

      Reply

    • Posted by sue stilling on January 25, 2013 at 12:44 am

      I agree with you Natalie… My son ended up (innocently) on benzos for anxiety after his dad died suddenly. They were prescribed to the entire family… I only took a few as did the rest of my kids. However, one of them kept getting worse. He kept needing more to manage his panic attacks. Then he was completely hooked–and like you, they didn’t make him HIGH. But when he tried to come off the nightmare really began. They are absolutely the drug from hell and the withdrawls as I understand it can last for years. He was far worse off than he was when he started. The opioids entered in out of frustration from the lack of efficacy of the benzos. We are still spinning… It is a tough battle and I wish you well. Don’t give up!!!!!

      Reply

  16. Posted by natalie on January 24, 2013 at 9:25 pm

    i am an addict so no offense taken sorry;P your digs were completely pointless and thats what i did not take too kindly too:P if you have ever been an addict you would know that the high does not only last a month and then you “maintain”. that statement is so far from the truth it was laughable. i also do not doctor shop nor do i want to which is why my main question was is it illegal to be on the combo or can she loss her license for giving me the subs while i am on benzos.bc i would like to continue care with her and try to get off of the benzos and in time the subs as well. the rest was me filling in the blanks. i need not prove anything to this small group of posters i was just asking a question and telling my story. i have been completely up front and honest about my faults and my issues. i do not get a high from the benzos and never have not since day one, i do not call taking a medication a doctor has given me in the proper way so that i can work, attend, family events me getting high or trying to rationalize anything to anyone. it is a fact. i unlike you did not take 6+ xanax a day at the very beginning when i took them as she told me to i took 7mg per week but once i realized how habit forming they were and wanted to get off of them i only took them as needed which is what my doctor and i discussed. yes they allow me to function differently, without them if i was put in a social situation i would try to find a place to be alone or leave all together and if i was forced to stay i would have a full on anxiety attack which for me includes vomitting, my entire body freezing up, extremely high heart rate, and thoughts that i am moments away from dying filling my head at a speed no person should ever ever have to endure! but with them i am able to sit calm and have a conversation with someone normally family or friends. if in YOUR mind that means im high then thats on you. if something makes me high i have no problem saying so, i would have said, to this small group of posters that i do not know, Oh no my doctor is about to take my super great drugs away what do i do? not be honest. im taking care of me which i have not done in a very long time and being honest is one thing i have committed myself to doing 100% of the time so please do not try to tell me how i feel or how high i am.

    Reply

  17. Posted by natalie on January 25, 2013 at 10:53 am

    thank you sue for understanding. i know i do not have to explain myself to anyone but i get very aggrivated when i am accused of something i know to be very untrue or when people try to put their own personal issues on me bc thats the way they felt. i neverdid and still dont abuse the benzos i have always taken them as i have been told unless i was trying to quit and then obviously i took much less. it is so hard to stop. they are for anxiety in my case and when i still have anxiety if you take my medication that helps that it only makes the anxiety worse. day to day life is not fun in the wonderful world we live in these days. i do know that a lot of these problems are bc of the choices i have made but i am trying to fix them. i hope your situation gets better. i have been clean for almost a year and my fiance has only been clean for 3 months and i will tell you it was a living hell watching him destroy his life as i chased trying to pick up the pieces knowing i have once done this to everyone i loved. when you see the other side it makes a huge difference i hope to never make those mistakes again.

    Reply

  18. Posted by ayabird on April 14, 2013 at 2:34 pm

    My son talked his subux doctor into giving him xanax. Within a few months he was buying off the street to supplement his script. Soon he was injecting xanax (didn’t even know that was possible!). A months later he overdosed and died from a lethal combination of xanax and heroin. He was 30 years old, and left a grief stricken family behind.

    All addicts who get subox/methadone and benzos should be required to submit a signed slip from a counselor/shrink/therapist at least 2X a month. Right along with their pee tests.

    At least make an effort to get the addict to address their “anxiety” issues without benzos.

    Reply

    • That’s a tragedy. I’m sorry for your loss.
      You are so right – any opioid mixed with any benzo is a potentially fatal situation, especially for people with the disease of addiction.
      I didn’t know xanax could be injected either. Could that be what killed him?

      Reply

    • Posted by db312 on April 15, 2013 at 1:50 am

      I’m very sorry for your loss. I could have easily been in the same shoes as your son, easily have lost my life. I may still from consequences of my addiction.

      You are right. While benzos+buprenorphine isn’t known to be a fatal combination, adding a benzo habit to an addict can lead straight to death. Addicts quickly get hooked on benzos (oh I loved benzos), and with benzos in their system, they are disinhibited, making the chances they don’t relapse to a full opiod agonist slim.

      Reply

  19. Posted by zeke on April 3, 2014 at 5:43 pm

    I know that methadone and alcohol can be fatal when taking it at togethe at the Same time but do you decrease the rate if you drink 10 hours agter your dose and wait 8 hours for your next dose of methadone?

    Reply

    • methadone is very long-actint, and there can still be enough in your body to cause an overdose alcohol even if you wait ten hours after your dose to drink alcohol. If you are on methadone maintenance, methadone will be in your body for weeks even if you stopped today.

      Reply

  20. Posted by Juanita Reid on October 6, 2014 at 3:04 am

    I Feel Like a Bad Person. I Read The Posts and Want To Say That 15 Years ago I was ut on Clonazepam for Night Terrors about rape as a child from age 2 Until *(Great Uncle Babysitted Me). My Life Was Fear Fear to sleep. I tried Many Other therapies, however I ended up staying on Benzos. Due to chronic pain from a broken neck and many injuries I live in chronic pain. The Doctor put me on methadone for pain. I did not want to continue the Oxycontin. |I was misinformed from the start. it never worked for 12 hours. Are Chronic pain patients who follow the rules suppose to suffer..ty for reading

    Reply

  21. My son passed away 2 years ago. He went for help but died instead. Why did the Doctor give him 1 Suboxone when his urine showed alcohol and diazepam in it? I did not find out about his urine until 9 months later. I am devastated and feel as if our doctor of 17 years failed miserably. I will never be the same again.

    Reply

    • I’m very sorry to hear of your loss.
      Have you been able to ask this doctor why he started your son on suboxone in view of the UDS with alcohol and benzos?

      Reply

    • Posted by sue on November 3, 2014 at 5:00 am

      First… I am so sorry for your loss. My 24 year old son has been abusing opiods and benzos for a long time and the combination is deadly,… His opiod of choice used to be oxy and he switched to heroine due to cost and availability. It is BENZOS that are the biggest culprit!! Mixed with alcohol or opiods(especially the combo) is Russian Roullette . The doctor was probably trying to get contriol of one addiction so he coulfd address the other. Benzos require a slower taper because of the risk of seizures, I really can’t point a finger at anyone in this circumstance. Your son’s addiction killed him. Not you… not suboxone and not the doctors treatment of his polysubstance abuse. I am hoping my son will wake up before I get the dreaded call… It is his addiction and he has to decide to take control over it. All the love and help in the world won’t change the outcome–only he can.

      Reply

  22. Posted by Dorian on November 23, 2014 at 5:17 pm

    I’ve been on a methadone clinic due to a motorcycle accident. During all of the time of work and bills piling up I was introduced to benzos for severe anxiety. I’m losing my home , my wife and everything I own. I’ve been slowly detoxing from the methadone clinic but I have serious suicidal thoughts when not taking the benzos. I can’t focus and I only think of all the bad and all the problems that I’m dealing with. I need serious help for I am in fear of taking my own life. I want to stop both drugs more than anything and am willing to do anything to get the help I need. Someone please help me. I am losing my home Aand will soon be on the streets this I fear will be my breaking point. PLEASE SOME ONE SAVE ME!

    Reply

    • It sounds like you are currently a patient of a methadone clinic?? Please contact a doctor/nurse/counselor at your program to tell them how you feel. I think they can help you if you let them. Let us know what happens, please.

      Reply

    • Posted by db312 on November 26, 2014 at 10:22 pm

      This will sound trite, but I have found something that may help – from experience. After causing some serious harm to my neurological system after benzo abuse, I searched a long time for something in nature that had affinity for the GABA-A receptors, especially the BZD subtype. I figured there must be something in our diets that hit these receptors, or cause or bodies to metabolize compounds that hit those receptors, else those receptors wouldn’t exist. It turns out – amazingly – that research in the last 10 years has shown that a large number of the flavonoids bind to the GABA-A receptors, including the BZD subtype. e.g. Apigenin, Chrysin, on and on…. These also have neuroprotective and other positive health benefits. So…. increase your vegetable consumption, find a good vegetable supplement, or get the isolated flavonoids. Be careful with dosing, they aren’t diazepam, but will do a heck of a lot for your psychological recovery. There is no telling how many mental and physical diseases and disorders in our society are primarily caused by insufficient fruit and vegetable intake. For me, Apigenin was able to snap me right out of a 6 month long depression after I quit benzos. Apigenin is also a potent MAOI, which could be an alternate mechanism of action. Either way, it worked.

      Reply

  23. Posted by Shannon on January 30, 2015 at 3:35 am

    Can xanax make me sick if I’m on the vivatral shot?

    Reply

  24. Posted by smokey joannides on June 19, 2015 at 10:29 am

    I am considering to move away from my current hopeless life situation as it is and had been for over 25years! my family is drug and alcohol addicted being a genetic symptom for over 80 plus years now! i have ruined two marriages plus atleast 3 family relationships envolving children where a real man could have made a eonderfil life for them! i just want to end my useless existance now at 63 yrs of age as i am alone but watching my sibling sister and her daughter abusing herione & booze while in charge of a 4 month old little baby boy! my eldest niece killed herself with a toxic coctail of pills and vodka which the pills were givin to her ny my sister of which i gave to my sister to help her sleep! plus i have been giving my sister a third of my suboxone to help her stay off blues but now realize she is trading them for heroine! i am too old feeling and toi tired of watching my family slowely negleting the children and grandchikdren if my famuly! how much suboxone would it take to put me to sleep peacefully forever? I have the 8mgs tabs i think…max dosage @ 3 per day wutever that comes to!

    Reply

    • First of all please call your doctor and explain how you are feeling. You use the term hopeless but nothing is hopeless, so long as you are still alive. Some people don’t even start recovery until older than 63!
      You could have a treatable second illness, depression, and your doctor can help.
      As for the overdose – I doubt you can overdose on suboxone if your body is used to taking it – that’s the thing about this medication, it’s much safer than full opioids for this reason. Once you take 24mg per day, you could take 124mg and you wouldn’t feel any different, so don’t even try. You will only waste your medication.

      Reply

    • Posted by sues4you on June 20, 2015 at 4:58 pm

      The doctor is right…Nothing is hopeless. Let the cycle end with you and show other family members by example. Stay on your suboxone(prescribed amount) and see your physician for depression or other underlying contributing psychological issues and get treatment. Addiction runs in my family as well. I was lucky and don’t have a problem but my son and brothers do. My 65 year old brother leads a wonderful drug/alcohol free life and my son is still fighting for his life. He gets discouraged but is on suboxone and hasn’t USED for 8 months and counting…. I pray you find solace ….don’t give up…and get help immediately.

      Reply

  25. Posted by Brooke on August 11, 2015 at 9:47 pm

    How much suboxone and klonopin would it take to kill a 110 lb 5’9″ female with medium tolerance

    Reply

    • No one can know for sure – too many variables. All we do know is that it’s not safe.

      Reply

    • Posted by dbbc11293018112 on August 12, 2015 at 4:33 pm

      Are you suicidal? If so, you won’t find Suboxone+Klonopin an effective combination. That’s not to say you couldn’t overdose on it, there is no set limit, like the doctor says. You could overdose 1000x more easily with a full agonist combined with a rapidly acting benzo like Xanax (alprazolam).

      HOWEVER, if you’re suicidal, try what i call the ”F it approach” first. Got problems with so and so? F them. Got problems with this or that? F that. Go live before you die.

      Reply

  26. Hello, I’ve lost my mother, brother, and father, several friends to overdose of drugs. My brother heroin, mom prescription pain pill addiction and dad…alcohol. I’m on suboxone for a dependency to pain meds after a car accident, also benzos for anxiety and bipolar. I want to know how much to take to die.

    Reply

    • Obviously, I’m not going to tell you that.
      Please take yourself to your local hospital’s emergency room, or call the doctor treating you for bipolar disorder and tell them how you are feeling.

      Reply

    • Posted by dbbc11293018112 on October 15, 2015 at 1:36 am

      LOL, I’m sure this is a joker. Well, joker, you will have a very hard time overdosing on Suboxone and benzos, and you’re more likely to accomplish nothing but a really terrible feeling that may permanently sicken you of both drugs… oh, and probably a trip to the hospital, and extended stay to follow. If you want to die, that isn’t the way.

      Despite the hardships of life, you can’t take back death, so you really have obligation to stick with it. There are people who have been through more, or are in more pain, than you.

      Do something crazy with your life instead of end it. Do something someone who cared about their life couldn’t. Maybe you will change the world!

      Reply

    • Posted by sue on October 15, 2015 at 3:28 am

      Nikki… You can very easily OD on a combination of suboxone and benzos…. Please seek help right away. Whatever desperation you are feeling now, can and will pass with the proper treatment and medical attention/counseling.

      Reply

  27. comment on an oldie – very interesting and informative and agree with most of your views. One question, though, that I have posed to respected colleagues for years, and it relates to your statement: “the effects of the two drugs together is usually more than would be expected, due to synergy. Synergy means that instead of 1+1=2, suddenly 1+1=4.”

    In the METHADONE-TOLERANT relatively long-term methadone MAINTENANCE patient, there are generally no signs of respiratory depression or any other pharmacological opioid effects that are of serious concern (the two effects against which tolerance usually does NOT occur are constipation and tendency to increased diaphoresis). So, as regards CNS depression, seems to me the correct formula to describe thje actions of methadone (in the tolerant individual) and benzodiazepines is: 0 + 1 = NOT 4 pr 3 or even 2 – – – – but 1 – i.e., just the effect of the benzodiazepine.

    I may well be wrong, but … A very key observation that would bear on my question is the relative frequency of combination overdose in patients getting methadone by prescription, for pain, as opposed to those who presumably are at a fairly constant, hopefully suitably high, maintenance dose for opioid dependence. Know of any such studies? Your blog makes several references to the concomitant rise in combination deaths involving methadone and the marked (!) increased in prescribed methadone for pain I also recall about 7-8 years ago Dr. H. Wesley Clark being quoted – in the Times I believe – that in overdose cases “methadone given for maintenance is not the culprit” (not sure of exact wording – but “methadone is not the culprit” indeed was his precise wording).

    Thanks for whatever light you can shed on this. Respectfully, and gratefully, robert newman (NYC)

    Reply

    • Hello Robert,
      Brands et al, 2008, Journal of Addictive Disease, studies 172 methadone patients. Regular and “problem” users of benzodiazepines were more likely to have overdoses, and also more likely to have positive UDS for opioid and cocaine. They had more severe co-occurring mental illness, and were felt to be more complex patients overall.
      Eiroa-orosa et al, 2010, in Drug and Alcohol Dependence, studies German patients in methadone and heroin maintenance. Users of benzos had poorer outcomes, and were also viewed as overall sicker patients.
      Lee et al, 2014, in Drug and Alcohol Dependence, found that benzo-using OTP patients on methadone had more severe outcomes than benzo-using OTP patients dosing with buprenorphine. This study found 16 deaths in methadone patients, and no deaths in the bupe patients. So yes, this seems to indicate a full opioid like methadone is riskier with benzos than a partial opioid like bupe.
      I don’t know of any studies comparing the frequency of overdose for pain patients on methadone versus OTP patients on methadone who are also taking benzos.

      As far as the interaction of opioids and benzos, not only do both medications lead to depression of the respiratory rate, but also have other pharmacologic actions. Diazepam inhibits methadone metabolism, and can increase methadone blood levels.(http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3454351/ ) This same article describes other aspects of opioid/benzo misuse in combination.
      You are right – I should stop using the term synergy because it is perhaps not quite appropriate.
      It’s probably more accurate to say that opioids and benzos combined can cause sedation in more than one manner.
      Thanks for reading and thanks for challenging my outdated terminology.

      Reply

  28. Posted by sues4you on December 14, 2015 at 8:41 pm

    Rick… Get help immediately! It is darkest before the dawn. This time of desperation will pass and you can feel better with help. Make a difference–first reach out then in turn be someone others reach out to.

    Reply

    • Posted by daadzcd00082101 on December 14, 2015 at 9:25 pm

      Regarding Rick, who would be there to help him, and really care? That’s the thing. We may all want to help, but our culture is one of selfishness and isolation. So, unless help is sincere, there is no good help. A 1-800 number doesn’t exactly establish the kind of personal connection required to help in these cases, nor does a trip to a psychiatric hospital, which would probably exacerbate his condition.

      Reply

      • Posted by sues4you on December 14, 2015 at 9:38 pm

        I understand what you are saying and I get it… But if he can just get through the crisis even if it is a suicide help line for now it buys precious time. I realize too that addicts many times have driven people who did care from there lives with their choices. It doesn’t mean it is forever however. Eventually, doing something to promote his self worth even if it is volunteering might open his eyes to the fact that he can be appreciated and even loved. I have experienced a lot of darkness and hopelessness but I am living proof that things can change but it has to start with you/him.

  29. Posted by Stephanie on December 18, 2015 at 4:56 am

    My brother kicked heroin for two years! He was on methadone doing great weaning off, took benzos with it and overdosed miss him every single day

    Reply

  30. Hi my fiance of 6 yrs died of methadone intoxication that he was prescripped im one who found him n my life hasn’t been same since I was wondering am I able claim compensation if so from who as would help me n his family out a bit

    Reply

  31. Posted by Liz on March 11, 2016 at 3:15 pm

    my fiance died of a drug overdose. I found him next to me in bed on 2/20/16. we are not sure of the drugs in particular because toxicology takes MONTHS, but others he spoke to that day said he has taken approx. 10 Xanax pills with an unknown amount of rockisette, and had in fact been taking at least 14 X and 7 R the week leading to his death. i see how this mix is dangerous. My actual question is if you know if people who die in this way feel any pain? he fell asleep and simply did not wake up so I’d like to think so, but maybe someone else would know better? the pain is unbearable so I’m hoping to have some peace.

    Reply

    • I am sorry for your loss.
      As I understand it, the combo of benzos and opioids turns off the brain center that tells us to breath while we sleep. I believe that means the person would go into a very deep sleep, stop breathing, and the heart and brain die from lack of oxygen while the person is unconscious. I don’t see how the person could feel any pain at all.

      Reply

  32. Posted by Cobus on April 6, 2016 at 11:12 pm

    I was in rehab for meth use recently and whilst there split a tooth. That same day a heroine addict came into the clinic. I was on diazepam for my comedown/withdrawals. I asked the staff for pain medication for my tooth that was arching badly. They gave me two pills and said I must put it under my tong. I got so out of it I did not know where I was, I couldn’t stand up straight, find the toilet or even my room and bed. I must have slept for at least 20 hours after which I woke up but was still in such a haze I did not know what was going on. I checked myself out of the rehab today but still feel confused and light headed. Could they possibly have mistakenly given me the heroine addicts Buprenorphine. I read up that that is a pill you put under your tong. This happened on Monday night. Can I still have my urine tested to see if there is Buprenorphine in my system? I have never felt so bad in my entire life and still feel confused.

    Reply

  33. Posted by Cobus on April 7, 2016 at 12:34 am

    Pa. I forgot to mention that my psychiatrist put me on seroquel that same day because I couldn’t sleep the previous night.

    Reply

  34. Posted by Johnny on May 5, 2016 at 5:02 pm

    I am a chronic pain & am under strict pain mgt. care. I have taken 10 mg Valium , 30 mg opana ER, & Percocet over the past two years. I’ve been taking pain Meds for ten years, I consider myself dependent, not an addict as I work full time in a very physical setting.
    I do worry about not waking up from the combo, so what I did was fit rate on my own.

    Of the Meds I mentioned I am prescribed 2/10 mg Valium/ 4/10 mg percocets as needed daily, & 2/30 mg opana ER , ALL daily.
    I had to stop one opana cold turkey as they are not breakable. It was relatively easily. I used a 3-month period to get down to no more than 2 /10 mg per share/day for breakthrough pain, & 1/2 of a 10mg Valium most days, or a whole one on stressful days. I take the benzo as far apart as I possibly can from the opioids to avoid shallow breathing while sleeping.
    I was shocked @ how easy this was to do & how much pain I can live with!
    I’m in Florida & the laws are so strict I’m lucky I have a good dr, that ive been with for 20-years. He started as my pcp then became a pain mgt specialist , so it just worked out that way!
    I used to take 2-40 mg OxyContin, 4-30 mg oxycodone,, Xanax, & soma. I’d be dead now if my dr. Didn’t change me to opana!
    If anyone out there is mixing opioids & benzos, take the last opiod of the day as early as you can & the benzo @ bedtime! Titration benzo slowly BT breaking into pieces.
    Take care!!!

    Reply

  35. Wow, you got quite a response from this topic. Thanks for taking the time to answer all the questions and provide sound advice without becoming their Doc.
    Your one response, essentially referencing the benzo withdrawal as being a response to the brain’s craving for the drug, is only partially right. We have tried to discriminate between patients that have a low ability to detox off of benzos and those, who appear to taper and find a sustainable quality of life. Much, is related to the duration and type of benzo, however, a much more important factor is the simple question: Did you have anxiety or panic attacks as a kid and prior to starting the benzos? These patients are, typically, in for a very long, uncomfortable ride that will include hallucinations, visual disturbance, waves of anxiety, out of body experiences, depersonalization and hundreds of other horrible symptoms. Probably the worst, is the inability to sleep. It makes for very long days, when one is up three days in a row with two hours of semi-sleep in between. Having experienced this syndrome in 1980 off of 80 mgs. of valium for eight years, and being dropped off by the treatment program, I truly don’t know if I could, or would do it again. I had my first panic attack at age 8 and hid it from family and friends because I thought that I was crazy. I graduated from college but never went to class because I was afraid that the professor would call on me. Sedatives became my best friend with methaqualone being the best of the best. Unfortunately, it, also, left me with two seizures and a transition to the valium.
    We recognize that each patient is unique and the Ashton model is the most humane way of helping benzo dependent patients out of this nightmare.
    We, also, use buprenorphine and have for eleven years. Patients that are dually addicted to opiates and benzos, are evaluated for a history of anxiety disorder and, if present, we do a very slow taper off of the benzo, stopping when the w/D becomes too much. I have yet to hear of any colleague programs who have had bupe/benzo deaths with patient in treatment. I, sometimes, think that it is one of those urban myths. However, we keep the benzo (klonipin) as low and possible and the bupe as low as possible. So far, we have had no negative experiences and have been able to get patients free of benzos or at extremely low doses with no tolerance buildup.

    Reply

    • Posted by da221Tura on June 21, 2016 at 9:25 pm

      That is a very pragmatic and sensible approach. Clonazepam (Klonopin) does a lot to reduce cravings. Further, the slow onset and relative lack of euphoria compared to other benzos make it ideal for those in recovery. You can take more, and not feel any better, unlike something like alprazolam. As a side note, one reason benzos differ is because they affect different GABA-A BZD and peripheral BZD receptor subtypes differently. Some agonize one BZD site, some antagonize another. Now, Clonazepam, like other benzos, causes problems it self, but so does every other pharmaceutical. It’s always a benefits/risk equation. Clonazepam also markedly helps with depression, and thus helps addicts begin to repair their damaged lives. Thus, I think it is beneficial to maintain select patients on Clonazepam until they are ready to be tapered off. As for withdrawals, watch out for DP/DR – depersonalization/derealization. For whatever reason, Clonazepam has that unusual withdrawal effect, and it can be very disturbing. For some older and middle-age patients with severely compromised GABAergic neurological systems, I am convinced that it is better to maintain them rather than subject them to the agony of post-acute withdrawal, which can last years in some individuals (or may never cease). I am one of those sensitive individuals, so I know. I spent 2 years trying to ‘get right’ after I voluntarily chose to abruptly discontinue a different benzo. Years later, I have finally accepting a low dose of Clonazepam gives me the best quality of life I can hope for. I have some serious vision problems, am middle age, and sometimes it’s just best to maintain on what works. That is certainly not true for a younger person who just got started on benzos though, which is why we must all be careful not to put patients into cookie cutters.

      As for the Ashton Manual, the definitive and (only?) guide for benzo tapering, it is should be noted that few, if any, Buprenorphine doctors will prescribe diazepam simply because it looks bad. I can’t blame them. I wouldn’t want to do anything to jeopardize my license, but that would be the best drug to use when benzo tapering is initiated, IMHO.

      Reply

  36. I take Suboxone and if off of it I will return to heroin but I take it in morning and when can’t sleep will take a valium to fall asleep. Never been a drink but will drink a cold beer occasionally but if I get off Suboxone I know I will go back to heroin. Willing to stop valium but have major insomnia as well

    Reply

    • A Valium at night when you are on suboxone (a partial agonist) for opioid maintenance is safer than taking it with methodone or heroine (both full agonists). Ideally, not taking a benzo at all is preferred. Try some melatonin or even a few 25mg diaphenhydramine (benedryll) to sleep instead. Better than taking a chance.

      Reply

  37. Posted by Martha carranza on December 20, 2016 at 6:07 am

    Hi doctor my son is on bupenorfin and I found out he’s mixing with lyrica, lucena, oxicodon colonopan what can i do I’m desperate please help me.

    Reply

    • If he’s of age, there’s not much you can do except perhaps call his prescriber, and describe what you are seeing. His doctor can’t give you information without your son’s consent, but you can always give information.
      It’s a heartbreaking situation with no good answers.
      Many people have found help deciding how they want to handle such situations in either alanon or naranon, 12-step groups for friends & families of alcoholics and addicts.
      Don’t do anything to make his drug use easier, tell him how worried you are about him, and take care of yourself.

      Reply

  38. Posted by robert newman on December 20, 2016 at 2:36 pm

    Dr. Jana Burson is, very sadly, correct: It’s a heartbreaking situation with no good answers. Ultimately, treatment goals have to conform to what the PATIENT wants . . . not what the care provider wants. And if the patient does not want to quit (or cut down, or . . . ) then such outcomes are most unlikely, regardless of what “treatment” may be provided. Bob Newman

    Reply

  39. Posted by edward on May 12, 2017 at 4:19 pm

    I’m not a doctor but I don’t need to be one to if the biggest risk when you take an opioid with a benzodiazepine is that you could suffer from respiratory depression now I have had an anxiety disorder for the majority of my life along with depression and attention deficit disorder and because people shop around at doctors for pills mainly opioids and benzodiazepines I have been unable to seek medications like Xanax or valium I’ve even went through numerous steps by taking Seroquel Effexor Depakote Buspar Trazodone Wellbutrin and others just to name a few along with counseling had blood work done numerous times have taken urine analysis screens to show i wasn’t using any other substance not even marijuana or alcohol and never once have I been offered to try Xanax Klonopin Valium because of this so I live my life everyday suffering from multiple panic attacks and all I really wish is that I could have a chance to use something that could help benefit me and help me be well and live a normal life without being scared to death multiple times a day everyday I’ve overcome my attention deficit disorder by myself we’re all subject to mistake but I refuse and will not take Adderall I tried to take it for one month and did it make it past day one as it made me feel like my heart was going to explode or I was on some kind of illicit drug but anxiety is a big gorilla on my back and I suffer daily with it so if any of you guys that abused benzodiazepines or opioids read this know that not only are you possibly harming yourself but in return you’re punishing others who could make good use of these medications effectively and don’t even ever get the opportunity because of the abuse

    Reply

    • Posted by sue stiling on May 14, 2017 at 9:16 pm

      I am sorry you cannot get Benzos for your anxiety. But even without using them along with alcohol or other meds, I believe them to be the most dangerous drug of all. Unless you use them for short term they make you a slave and create a dependency unlike I have ever seen. They call it the withdraw from hell because it is! A tolerance is developed so quickly that you begin needing higher and higher doses to achieve the same relief. Cut back and you go crazy! Keep looking and find another treatment and/or medication because in the long run all they do is make your anxiety worse.I wish you the best and good luck.

      Reply

      • Posted by dbcincsa on November 28, 2017 at 6:27 am

        This is correct. Benzodiazepines are extremely dangerous and have a strong correlation with dementia and possibly other neurological deterioration. Cognitive capabilities have been shown to decline for sure, though while on them you don’t notice. They are also extremely difficult to get off of, with protracted withdrawals far beyond opioids, and are harder to qualify because the withdrawals are so psychological. How do you describe depersonalization and derealization to someone? It’s hard, especially when you are in such extreme psychosis. These medicines, further, are prescribed at an incredible rate. Most Suboxone clinics will prescribe clonazepam, not because it is less dangerous, but because it is slightly less rewarding than diazepam, but the net result is the same when it comes to withdrawals. And there is no partial agonist out there to aid with withdrawals, and I dunno which is worse, tapering or just jumping off and suffering (dangerous at some levels due to the high risk of seizure). Support groups describe PAWS (post-acute withdrawal) lasting for months or years for some individuals. I can attest to at least months, and what I believe are permanent neurological changes. The older you get, the less able you are to recover, so the sooner you quit benzos, the better. …. And all this is not to mention that without the *combination* of benzos with opiods, much fewer overdose deaths would occur.

  40. My ex-methadone clinic pharmacist had given me triple my 60mg dose, 170mg by mistake.
    That’s going from 60 one day, then 170 the next. Needless to say I had an ambulance take me to the emergency hospital hooked up in wires to heart machines and IV drips. The nurses made sure I did not fall asleep or die!
    My lawyer successfully sued the pharmacy for medical negligence.

    Reply

    • Posted by dbcincsa on November 28, 2017 at 6:22 am

      As an experienced drug user (assumption: on Methadone), I am sure you had no idea ;p. I would say maybe it was negligence if you had been dosed with a liquid at the clinic, under their supervision, but the mention of the pharmacy makes me think it’s wafers. Maybe not. Either way, how did that money work out for you? Did it help or hurt your life, aside from providing temporary financial security?

      Reply

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