Alternatives to Benzodiazepines. PCPs Look Here!

[101N]

Dear PCPs. The combination of benzos and opioids is dangerous. Approximately 1/3rd of opioid OD deaths include a benzo. So here is a list of non-benzo alternatives for you to use for sleep, anxiety, and panic attacks.

4/11/16 Update:

Drug Alcohol Depend. 2004 Oct 5;76(1):31-5.
Benzodiazepine co-dependence exacerbates the opiate withdrawal syndrome.
de Wet C1, Reed L, Glasper A, Moran P, Bearn J, Gossop M.
Author information

Abstract
Patients seeking treatment for opiate withdrawal are commonly also dependent on benzodiazepines, although the interactions between benzodiazepine and opiate dependence and withdrawal syndromes have been subject to little systematic investigation. This is the first study comparing type, severity and course of opiate withdrawal symptoms between opiate dependent patients with, and without, concurrent benzodiazepine dependence. Patients dependent only on opiates (n = 39), and patients dependent on both opiates and benzodiazepines (n = 22), were recruited from consecutive admissions to an in-patient drug treatment unit. Quantity and duration of prior opiate use was similar for both groups. Patients completed daily self-ratings of opiate withdrawal (SOWS) for the duration of a standard in-patient detoxification treatment. Co-dependent patients were detoxified from benzodiazepines and opiates concurrently. Co-dependent patients reported a more severe withdrawal symptoms than patients withdrawing from opiates alone. Co-dependent patients had significantly more severe opiate withdrawal symptoms. Concurrent benzodiazepine withdrawal exacerbates opiate specific withdrawal symptoms. Possible psychological and neurophysiological mechanisms for the observed sensitisation are discussed.

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[lobelsteve]

" the doctor I'm allergic to all of these things."

 

[oreosandsake]

Like +1000

 

[NJPAIN]

I think the psychiatrists need to see this also.

 

[jettavr6]

I think the psychiatrists need to see this also.

Yes, absolutely. Unfortunately, a lot of psychiatrists end up becoming the worst offenders out there. I've seen psychiatrists prescribe 2 different benzodiazepines at the same time. Not the way we were trained.

 

[VA Hopeful Dr]

I can't be alone in kinda wishing that, if not all benzos, at least xanax would get changed to schedule 2. In the last month, I've had 3 different new patients curse at me for not continuing the 2mg TID xanax their last PCP started them on.

I'm just a few more of those away from going all Punisher on some of the worse local offenders.

 

[lobelsteve]

Couple pcps here like 2mg tid or qid xanax. My notes are truthful, derogatory. Cc. Hoping to save lives.

 

[bedrock]

Couple pcps here like 2mg tid or qid xanax. My notes are truthful, derogatory. Cc. Hoping to save lives.

Those notes should be. I also rip those psychiatrists/PCPs a new one as TID Xanax hasn't been the standard of care for anxiety treatment since the 60s.

I don't prescribe opioids to anyone on benzos, and make that clear in all my notes.

 

[Extralong]

I like this document, though, Lamotrigine is misspelled.

In my humble opinion, I wouldn't be comfortable with PCPs just throwing depakote and lamotrigine out there without proper training. But its sure as hell better then having pts on opiates and benzo.

 

[101N]

I like this document, though, Lamotrigine is misspelled.

In my humble opinion, I wouldn't be comfortable with PCPs just throwing depakote and lamotrigine out there without proper training. But its sure as hell better then having pts on opiates and benzo.

Thanks, will fix.

I'd much rather they wrote for depakote and lamotrigine than benzos and opioids.

 

[101N]

Corrected spelling and added a couple of more alternatives:

 

[clubdeac]

Yeah depakote is knasty stuff