BUPRENORPHINE/BENZODIAZEPINE INTERACTIONS (OR LACK THEREOF)

[cant_overdose]

Hello all, I have a kind of issue and don't have anywhere else to turn. I'm a new member, so I hope this is posted in the correct format and forum. I have U(d)TFSE ad nauseam and can't find anything to support what I believe.

I have a doctor I see monthly (as per the law in Texas) to get my buprenorphine prescription (8mg x2/day). The guy's pretty cool, and after passing UAs for a couple years I was able to get him to prescribe some Xanax too. I've been on this combination of meds for a long time now, and they work - I haven't used an illicit substance in as long as I can remember.

The xanax has been enormously helpful. I suffer from PTSD, general anxiety, and a condition they finally labeled as "schizoaffective disorder," one symptom of which is auditory hallucinations. Especially at night or when I'm afraid and this makes sleep impossible and by extension, the keeping of any kind of schedule very difficult. Also I sometimes will take a Xanax instead of one of the suboxone - I feel like this is progress (the idea is supposed to be to taper off it, right? Except, in truth, I need to always be on it so that the option of opiates is simply not there for me).

I started out on 1mg alprazolam x2/day, but after a few months he decided to reduce it to the .50mg ones. This is because he is, of course, familiar with conventional warnings about oversedation, etc. when mixing opiates and benzos. He's said many times, "Now be sure to take them far apart so you don't die on me!" I even offered to lower my suboxone to half my current dose so that he'd feel better about raising the xanax back up but he wouldn't.

At 240 pounds, however, I can easily take 6 of these stupid things without discernable effect. Even when I'm benzo-naïve, and haven't taken any for a couple weeks. So tolerance is not the issue. I never build up a tolerance because I'm always out of these half-milligram ones way before I can get a refill.

I have noticed too, that to me buprenorphine produces absolutely none of the euphoria and sedation of other opiates. It does block the others, but I don't see how people can claim it reduces craving other than that it prevents withdrawal symptoms. That's fine, but even when I DO mix them with xanax there's no potentiation of either. I do not believe that xanax and suboxone potentiate one another at all.

I am convinced of this, and I really want him to raise the dose back up. But every time I ask he says he's worried I'll overdose. It's just not a high enough dose of xanax to be effective, and only works if I overtake to ridiculous proportions, but then I'm out prematurely.

Has anyone else here ever felt that buprenorphine is some kind of exception to the rule about mixing sedatives and opiates? Better yet, can anyone point me to some kind of citable article or scientific literature to that effect so that I could show it to him? I KNOW I'm right, and there's got to be something somewhere that doesn't just repeat the same old information.

I've been seeing this MD for four years, and he doesn't take insurance so I have spent a LOT of money at his practice, and like I said I haven't had a bad UA in a couple years. So I think he'd be receptive if I could just show him something that supports my argument that there's little chance of an overdose.

Also, I have avoided telling him about my psychiatric issues because I know he'd try to refer me to a psychiatrist and I don't need that crap. Can't afford ANOTHER doctor.

I've tried mixing drugs like amlodipine and famotidine with Xanax to make it work better, as these supposedly enhance metabolization of it. Then, I got desperate and tried to substitute first chlorbutanol, then 2M2B (neither of which proved to be a viable alternative). What about muscimol? I just ordered some. I can't order the RCs benzos - don't know how.

I really could use some help from the knowledgeable on this. Thanks for your time.

 

[AlsoTapered]

Well weirdly bupe makes me anxious. Others have mentioned this, but it's idiosyncratic and you know 10 minutes after you take the bupe. Below is a link. I'm not happy with it but it's the best I could do.

Mixing meds: Weighing the pros and cons of adding benzodiazepines to buprenorphine treatment for individuals with opioid use disorder

Visit the post for more.

www.recoveryanswers.org

 

[cant_overdose]

Hey thanks for taking the time to find that for me.

"Though combining benzodiazepines with buprenorphine appears to increase risk for overdose and death, it also appears to decrease risk of buprenorphine treatment discontinuation."

That pretty much sums it up I think. Unfortunately if I showed him this article the first thing he'd probably see is that graph showing higher mortality rates with concomitant Bupe/BZD use and then he wouldn't care to hear anything else about it.

Even after reading this, I just still can't believe that there's actual tests proving without a doubt that some people manage to overdose on suboxone and benzos. I mean...HOW?!? Maybe I'm just different.

Well, thanks again man.

 

[AlsoTapered]

Truly, it's my pleasure. If I could, I would have chased up for references (which they should provide if a reliable source) but I'm just to sick at the moment.

Not drugs, I hasten to add.

 

[Keif' Richards]

I don't like hearing anyone say they need to be on Benzodiazepines all the time. That's an idea you need to really try to get out of your head. If they would continue to work as well as they do on day one of treatment, that would be a different story.

I think the issue here is that it's just a lower dose of Benzodiazepines. It sounds like you're looking for a stronger experience. I get that. The best thing you can do is to use the Benzodiazepines as prescribed while simultaneously working on non-medication treatments. I don't know what that would be for you exactly. I go to 12 step meetings. Some folks like therapy. I know especially for addicts that stuff like CBT has been proven effective.

There's not really a great potentiator for Alprazolam that you can realistically get. I understand that it's partially sensitive to the Grapefruit Flavonoids that you've probably heard of. The problem is that this isn't going to make a huge difference. Given what you're looking for, a potentiator that can provide a 10% boost in effects would be a waste of time, money and energy.

I'm worried about your situation. I am not doubting any of your diagnoses, your experiences or anything like that. I'm not judging you either. It sounds like the high is an important thing for you. The fact that you've gone through all of these other drugs strikes me as someone who wants to be numb as opposed to someone looking for a long-term functional solution to their issues.

Just think about it and do some reading. You're not going to meet or read about many people whose lives were improved by chronic Benzodiazepine use. You're lucky to have a script for both Buprenorphine and a Benzodiazepine. I don't know a doctor personally who would ever do that in my neck of the woods if it weren't for something like a seizure disorder.

My point is to take what you have. Maybe it's not enough Alprazolam to get you feeling nice. It is affecting you though even at a difficult-to-perceive dose. Use this time wisely to try to solve some of your issues. You have a limited time frame regarding the effectiveness of Benzodiazepines, so use the time wisely.

Lastly, as others have said, there definitely is an interaction between Buprenorphine and Benzodiazepines. It's a combination that can kill like any other Benzo/Opioid combination, if not with a slightly lower danger due to Buprenorphine's inherently less dangerous effects.

 

[AlsoTapered]

The US seems to prescribe alprazolam (specifically) for a wider range of indications than other nations, not just the 'Short term treatment of anxiety' the BNF (UK PDR) states.

It seems that a lot of people are given it for months, years even.

I think it's because the DSM V has 'generalized anxiety disorder' and the ONLY medication in the PDR is alprazolam, or was for some years - I don't have a recent PDR.

https://www.choosingtherapy.com/how-to-get-prescribed-xanax/

That the above is LEGAL amazes me.

 

[SpiralusSancti]

I find alprazolam even okish antidepressant. Nowhere near as good as etizolam. Than diazepam is pretty good muscle relaxant and good for some types of pain. Still I agree all benzos are better avoided if possible but than again there’s quite a few possible reasons why someone stays on benzos, are those any better or worse, any more right or any more bad than staying on few beers or something? idk

 

[AlsoTapered]

Tolerance and Dependence following Chronic Alprazolam Treatment: Quantitative Observation Studies in Female Rhesus Monkeys

In order to understand mechanisms underlying tolerance and dependence following chronic benzodiazepine treatments, quantitative and reproducible behavioral models of these phenomena are required.This research evaluated the ability of chronic treatment ...

www.ncbi.nlm.nih.gov

A Review of Alprazolam Use, Misuse, and Withdrawal

Alprazolam is one of the most widely prescribed benzodiazepines for the treatment of generalized anxiety disorder and panic disorder. Its clinical use has been a point of contention as most addiction specialists consider it to be highly addictive, given ...

www.ncbi.nlm.nih.gov

As I have said elsewhere, Upjohn was acquired by Pfizer and in informed source (Dan - who was lead in Upjohn drug discover laboratory) stated that the ONLY thing Pfizer wanted was alprazolam. Then, within months, the DSM V comes out with GAD as a new diagnosis and then a few months later the PDR lists alprazolam as the ONLY medication for GAD.

I know, those time-frames don't look possible but who knows when Pfizer decided they wanted Upjohn? They could buy alprazolam from a drug library or make it so if they hold sway with the authors of the DSM. They do - they bribed them. Not cash but the classic 'free 10 day 'conference' in Hawaii for member and spouse - conference is two 1 hour lectures on days 2 and 12. And they were caught... or at least a journalist published the 'conference' details. No idea how they got an ML so fast. Maybe Upjohn were already 95% way through the process? But who knows.

 

[somnilicious]

One of the worst mistakes I ever made in life was getting myself dependent on benzos and long-half life opioids. Specifically methadone in my case. I was addicted to either Xanax or Klonopin depending on the day or year.

 

[cant_overdose]

I don't like hearing anyone say they need to be on Benzodiazepines all the time. That's an idea you need to really try to get out of your head. If they would continue to work as well as they do on day one of treatment, that would be a different story.

I think the issue here is that it's just a lower dose of Benzodiazepines. It sounds like you're looking for a stronger experience. I get that. The best thing you can do is to use the Benzodiazepines as prescribed while simultaneously working on non-medication treatments. I don't know what that would be for you exactly. I go to 12 step meetings. Some folks like therapy. I know especially for addicts that stuff like CBT has been proven effective.

There's not really a great potentiator for Alprazolam that you can realistically get. I understand that it's partially sensitive to the Grapefruit Flavonoids that you've probably heard of. The problem is that this isn't going to make a huge difference. Given what you're looking for, a potentiator that can provide a 10% boost in effects would be a waste of time, money and energy.

I'm worried about your situation. I am not doubting any of your diagnoses, your experiences or anything like that. I'm not judging you either. It sounds like the high is an important thing for you. The fact that you've gone through all of these other drugs strikes me as someone who wants to be numb as opposed to someone looking for a long-term functional solution to their issues.

Just think about it and do some reading. You're not going to meet or read about many people whose lives were improved by chronic Benzodiazepine use. You're lucky to have a script for both Buprenorphine and a Benzodiazepine. I don't know a doctor personally who would ever do that in my neck of the woods if it weren't for something like a seizure disorder.

My point is to take what you have. Maybe it's not enough Alprazolam to get you feeling nice. It is affecting you though even at a difficult-to-perceive dose. Use this time wisely to try to solve some of your issues. You have a limited time frame regarding the effectiveness of Benzodiazepines, so use the time wisely.

Lastly, as others have said, there definitely is an interaction between Buprenorphine and Benzodiazepines. It's a combination that can kill like any other Benzo/Opioid combination, if not with a slightly lower danger due to Buprenorphine's inherently less dangerous effects.

For the sake of clarification. I'm not exactly new to this, I'm someone who has already experienced pretty much every kind of addiction and withdrawal that there is in my 50 years. And I realize that long-term, every day use of BZDs isn't really a realistic solution. I don't know what the answer is. I've already been on every kind of anti-depressant and sleep med they make, and none of them work for me, they're placebos. I have done some reading, and a lot of people feel that way.
All I know is this: on days I don't have any xanax, I just don't have the desire to do anything, not even eat. I hate every second of my life because all joy and pleasure has been stolen from me. I've lost interest in even the things I used to enjoy. At night, I can't sleep because several times a night i hear things, or even smell strange things, and have to get up and walk around the house with a gun. No matter how many times I've done this before, I'm always convinced it's real this time. When I do fall asleep from sheer exhaustion, I wake myself up sobbing in my sleep, and thus begins a new day just like the one before it.
As for the high being important, well it doesn't really give me what I'd call a high. When I do have xanax, I only take it at night and then go right to bed as soon as it starts working. Being able to sleep uninterrupted for several hours is a priceless blessing in itself, but I've noticed that the following day I'm usually in a pretty good mood too, able to actually engage in things the way I used to before this got so bad. I read somewhere xanax USED to be prescribed for its mood-elevating effects.
I'm not addicted yet, I don't get enough to have a real habit. And I don't get sick when I run out, the dysphoria or anhedonia or whatever you want to call it, is not a result of xanax deprivation - I lived like that for a long time before I started the pills. I've been court-ordered into psychiatric facilities twice just this YEAR. Against my will. So there's no question about my diagnoses being real (whether they're accurate though...).
Like I said, I know even if I had as many as I wanted, they would start to lose their effect and I'd need them just to get up and face they day in ever-increasing amounts. But I'm nowhere near that. For now, this is what works for me.
Therapy, 12-step meetings...I'm sorry but I've been forced to do these things all my life and I have come to loathe both. I know N.A. is something people are passionate about so I'll just say it's not for me.
I do appreciate your concern, and thank you for taking the time to post. You definitely got me thinking when you said I should appreciate what I have, because most doctors wouldn't even do that. I think you're probably right about that.

 

[cant_overdose]

One of the worst mistakes I ever made in life was getting myself dependent on benzos and long-half life opioids. Specifically methadone in my case. I was addicted to either Xanax or Klonopin depending on the day or year.

I had to kick methadone twice. It was agony incarnate, day and night, for weeks. And I remember not being able to sleep for more than a couple hours for moooonths. And I did not shit anything solid for like a year. That's why I'm on buprenorphine this time. Methadone also made me a different person, I was not myself.

 

[somnilicious]

I had to kick methadone twice. It was agony incarnate, day and night, for weeks. And I remember not being able to sleep for more than a couple hours for moooonths. And I did not shit anything solid for like a year. That's why I'm on buprenorphine this time. Methadone also made me a different person, I was not myself.

Yeah, it's fucking horrible. I just walked off 90mgs almost 6mths ago. At least this time I wasn't also withdrawing off long term high dosage benzos use as well, which was another layer of hell.

 

[cant_overdose]

Tolerance and Dependence following Chronic Alprazolam Treatment: Quantitative Observation Studies in Female Rhesus Monkeys

In order to understand mechanisms underlying tolerance and dependence following chronic benzodiazepine treatments, quantitative and reproducible behavioral models of these phenomena are required.This research evaluated the ability of chronic treatment ...

www.ncbi.nlm.nih.gov

A Review of Alprazolam Use, Misuse, and Withdrawal

Alprazolam is one of the most widely prescribed benzodiazepines for the treatment of generalized anxiety disorder and panic disorder. Its clinical use has been a point of contention as most addiction specialists consider it to be highly addictive, given ...

www.ncbi.nlm.nih.gov

As I have said elsewhere, Upjohn was acquired by Pfizer and in informed source (Dan - who was lead in Upjohn drug discover laboratory) stated that the ONLY thing Pfizer wanted was alprazolam. Then, within months, the DSM V comes out with GAD as a new diagnosis and then a few months later the PDR lists alprazolam as the ONLY medication for GAD.

I know, those time-frames don't look possible but who knows when Pfizer decided they wanted Upjohn? They could buy alprazolam from a drug library or make it so if they hold sway with the authors of the DSM. They do - they bribed them. Not cash but the classic 'free 10 day 'conference' in Hawaii for member and spouse - conference is two 1 hour lectures on days 2 and 12. And they were caught... or at least a journalist published the 'conference' details. No idea how they got an ML so fast. Maybe Upjohn were already 95% way through the process? But who knows.

Do you think something similar happened with Ritalin and ADHD? Some kind of collaboration with drug manufacturers and the DSM people to invent a diagnosis that would help them market it?

 

[AlsoTapered]

Yeah, it's fucking horrible. I just walked off 90mgs almost 6mths ago. At least this time I wasn't also withdrawing off long term high dosage benzos use as well.

So essentially you have been 'parked' on buprenorphine?

You know, the discoverers specifically stated that it was of utility in 'opioid detoxicifaction' i.e. the acute period i.e. a couple of weeks. But I guess a medicine one takes for 2 weeks isn't nearly as profitable as something you take for years.

And guess what? The Chinese have developed thienorphine. New drug, still on-patent. Are you a betting man? If it gets an ML in your nation and you live somewhere where YOU pay for medication - thienorphine is going to be 'sold' as being superior. I mean it IS since it's duration is 2-3 days... but I bet it's hard to stop.

Yep - ADHD is a real condition but medicines are not needed for every case. When was it added to the DSM? Or, specifically, which version of the DSM indicated methylphenidate? It's not new - it was recognized in the 1960s but pills were the last resort. When did THAT change?

 

[AlsoTapered]

Journal of Chromatography B vol. 859 iss. 1 pp.52—61 Simultaneous determination of thienorphine and its active metabolite thienorphine-glucuronide in rat plasma by liquid chromatography–tandem mass spectrometry and its application to pharmacokinetic studies DOI: 10.1016/j.jchromb.2007.09.028 a a	Qi Kong; Jianzhong Qiao; Xiaoying Wang; Shulan Yuan; Zhenqing Zhang; Zehui Gong; Jinxiu Ruan		2007 November		English
	World Journal of Gastroenterology vol. 19 iss. 9 pp.1444 Effect of thienorphine on intestinal transit and isolated guinea-pig ileum contraction DOI: 10.3748/wjg.v19.i9.1444 a a	Zhou, Pei-Lan	Baishideng Publishing Group Inc.	2013		English
	ChemInform vol. 36 iss. 48 pp.0—0 Synthesis and Characterization of Thienorphine and Its Glucuronide Conjugate. DOI: 10.1002/chin.200548202 a a	Chun-He Liu; He Liu; Xiang-Yu Han; Bo Wu; Bo-Hua Zhong; Ze-Hui Gong		2005 November 29
	Acta Pharmaceutica Sinica B vol. 2 iss. 2 pp.174—180 Biliary excretion and enterohepatic circulation of thienorphine and its glucuronide conjugate in rats DOI: 10.1016/j.apsb.2012.02.007 a a	Jingting Deng; Xiaomei Zhuang; Guolin Shen; Hua Li; Zehui Gong		2012 April		English
	Neuroscience Letters vol. 513 iss. 2 pp.132—136 Effects of thienorphine on release of dopamine and noradrenalin: An in vivo microdialysis study in rats DOI: 10.1016/j.neulet.2012.02.013 a a	Zheng Yong; Lingdi Yan; Peilan Zhou; Gang Yu; Huajing Dong; Zehui Gong		2012 April		English
	European Journal of Pharmacology vol. 713 iss. 1-3 pp.44—46 Up-regulation of monoamine oxidase activity in the striatum of rats following chronic treatment of thienorphine DOI: 10.1016/j.ejphar.2013.04.041 a a	Yong, Zheng; Yan, Lingdi; Wang, Xiao; Su, Ruibin; Gong, Zehui		2013 August		English
	European Journal of Pharmacology vol. 737 pp.22—28 Effects of thienorphine on contraction of the Guinea pig sphincter of Oddi, choledochus and gall bladder DOI: 10.1016/j.ejphar.2014.04.044 a a	Zhou, Peilan; Li, Tingting; Su, Ruibin; Gong, Zehui		2014 August		English
	European Journal of Pharmacology vol. 703 iss. 1-3 pp.83—90 Effect of thienorphine on the isolated uterine strips from pregnant rats DOI: 10.1016/j.ejphar.2013.01.063 a a	Zhou, Peilan; Yan, Lingdi; Yong, Zheng; Yu, Gang; Dong, Huajin; Yan, Hui; Su, Ruibin; Gong, Zehui		2013 March		English
	Drug Delivery vol. 23 iss. 3 pp.777—783 Preparation and in vitro evaluation of thienorphine-loaded PLGA nanoparticles DOI: 10.3109/10717544.2014.916765 a a	Yang, Yang; Xie, Xiang Yang; Mei, Xing Guo		2014 May 28		English
	Neuroscience vol. 274 pp.53—58 Effects of thienorphine on synaptic structure and synaptophysin expression in the rat nucleus accumbens DOI: 10.1016/j.neuroscience.2014.05.026 a a	Yong, Z.; Yan, L.; Gao, X.; Gong, Z.; Su, R.		2014 August		English
	Xenobiotica vol. 43 iss. 2 pp.133—139 Deep understanding of the interaction between thienorphine and UDP-glucuronosyltransferase (UGT) isoforms DOI: 10.3109/00498254.2012.706723 a a	Dong, Rui-Hua; Fang, Zhong-Ze; Zhu, Liang-Liang; Ge, Guang-Bo; Li, Xiao-Bao; Hu, Cui-Min; Cao, Yun-Feng;[...]		2012 July 20		English
	CNS Neuroscience & Therapeutics vol. 20 iss. 3 pp.282—288 Multiple Mechanisms Underlying the Long Duration of Action of Thienorphine, A Novel Partial Opioid Agonist for the Treatment of Addiction DOI: 10.1111/cns.12210 a a	Yu, Gang; Li, Shu-Hui; Cui, Meng-Xun; Yan, Ling-Di; Yong, Zheng; Zhou, Pei-Lan; Su, Rui-Bin; Gong, Ze-Hui		2013 December 16		English
	Synapse vol. 67 iss. 11 pp.779—785 The effect of chronic thienorphine administration on long-term potentiation and synaptic structure in rat hippocampus DOI: 10.1002/syn.21682 a a	Yong, Zheng; Yan, Lingdi; Dong, Zhaoqi; Wang, Xiao; Su, Ruibin; Gong, Zehui		2013 July 04		English
	Pharmaceutical Development and Technology vol. 18 iss. 5 pp.1169—1174 Effects of formulation parameters on encapsulation efficiency and release behavior of thienorphine loaded PLGA microspheres DOI: 10.3109/10837450.2011.618948 a a	Yang, Yang; Gao, Yongliang; Mei, Xingguo		2011 October 04		English
	Synthetic Communications vol. 35 iss. 5 pp.701—710 Synthesis and Characterization of Thienorphine and Its Glucuronide Conjugate DOI: 10.1081/SCC-200050367 a a	Liu, Chun‐He; Liu, He; Han, Xiang‐Yu; Wu, Bo; Zhong, Bo‐Hua; Gong, Ze‐Hui		2005 March		English
	Journal of Pharmacology and Experimental Therapeutics vol. 321 iss. 1 pp.227—236 Thienorphine: Receptor Binding and Behavioral Effects in Rhesus Monkeys DOI: 10.1124/jpet.106.113290 a a	Li, J.-X.; Becker, G. L.; Traynor, J. R.; Gong, Z.-H.; France, C. P.		2007 January 12		English
	Journal of Pharmacology and Experimental Therapeutics vol. 318 iss. 1 pp.282—287 Thienorphine Is a Potent Long-Acting Partial Opioid Agonist: A Comparative Study with Buprenorphine DOI: 10.1124/jpet.105.099937 a a	Yu, G.		2006 March 28		English
	European Journal of Pharmacology vol. 789 pp.144—151 Effects of thienorphine on the contraction of isolated ureter and bladder of guinea pigs DOI: 10.1016/j.ejphar.2016.07.029 a a	Zhou, Peilan; Li, Yulei; Yong, Zheng; Yan, Hui; Su, Ruibin; Gong, Zehui		2016 October		English
	CHEMICAL & PHARMACEUTICAL BULLETIN vol. 60 iss. 12 pp.1479—1486 Formulation and Evaluation of Thienorphine Hydrochloride Sublingual Delivery System DOI: 10.1248/cpb.c12-00508 a a	Liu, Fei; Zhao, Yumei; Sun, Jianxu; Gao, Yongliang; Zhang, Zhenqing		2012		English
	Frontiers in Pharmacology vol. 7 Inhibition of P-Glycoprotein and Multidrug Resistance-Associated Protein 2 Regulates the Hepatobiliary Excretion and Plasma Exposure of Thienorphine and Its Glucuronide Conjugate DOI: 10.3389/fphar.2016.00242 a a	Kong, Ling-Lei; Shen, Guo-Lin; Wang, Zhi-Yuan; Zhuang, Xiao-Mei; Xiao, Wei-Bin; Yuan, Mei; Gong, Ze-Hui;[...]		2016 August 09		English
	Brain Research vol. 1748 pp.147083 Thienorphine induces antinociception without dependence through activation of κ- and δ-, and partial activation of μ- opioid receptor DOI: 10.1016/j.brainres.2020.147083 a a	Zhou, Peilan; Li, Yulei; Yong, Zheng; Chen, Ming; Zhang, Yixin; Su, Ruibin; Gong, Zehui		2020 December		English

Hotlinks to the papers on thienorphine. Now everyone can decide if they agree or disagree with my opinion...

I would LIKE to be wrong.

 

[Señor Moreno]

Methadone is a monster and you don't learn it after it's too late. But buprenorphine is a limited drug, it can't hold everybody, specially in these fent days.
As for your question, I also think you are safe on those dosages if you are a tolerant 240 pounds guy. But what @Keif' Richards and @Somnilicius said is one of the biggest truths in this universe, if you remember your methadone wds like hell (as I do), we don't want to endure a long timed solid xanax dose.
If you feel you need to keep taking them for a while I strongly suggest you to tell your doc to try diazepam, better than kpins imo. I think that your doc, who clearly trust you like you deserve, would be happy to work with a much more long lasting and forgiving benzo, the safe zone gets wider with diaz/ Valium. They both are benzos but works differently, you might need an adjusting time, but you would be doing yourself a favour, very specially when the day to quit finally arrives.

 

[somnilicious]

So essentially you have been 'parked' on buprenorphine?

You know, the discovered specifically stated that it was of utility in 'opioid detoxicifaction' i.e. the acute period i.e. a couple of weeks. But I guess a medicine one takes for 2 weeks isn't nearly as profitable as something you take for years.

And guess what? The Chinese have developed thienorphine. New drug, still on-patent. Are you a betting man? If it gets an ML in your nation and you live somewhere where YOU pay for medication - thienorphine is going to be 'sold' as being superior. I mean it IS since it's duration is 2-3 days... but I bet it's hard to stop.

Yep - ADHD is a real condition but medicines are not needed for every case. When was it added to the DSM? Or, specifically, which version of the DSM indicated methylphenidate? It's not new - it was recognized in the 1960s but pills were the last resort. When did THAT change?

Nah, I was on methadone but one day I just decided to rip the cord at 90mgs and walked off 6mths ago. I'm on nothing now cept some drinks and pot when the mood strikes. I've never been on Bupe before cept used for a few short detox's from heroin. I was on methadone and klonopin/Xanax for close to 12yrs and had to withdraw from that in 2014-15.

 

[cant_overdose]

Methadone is a monster and you don't learn it after it's too late. But buprenorphine is a limited drug, it can't hold everybody, specially in these fent days.
As for your question, I also think you are safe on those dosages if you are a tolerant 240 pounds guy. But what @Keif' Richards and @Somnilicius said is one of the biggest truths in this universe, if you remember your methadone wds like hell (as I do), we don't want to endure a long timed solid xanax dose.
If you feel you need to keep taking them for a while I strongly suggest you to tell your doc to try diazepam, better than kpins imo. I think that your doc, who clearly trust you like you deserve, would be happy to work with a much more long lasting and forgiving benzo, the safe zone gets wider with diaz/ Valium. They both are benzos but works differently, you might need an adjusting time, but you would be doing yourself a favour, very specially when the day to quit finally arrives.

yeah he's been good to me. The first year, I kept testing positive for meth and finally he told me he was going to have to cut me off if it happened again, and I think that was the last time I used it. That was about 3 years ago. He gave me a script for modafinil to help with meth cravings. It kinna works. But it's funny you should say that about diazepam. I wanted to switch from xanax to that because the xanax just knocks me out. Obviously I didn't use that phraseology, but he didn't want to change anything. I don't know why he was against it but I didn't argue. When your doctor knows you're an addict sometimes requesting a different drug or milligram amount can be a delicate matter, you know?

 

[Señor Moreno]

Got you, very true that requesting drugs isn't the best thing to do at an addiction clinic.
But in fact, diazepam means taking some steps down from xanax. I know when the benzo use is sporadic, docs tend to distrust the superlong half life of diaz in favour of xanax or lorazepam or whatever, but when they are prescribed to be taken on the daily, my experience is they start to see the good part of diaz or clonazepam.
Maybe @AlsoTapered has given us an answer:

The US seems to prescribe alprazolam (specifically) for a wider range of indications than other nations, not just the 'Short term treatment of anxiety' the BNF (UK PDR) states.

 

[AlsoTapered]

I can see ciclotizolam and the other high-affinity low-efficacy benzodiazipines being used to ween people off other benzos.