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"Doctor I need..."
No. No you do not.
No. No you do not.
Plastic surgery, Xanax, Adderall, and hormone replacement
- Thread starter F0nzie
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Yesterday. Friday. 4:30pm:
"I been takin' Xanax four pills a day and 3 Trazodone a day for 20 years from my old doctor. That and 3 pills of Hydrocodone are all that work so I can sleep. That other B**** doctor cut me off 8 months ago! I NEED it and you gotta prescribe it."
Find out from the primary care doctor's notes that the patient that has been buying these drugs off the street for the last few months, and patient tells me EMS had to respond to a call last night because he passed out after taking these drugs. I simply said "I cannot do that."
I will probably have to explain myself to clinic management later, when the inevitable complaint is filed, because I said "I cannot do that" .
What I'm learning anew every day: you just can't reason with people addicted to benzos and no desire to get clean any more than you can reason with a person with strong psychotic delusions. Folks with benzodiazepine dependence are illogical and completely lack insight. I have tried to give very good, supportive explanations on the best way to treat anxiety per evidence, after listening empathically for a while, and attempt to use motivational interviewing. It takes forever, and I can't afford to get behind with a waiting room full of patients while the addicted patient throws a tantrum and tries to negotiate with the single minded goal of scoring more Xanax. It's like beating my head against a brick wall. I come away with a headache.
A simple "I cannot do that" and moving on has proved much more effective in avoiding temper tantrums by adults in my office that take time away from other patients.
"I been takin' Xanax four pills a day and 3 Trazodone a day for 20 years from my old doctor. That and 3 pills of Hydrocodone are all that work so I can sleep. That other B**** doctor cut me off 8 months ago! I NEED it and you gotta prescribe it."
Find out from the primary care doctor's notes that the patient that has been buying these drugs off the street for the last few months, and patient tells me EMS had to respond to a call last night because he passed out after taking these drugs. I simply said "I cannot do that."
I will probably have to explain myself to clinic management later, when the inevitable complaint is filed, because I said "I cannot do that" .
What I'm learning anew every day: you just can't reason with people addicted to benzos and no desire to get clean any more than you can reason with a person with strong psychotic delusions. Folks with benzodiazepine dependence are illogical and completely lack insight. I have tried to give very good, supportive explanations on the best way to treat anxiety per evidence, after listening empathically for a while, and attempt to use motivational interviewing. It takes forever, and I can't afford to get behind with a waiting room full of patients while the addicted patient throws a tantrum and tries to negotiate with the single minded goal of scoring more Xanax. It's like beating my head against a brick wall. I come away with a headache.
A simple "I cannot do that" and moving on has proved much more effective in avoiding temper tantrums by adults in my office that take time away from other patients.
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I feel I need a support group for this.
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Them: "Yeah…I take…what's the name….oh yeah…dilaudid. That's the only thing that helps me relax."
Me: "Uh-huh…"
Me: "Uh-huh…"
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Someone my husband works with used to work at the SA Health Department's authority prescriptions phone lines (basically the place a Doctor phones when they need to get an authorisation code on a script , like Xanax). Apparently almost every shift they'd get at least one idiot obviously phoning in from a phone box (complete with traffic noise in the back ground), who'd start the call off with any slurred variation of - "Um yeah, I think I'll have..." Seriously, you're not ordering off a f**king menu here, and how wasted do you have to be to think the fact that you're calling from a phone box, in the middle of a busy street, with really audible traffic noises in the background, is totally NOT going to raise any immediate suspicions whatsoever.
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People with benzodiazepine dependence have an actual chemical imbalance (not just the theorized type) that affects the entire body and mind.
The ones I have met through benzobuddies.org are some of the most earnest, thoughtful, caring people I have met, and they often deal with psychiatrists who will not help them withdraw or who can't fathom why they want to withdraw from benzodiazepines.
Watch this video and tell me if the person lacks logic and insight:
There are thousands of people helping each other, and they all are benzodiazepine dependent. And they didn't become benzodiazepine dependent without the help of doctors. And yet many of them are getting clean without the help of doctors.
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Nope, sorry, what Wolfvgang describes is classic drug seeking behaviour WITH corroborating evidence to back up the fact that this patient is actually ABUSING the drugs they are being prescribed. And if the patient had already been cut off previously 8 months prior, then unless they were scoring off the streets (which they were in this case), or Doctor shopping (both indicative of an addiction versus simple dependence) then no, they don't actually 'need' those drugs, seeing as if they'd been off them for that amount of time they would no longer be dependent on them - addicted maybe, dependent no.
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You cut off the quote that I was referencing. I wasn't referring to the anecdote, I was referring to the very generalized statement that I bolded: "Folks with benzodiazepine dependence are illogical and completely lack insight."
It's not helpful, as you said, to start conflating addictive behavior where a person is seeking ever greater amounts of a drug to abuse or use not as prescribed with a person who is benzodiazepine dependent. The conversation I quoted went from one to the other with no segue, and I was pointing out that the generalized statement regarding people with benzodiazepine dependence isn't true.
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I didn't see the bolded part, although even if I had I still would have agreed with the sentiment - dependent or addicted, it doesn't matter, if you find your supply suddenly cut off and you know you're facing withdrawal, then you will lose all insight, reason and logic in a desperate attempt to prevent that happening. As you know I went from being a Benzo addict/abuser, to a dependent addict, to being solely dependent after I completely lost any psychological drive or addiction towards those pills but still couldn't just get off the damn things because of the horrendous withdrawals I knew I'd be facing. Believe me, dependent alone with no added addiction features, when I found myself suddenly cut off from my supply oh how I did scream, and cry, and beg, and threaten, and cajole and basically do everything but start bartering sexual favours with the nearest Doctor I could get hold of. I totally lost all reason at that point, because all I was thinking was "Oh god, I don't want to go through withdrawal' - that wasn't addiction driving that response, it was plain old, simple dependence.
Edited to add: Wolfvgang also quantified that he was talking about people with 'no desire to get clean' in his prior sentence as well. So obviously he's not talking about someone who is benzo dependent legitimately coming to him for help.
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I hear you, birch. I know about benzobuddies. Good on them for working with their doctors!
I do have FOUR patients that are dependent on benzodiazepines that are working with me to titrate from Xanax to longer acting benzodiazepines, and then gradually reducing dependence on the longer acting benzos. I got no problem with those patients, I like 'em and I'm very proud of those four. I'm also very proud of all but one of my patients on Suboxone, these are people who have turned their lives around, it's great. I just wish I had a suboxone-like treatment for benzos.
I was venting because many of the other patients I have with benzodiazepine dependence aren't like those four, and they don't want me to help them. Yet, I'm not allowed to turn them away. Sometimes it's really frustrating - especially when "patient satisfaction" determines a large part of whether I'm considered a good doctor or not by my organization.
This is a forum for psychiatrists and psychiatrists in training. This thread started out with some venting about having to say no to demanding patients. My bad if that wasn't what it was about.
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I'm sorry, as well. I am tapering myself and am more prone to being irritable. I also was doing the crossover to a longer-acting benzo, but it was too sedating and it seemed to be disproportionately powerful at its theoretical equivalence, so I am now doing what I've termed a "partial crossover taper." Keeping a small dose of the long-acting on board that I already substituted for some of the short-acting, while doing a liquid taper of the remaining short-acting. I jumped on that one line, and I do understand it wasn't fair in the larger context of what you are writing. It's always good to be reminded that there are good psychiatrists who are willing to work with patients on benzodiazepine withdrawal. It's a frustrating process and frustrating to have relatives and other people in your life who see it as simpler than it is, and so I am prone to frustration. It's a vulnerable place to be. You are in a way an addict—I need my psychiatrist to prescribe my drugs. And it's very frustrating as well because when I was put on these at age 15 I was terrified of going on anything at all and had no idea what type of substance I was really taking. As someone who is benzo-dependent, I know that I haven't done anything wrong, but it doesn't feel that way. It is a hard position to be in when you need others' help so much. Before I was brave enough to taper I had spent years reading horror stories of withdrawal and with my OCD obsessed about the seizures and cardiac arrest (which I rationally know only happen with sudden withdrawal but I extrapolated to myself). So I do have a fear of what would happen if my psychiatrist suddenly left (it's happened before) and the next one just saw me as a drug addict and cut me off. So I guess I have some need to defend my state. And the irony of being in this state due to previous psychiatric care is never lost on me--although I try to not go down that path. I don't have nearly the patience and tranquility and forgiveness that most of the people on benzobuddies have. They are quite inspiring. And I am probably uniquely difficult in some ways both to myself and to others.
It sounds like you work in a very different place than any I've been to where you have to worry about patient satisfaction, and you sound like a great doctor. I also wish there more of a clinic like you mentioned. I need a LOT of reassurance, and I can only see my psychiatrist every 2-3 months and she doesn't take phone calls or e-mails. She's the best I've found for being flexible and being benzo knowledgable. She's now listed as a "benzo-wise" doctor and has a full roster. I see my psychologist every week but he can't offer the type of fine-grain advice that she can. It would be great to have more support somehow. But BenzoBuddies has been amazing. I hope that one day I can give people on that site as much advice as they've given me.
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I really wish you had access to better, and more regular help and support as well, Birchswing. Just remember though, you know you're not a drug seeker who's just making up excuses to keep scoring pills, I know you're not a drug seeker who's just making up excuses to keep scoring pills, and the Doctors who've gotten to know you on here know you're not a drug seeker who's just making up excuses to keep scoring pills - you don't need to defend or prove yourself to anybody. Now some newbie coming in here and talking smack to you when they know jack about your situation, that's another story, but the rest of us, you don't need to prove a damn thing.
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I am seeing a lot of performance enhancing junkies in the affluent group at my private practice. Not sure if bipolar, %#*%*, or too much testosterone.
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The worst part is they are receiving these treatments from doctors and believing these are legitimate treatments.
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Seems like a winning combo for the entrepreneurs (even the young ones) is hormone injections from their anti-aging clinic to enhance their sexuality, stimulants for concentration, and benzos to help them wind down from the hormones and stimulants.
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Speaking of benzos I have tapered over 50 long term benzo users at my SMI clinic. My caseload is 100% benzo free. Sure I had my life and car paint threatened. But everybody is doing fine if not better. I just present the evidence, respond empathically, and initiate the taper. Every new referral I get from another psychiatrist gets their starting taper on my intake.
I did recently give Ativan for a catatonic patient and cured that pretty quickly. But that's about it.
I did recently give Ativan for a catatonic patient and cured that pretty quickly. But that's about it.
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I'm impressed... I'm not there yet. I inhereted a lot of people on BZD. You give me great hope!
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Just to clarify not all the long term benzodiazepine patients had issues with addiction. All of them were physically dependent though-- which is the nature of the beast when taken long-term.
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There was a Doctor here (GP) who handed out performance enhancers, mostly testosterone injections, to anyone who asked. They didn't need a legitimate reason, neither did the junkies and benzo seekers looking to score either, if you couldn't come up with a BS enough excuse to get something, he'd just tell you to ask for what you wanted and he'd just make something up later on so it was all 'above board'. His waiting room was pretty much like a mix between a Narc Anon meeting and a 'Steroids R Us' convention.
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Wow
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[edited for TMI ramblings]
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This is the beat I'm dancing to
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When I thought I heard it all, a 74 yr old guy shows up saying that he was using his nephew's oxycontin and vicodin for about 3-4 days and he was wondering if there was a medication which would work the same (euphoria) without the depenency issues..
great post.
That's the strategy I use with many patients now, with one perhaps slightly different caveat. I *don't* try to oversell the non-narcotic treatments for GAD/SAD we have. I mean they've done those things and they've done therapy before. Now in some cases we could quibble over whether it was a therapeutic dose or not, but you're really just splitting hairs.
Basically, what I'll say is: I get it. You're anxious. It's distressing. But I'm not going to give you more/any controlled substances, and that's just the way it is. I know you are upset with this, and if you can find a prescriber who takes a different approach here I would suggest you do it.
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I'm going to get one of those 1 gallon fishbowls and just fill it up with BZD, Opiates and stimulants....
On your way out, just grab a handful. Like the Doritos commercial, I bet you can't eat just one!
On your way out, just grab a handful. Like the Doritos commercial, I bet you can't eat just one!
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Sometimes I think life would be simpler if I were a pez dispenser. Pull my head back and I puke Xanax bars.
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You need a stoma, would be more realistic.
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Maybe.
Today I learned that a patient killed herself and that my aunt has a brain tumor
I've been better.
What are the odds? Srsly.
Today I learned that a patient killed herself and that my aunt has a brain tumor
I've been better.
What are the odds? Srsly.
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Sucks. PM if you need to vent.
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And some are buying the pills off the street. Or take from family members.
And some abuse the ones the docs give them.
And on..
and on...
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What is the prevalence of that versus the prevalence of people who are iatrogenically benzodiazepine dependent?
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Too hard to tell but anecdotally speaking, likely the former over the latter.
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All these people snorting pills. Mixing with alcohol. We didn't tell them to do that.
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I'm really sorry to hear that. I hope you can reach out to your colleagues for support if you need it.
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Shhh, you'll ruin their high.
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For the ultimate buzzkill they could always try bunting the tablets instead - and then end up with a venous blood clot from the impurities they didn't manage to filter out, and have the clot break off and lodge in the brain, causing a stroke and leaving them paralysed with a walking frame and speech impediment at the age of 20 something. Yeah, fun times all round, only not.
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Then they'll sue the doc. It is the US after all.
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*shakes head* Unbelievable that a Doctor could be held accountable for what any patient ultimately decides to do to themselves. To me this would be like the equivalent of someone coming home from having surgery, tearing their stitches out, packing the incision with dirt, and then suing the surgeon because they got an infection.
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*shakes head* Unbelievable that a Doctor could be held accountable for what any patient ultimately decides to do to themselves. To me this would be like the equivalent of someone coming home from having surgery, tearing their stitches out, packing the incision with dirt, and then suing the surgeon because they got an infection.
I'm all for masturbation, but it's problematic if you start conflating the the hypothetical patient you get off on with ones who exist in reality—you know the people on planet earth who have never actually sued you for snorting tablets. Or the 99.99% like myself who have no idea what bunting is.
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When they do sue, it's bc they took too many pills and downed them with alcohol.
Who's fault is that?
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Sorry, I slipped into slang terminology there - bunting = IV injection. And someone sueing a Doctor for their own stupidity isn't something I hear of happening a lot here, I get the impression though that things are different in the United States.
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I have just never heard of such a case. I've never heard of a psychiatrist being held responsible for prescribing benzodiazepines long-term and not giving informed consent as to the risks vs benefits of doing so, let alone a psychiatrist being responsible for the personal choices of a patient.
I can tell you as someone who has been legally prescribed benzodiazepines for 17 years that not one psychiatrist has ever told me not to drink alcohol. But I never have drunk alcohol in my life because I have done a lot of research on the interactions medications have. No one's told me not to drink grapefruit juice that interacts with my Seroquel, but I don't anyway. No one's told me to avoid limes or bergamot. I have sacrificed my Earl Grey tea for over a decade to be on the safe side. Not one doctor ever recommended having my blood sugar and lipids checked even though I take Seroquel. I take all responsibility for these things, but when I've seen psychiatrists not follow a standard of care, I have never seen a repercussion for it. I just created a thread about all the criminal acts of psychiatrists near where I live and how all of them are still practicing. To imagine a junkie having the means to sue a psychiatrist for their own bad behavior seems nearly impossible to me, when I haven't seen psychiatrists successfully sued for their own bad behavior.
