Is this unethical?

[nuttynutskin]

I've been taking 2mgs of zanax daily for about 7 years now and my new dr wants me to taper off. Right now down to 1.5mgs then in 5 days down to 1 mg. I feel this is way too fast and am furious but she thinks it's safe. I think it's a going to give me a lot of unneeded symptoms. What do you guys think? I think I may try find a new dr or psychiatrist that doesn't hate benzos.

 

[simco]

I don't exactly think it's •unethical• but highly suspect and really stupid...absolutely. I would find a new doctor.

Any idea why this doc is so determined to do this?

 

[cj]

I would find a new doctor asap! That's going to be horrible. I would say that is borderline malpractice.

 

[Jabberwocky]

I'd have to agree with cj and simco.

Legally speaking, no it isn't unethical exactly. At least not in terms of a lawsuit.

That said, I would say that this kind of "taper" to be both unethical and unprofessional. Especially considering it seems to be disregarding your interests for the "wisdom" of a "professional." A proper taper would at least involve replacing the alprazolam with a more appropriate medication, such as diazepam or clonazepam. It would also be far slower, with the pace ultimate at the discretion of what the patient feels comfortable with.

Definitely find yourself a doctor who knows what the hell they're doing with benzos. This doctor evidently doesn't have much of a clue. At the very least I'd bring them one of the many well established taper protocols for benzos out there.

 

[nuttynutskin]

Thanks for the replies, I think I my have to find a new dr. I'm just afraid that if I find a new dr they might do the same thing. Plus if I have to wait I'd be without ANY benzos. This whole thing has got me stressed.

 

[nuttynutskin]

Any idea why this doc is so determined to do this?

Honestly I was so angry when I went in, no. I think it may have been the fact I was drinking while on the xanax but I'd been doing that for years. I'm trying to quit the booze, but this isn't going to help AT ALL.

 

[aihfl]

I think it may have been the fact I was drinking while on the xanax but I'd been doing that for years. I'm trying to quit the booze, but this isn't going to help AT ALL.

I could very easily see this as a situation where the doctor for whatever reason feels compelled to "punish" the addict instead of doing what is in the addict's best interests but not knowing anything about the situation that is pure speculation on my part. I think many, if not all of us, have encountered physicians who continue to hold the 19th century notion that addiction is simply a matter of a personal failing versus a medically legitimate issue. Whatever the case may be, I don't think you have to have a MD or DO degree to understand why ramping up the baseline anxiety of someone with AUD can only be counterproductive.

My recommendation would be to seek out a reputable addiction physician and explain the gravity and urgency of the situation. One that is truly compassionate will make the time on short notice for you.

 

[Jabberwocky]

A fast taper off benzos is definitely not going to help you quit drinking. Besides finding a doctor who is willing to work with you to provide a proper diazepam taper, I'd also suggest looking into baclofen to replace the alcohol with. It is a rather effective medication when it comes to managing alcohol cravings. Only caveat is that drinking on baclofen is very dangerous. That can be said of drinking on alprazolam or any benzo though.

 

[aihfl]

A fast taper off benzos is definitely not going to help you quit drinking. Besides finding a doctor who is willing to work with you to provide a proper diazepam taper, I'd also suggest looking into baclofen to replace the alcohol with. It is a rather effective medication when it comes to managing alcohol cravings. Only caveat is that drinking on baclofen is very dangerous. That can be said of drinking on alprazolam or any benzo though.

I've been on baclofen for AUD. There is a fringe school of thought out there (I think; I hope they have been discredited) that you take progressively higher and higher doses of baclofen while continuing to drink, and at some point you will hit a "switch" and find yourself indifferent to alcohol and even be able to drink moderately. I've heard of people taking ridiculously high doses of baclofen (buying from ridiculously expensive black market pharmacies because no doctor in their right mind would condone this; the only one I knew about lost his Illinois medical license), well over 200mg/day looking for that elusive "switch" which never seemed to materialize. And while I did find it helped with craving, this "indifference," that's been described in the medical literature went out the window with one drink for me. So yeah, I could sit with friends in a bar while they drank, but once alcohol hit my system I was no longer "indifferent." Maybe some people can drink moderately with it, but I think I am too far advanced in my own AUD for this to be viable.

Also, from personal experience, I can say that abusing baclofen with alcohol, while no more or less dangerous than abusing benzos with alcohol, it IS far more unpleasant. Benzos and alcohol just cause mad blackouts. You're so dizzy and disoriented on alcohol and baclofen that you wish you were blacked out but aren't.

There is also oral naltrexone and The Sinclair Method that also operates on the principle of pharmacological extinction that is an interesting and novel idea as well. I just didn't tolerate oral naltrexone very well. It felt like I would go into mini opiate withdrawal within 20 minutes of taking it, so that wasn't viable for me.

 

[Mmp85]

Is this a general practioner or a psychiatrist?
Avoid having a GP handle any psychiatric meds, they can be totally clueless. I had doctors not even recognize some of the meds I told them I was on or say something like "I didn't know it could be prescribed that way..." Psychiatrists know way more about the drugs they're prescribing.

 

[Captain.Heroin]

I've been taking 2mgs of zanax daily for about 7 years now and my new dr wants me to taper off. Right now down to 1.5mgs then in 5 days down to 1 mg. I feel this is way too fast and am furious but she thinks it's safe. I think it's a going to give me a lot of unneeded symptoms. What do you guys think? I think I may try find a new dr or psychiatrist that doesn't hate benzos.

It's not unethical, but it's also your right to seek out a new doctor if you feel that is best.

 

[Stargazer]

Not w benzos- but w OxyContin ( I was on 3 80mgs per day at that time) I went to my appt and the Dr put my chart on the desk and said "10yrs - no more scripts" Whaa?? He then went on to tell me one of his associates "fellows" was being sued for turning the patient into an addict. Oooh! You mean exactly what you did to me? Telling me OxyContin is non-addictive and much better than short acting narcs I could get addicted to. This is the truth as insane as it is and sounds.

Anyway, I asked him if he could at least write me another months worth-so I could find another Dr. He said, and I quote " No Dr is going to write this" I found another Dr and had my script that afternoon.

I know how un-nerving this is- but try to stay calm and find an addictions Dr. Or go to the emergency room and get into rehab so you have medical supervision.

 

[Jabberwocky]

Generally speaking rehabs are some of the worst places to detox from benzos. An outpatient program that employs a supervised taper would be prettt stellar though if you feel you'd benefit from treatment.

I'd only suggest doing the inpatient detox thing is you don't have any other options, which is probably not your situation as it isn't that difficult to find another psychiatrist or pharmacologist in most cities.

Likewise, hospital ERs are pretty last rung options, given that most of them treat folks seeking treatment for withdrawal pretty poorly, even when they have to take care of them because they witness a seizure or something.

Such a shitty situations, but it does sound like there is probably a more appropriate medication out there than alprazolam given the OPs situation with the drinking and such.

 

[Stargazer]

TPD knows better than I for sure.

I have been put in horrible positions throughout my years of chronic pain. I was trying to think of a prompt solution.

Definately. Tpd is better equipped to answer. Best wishes to you OP.

 

[somnilicious]

As a last resort, while looking for another doc in an emergency situation you can go to the ER. I have never been denied a short benzo script due to the seizure dangers. Just a thought for something to fill the gap to make it till you find another prescriber if necessary.

 

[Stargazer]

I'm a seizure risk when I detox from just opiates. I have no idea why that is but it's how my body responds to sudden cessation of opiates when dependent on them. Who the hell knows. Crazy. I really hope you aren't stuck in a position that endangers you OP.

I just know how desperate things can become. If for nothing else- I'd rather seize in the ER where I'm in the immediate vicinity of medical staff than sitting home out of options.

Again, TPD is a wealth of information. I'm sure he will point you in the necessary direction. I wish you the very best.

 

[cj]

Generally speaking rehabs are some of the worst places to detox from benzos. An outpatient program that employs a supervised taper would be prettt stellar though if you feel you'd benefit from treatment.

I'd only suggest doing the inpatient detox thing is you don't have any other options, which is probably not your situation as it isn't that difficult to find another psychiatrist or pharmacologist in most cities.

Likewise, hospital ERs are pretty last rung options, given that most of them treat folks seeking treatment for withdrawal pretty poorly, even when they have to take care of them because they witness a seizure or something.

Such a shitty situations, but it does sound like there is probably a more appropriate medication out there than alprazolam given the OPs situation with the drinking and such.

I dunno the hospital treated me really well when I was coming off benzos. It's a crapshoot though. Don't let the fear of some nurse being a bitch stop you from getting help.

 

[Jabberwocky]

It's absolutely true that if one is concerned about their detox and doesn't have other options, the ER is definitely a better options than some others. My comments were coming from a place of worst/best case scenarios. If one can't do it at home, anywhere that actually will give the patient treatment, whether it's medical detox or a hospital, is a far better option than risking it at home.

That all said, that kinda choice, while pretty par for the course, is really not much of a choice. I mean, compared to finding a doctor to work with someone individually on it. It only seems like hospital and detox centers are a good idea when one doesn't have access to a doctor willing to help them manage the taper/detox/condition(s).

 

[aihfl]

My experience coming of alcohol and benzos the past two times at inpatient detox was ok (meaning not a complete nightmare) and the doctor there worked with me on a librium taper. He gave me his card. I have a good rapport with my current psychiatrist but if for whatever reason I was not able to continue seeing him, I would not hesitate to go see the doc from detox at his private practice. The longer I'm at this, the more I can see it's just extremely difficult to make generalizations.

That said, I am still terrified of going near an ER for withdrawals. In Florida, a seizure is an automatic, unequivocal loss of your driver license for six months minimum and there is no hardship provision like there would be with a DUI. I had one at an ER and the only reason I didn't lose my DL was because the doctor fucked up and should have taken it to return to the state DMV in Tallahassee but didn't. So yeah, from that perspective, I think working on a doctor one on one is the best. Not that it would be a big deal now since I'm not having to drive to a job 40 miles away and with the rise of Uber and Lyft getting around is much easier, but I'd still rather not lose my license.

 

[rainyday107]

If you decide to stick with your current doc, when is your next appointment? I think you should be having a med check monthly, at the very least.

If you start the taper via this doctor's method - I would call the doc if you feel bad - describe the symptoms and say you need to come in or at least return your call and advise you. I'd do this EVERY time you feel really bad---don't call several times per day, but so call daily if you're feeling horrible.

Sometimes doctors will go with another strategy after they hear your negative symptoms, etc. just be assertive but not rude...but describe your symptoms and ask what can be done.

I DO think it's important to follow the doc's taper instructions. Call if you feel bad, describe symptoms, ask what can be done as you need help. Don't call and say you felt like crap so you took more than instructed.

Ive never done a benzo taper .... I hope this helps. Most docs want their patients to feel well. And if their med regimen is not working...it's their job to change it. My psychiatrist is very responsive when I describe specifically what my symptoms are and then he makes a med decision and we discuss it.

Keep us posted. Thinking of you. xo