Sorry for the long post, but we're going through some similar difficulties, and I'd like both to give my opinon on the OPs situation, and if you're up for it, man, PM me or post your impression of the mess I'm in. First, the benzos: he wants you to drop from 15mgs a day to zero after 9 years on benzos in a few weeks? That's insane. I've always read that 1-2mgs or 10% of your daily dose should be the maximum reduction every two weeks. What's he planning? A series of 5mg drops, or a daily dose reduction? Either way, clinical guidelines in the UK state that the end of a taper is the slowest and most precarious part - once you get down to 2mgs here, they switch you to a liquid titration, going from 2 to 1.5, 1, .75, .5, .25, then kick...and monitor you closely for a month or so afterwards. I think you need to tell him, politely but forcefully, that after nine years, you're just not ready for that rapid a reduction, that the thought of it's keeping you up at night, and that you fear you'll relapse to high doses if forced to reduce that quickly. You're at the tail-end of a very long process, and too rapid a cessation could result in the worst physical withdrawal symptoms. At the very least, you need a supplementary anti-convulsant for a short space of time - but fuck that, you don't drop from 15mgs to zero over a few weeks after nine years. Put it too him that you've been dependent for almost a decade, and you're not confident you can get off unless you're allowed to taper gently and comfortably for the remainder of the course, What's the rush, after ten years? I would have thought that a milligram a week should be your maximum reduction once down to ten, and if your doctor disagrees, you're going to have to find additional supplies somehow. Tell him, frankly, that you need a few more months - it's been ten years, and rapid reduction means you'll be popping bars like candy when your final script runs out. You're on a lot of pharms there, man, and the faster you drop, the greater the likelihood of relapse. Forgive the long post, but here's my experience...
I started using benzos and opiates regularly about two and a half years ago, and after a general life crisis, had my last benzo-free days in December 2010. In 2011, my 'year of pills and pizza', I was on high-dose pharm opiates and benzos for six months - nitrazepam, temazepam, and alprazolam were my benzos of choice, but I always kept an emergency supply of diazepam and phenazepam, though I tossed the latter, and sampled, along the way, bromazepam, oxazepam, midazolam. clonazepam, lorazepam when there was nothing else to be had, etizolam, again as a stopgap, and on the opiate side of things, oral morphine, in the form of crushed MSTs and instant release linctus, oxy, fent, hydro, dhc, and demerol. Everything was outwardly fine, for a while, but I began to fuck up at work, tapered myself off the opiates with far less trouble than if I'd asked for 'help', which would have meant a methadone 'script and a habit I doubt I'd have been able to break. I then turned to tapering off the benzos, switching from a cocktail to alprazolam, then to diazepam, and finding I was stable on doses of 120-150mgs a day. From there, I found it easy to take big jumps down, until I got to seventy mgs or so. Then it turned nastier, and I had to slow down, but I stuck at it, and managed to get as low as 25mg for a few weeks (though that was after a 15mg drop form 40, and there were some very rough nights in those few weeks.
Until, that is, I had a panic attack: I'm deeply phobic of rodents (rat-infested house as a kid), had a mouse infestation, and had to barricade myself in a storeroom wrapped in multiple leather jackets with an array of cudgels at hand. I took an extra 60mgs of diaz to calm down and get to sleep. I could probably have gone back to 25mgs a day and let the one-off relapse work its way through my sytem, but, remaining panicky and feeling under seige, got stuck on doses of 50-70mgs a day. I sought medical help, and was pretty much told to get fucked, 'yes, very serious, you could die in withdrawal. It's your problem, I have patients with illnesses that aren't self-inflicted. Go and get them in the street.' I spent a year on 10mgs of etizolam or 50-70 of diaz a day, before losing my job, and being forced to move cross-country and live with my mom. Throughout that period, my tolerance didn't seem to drop at all. 50mgs of diaz would hold me, but to knock myself out required 150mgs or so, and in one rock-bottom binge, I slept for 24 hours in 3 eight hour shifts. eating three doses of 150mgs.
I went into treatment after moving to a part of the country with a generally good rep for a clinical harm minimisation approach, and asked around till I found a doctor who I felt confident would give me a sympathetic hearing. My doses had been rising again, and I was on about 70-90mgs a day, though from a combination of self-deception and embarassment, I understated this as '60-70', and started my formal taper at 55mgs for two weeks. I stuck to it, and dropped to 50 with no great difficulty...for the first ten days or so. Then I had a panic attack, and switched to dropping by 2mg increments. I never discussed my opiate history with my doctor, not wanting it on my medical records, and throughout this period, had the occasional, then increasingly frequent, opiate relapse - oxy, morphine, dhc, and very poor smack, when pharms weren't available. Recently, occasional became weekly became bi-weekly, then every other day, then, after a week of three little methadone binges, a habit. And I bought extra diaz to supplement my taper, first on rare occasions, but over the past few weeks, more often than not. I'm supposed to be on 44mgs a day - it's been more like fifty again, and there've been a few high dose binges, usually when opiate cravings have gone unsatisfied.
My tolerance is now completely scrambled. There have been nights when 7 msjs - a notoriously unreliable brand, dosed very inconsistently - have knocked me out. One night a few week ago, I took 13 of the same batch of msjs, and 7 prescription Teva 10s - 200mgs, in theory, and couldn't get to sleep. Two nights ago, a total dose of 94mgs knocked me out for around twenty hours (there was some dope in my system), and on waking, I took another 40, which put me in a fitful daze of restless sleep till morning. Today I woke up slightly junk-sick, have chewed up about thirty 60mg time release dhc tablets, which straightened me out but produced no high, and took 10mgs of Ritalin, to seem vaguely normal. I've had 56mgs of diaz, and feel there's a long night ahead of me. I can't take any more, because I'm going to be dropping to 42mgs on Monday, so far as prescription supplies are concerned, I don't want to go looking for black market connects, and my one source sold me his last three trips of 2mg actavis today. saying he's having increasing trouble getting pills (there was a customs crackdown, and I think it's worked its way through to the retail level). If I didn't know I'd eaten a fistful of pills, I wouldn't know I was on anything. I'm right back where I started, two years ago. I don't know whether I can admit to my doctor that I've relapsed without facing testing and the indignity of being put on a three-day pick up for my 'script - or whether I can ride out the recent overdoses. I think I'm going to have a supplement a little, and try reducing 1mg a day till I'm where I'm supposed to be.
My experience, in short, is that benzo tolerance doesn't really go down while you're tapering: you can get by with less as you reduce, but higher doses accomplish nothing but to set back the process of recovery. It's probably better, if relapsing, to use short-acting benzos: some of my overdoses haven't caught up with me yet, and I had the shakes a few nights ago. I let myself lose track, and am going to have to pay the price for it: but that aside, I don't understand why one night, 70mgs knocks me flat, and another, 200 feels like 40 or fifty. I don't drink or use potentiators, never sleep at all if I put opiates into the mix (especially dope), but the drawback to diaz is its advantage - the long half-life. Ideal if you can stick to a taper, but a guarantee of hell to pay if you fuck up. And I've been fucking up, more and more. My stable dose is around 50mgs - just like it was a year ago. Exceeding that seems to have random results. The only way that I can be sure of getting to sleep is to take methadone along with diaz - and that pretty much puts me in a coma. So...
I think dropping from 15mgs to zero safely, minimising likelihood of relapse, with all the other drugs you're on, should take place over a couple of months. You've been on the shit too long to just brush it off and walk away. At the very least, get him to extend the process till the end of the year, or else find alternative sources and decide on a pace that suits you. After nine years, what's a few months? You need a soft landing if you're going to stay off. Part of this is facing the fact that benzos won't be any use to you, recreationally, for years to come, if ever. The receptors take a very long time to heal, if they ever do. Some day vinpocetine helps, but I don't think that's reliable. There's no methadone for benzos, and no DXM. If he won't stretch out the taper, and you can't get additional supplies, then you need another doctor. Don't start substituting xanax - it'll just confuse your neurotrasnmitters further, and you'll end up dosing three times a day.
I can't believe how ignorant doctors are about diaz withdrawal - a recent thread in this forum had one long-term benzo addict talking of being switched to Librium, with his doc planning for 60% dose reductions. It's not rocket science. The longer you've been on, the slower you need to reduce. Enforced rapid withdrawal increases the likelihood of relapse. Problem is 'pharmaceutical Calvinism': when doctors treat addiction as a moral issue, rather than a practical one, it blinds them to the practicalities.
As to everything else you're on, my impression is (I've only had suboxone once, and wasn't hooked at the time - it gave me once of the best opiate highs of my life) that regular sub use tends to tamp down on your ability to get high, on more or less any and everything. Given the doses you're talking about - that's a lot of sub - and the trazodone, you've got a neurochemical wall that very little is going to get past. Your benzo tolerance, like mine, probably hasn't come down much - you've just adapted to a starvation diet.
And, like me, you still want to get to high. Maybe we always will. Simultaneous withdrawal is hell - I'm hoping I've nipped my dope habit in the bud, and a few days of codeine, with one or two of methadone if necessary, followed by loperamide or kratom, will let me walk away. I always tell myself 'if I could just get some subs/oxy/hydro for a cwe, I'd have that one perfect high and be able to walk away...', but it's bullshit. Opiates come in two doses once you've had a habit: too much (dead) and not enough. You can't taper off of four drugs at once, especially not when SSRI, benzo, opiate and traz w/ds all cause an increase in anxiety, and you're conditioned to deal with anxiety through pills.
I think you need to take these one by one. Get off the benzos, and have a month clear before starting to reduce either the subs or the traz, and save for the effexor for last. Shit, that still leaves lyrica - you definately need to take ;em one by one, Get off the benzos, then the lyrica, so you're clear of GABAdrenergics, then give it a month and decide which to tackle next. You need a doctor who isn't an idiot, one who understands that withdrawal from 5 powerful chemicals is a traumatic and potentially dangerous experience, and unless handled slowly and responsibly, you're not going to make it. Once you're benzo-free, the lyrica and trazodone should help with the immediate aftermath, but you'll need a break before you starty coming off anything else. Ask to be stabilised for a month, then take 'em down, one by one, begging and storking his ego as subtly as you can. Because frankly it sounds like he's a schmuck, and we all know schmucks like to be stroked.
Okay, I don't think I can do much more than repeat myself, except to say you might hit him with a question as to what's the overall plan to get from where you are to clean, and in working that out, push him towards lengthening the time allowed for each taper. And I think we're in the same situation, inasmuch as we'll always want to get high, probably can't anymore, and have to swallow the bitter fact that we've burned out as druggies and need to get clean. Maybe we'll be able to indulge in the distant future - but maybe we need to face the grey reality of drawn-out sobriety. As to feeling 'normal'...I don't think I ever did. 'Normal' people don't generally end up obsessed with their daily drug diet and squatting in OD most nights. Fuck 'normal', I'll settle for pill-free and able to sleep...and that's a very long way off.
Godo luck, it's incredible you're down to 15mgs, and don't let sawbones fuck it up by trying to rush you to zero. Keep us posted, and if you have any thoughts on my own little mess, post or PM me: I coul use some advice, and you live in my neighbourhood, as it were. At least where benzos and opiates are concerned. I think I could use a little trazodone, or seroquel, or lyrica - something for mood stabilisation and to take the edge off benzo dose reductions, but I don;t know how to go about asking for them without seeming suspicious, and if I get pushed off the diaz 'script, I'm fucked.
Take it easy, it's still a long way down.
