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Offline insights

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Re: Afraid, doctor lowered my Xanax script and said nothing?
« Reply #10 on: June 27, 2014, 07:52:10 AM »
I am just curious as to why you believe physicians are becoming more hesitant to write for BZDs.  What do you believe is their motivation?  Are they merely sadistic?

No, they've been conned into thinking BZDs are evil by people like you, and by drug company reps pushing antidepressants. Everything can be evil when misused. Aspirin kills about 2,000 Americans every year, about the same number as heroin, and is the reason for about 20% of kidney transplants. But when used wisely it also saves many lives. Similarly, for many anxiety sufferers BZDs would be a better option than antidepressants.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline ShawnW

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Re: Afraid, doctor lowered my Xanax script and said nothing?
« Reply #11 on: June 29, 2014, 12:05:54 AM »
I am just curious as to why you believe physicians are becoming more hesitant to write for BZDs.  What do you believe is their motivation?  Are they merely sadistic?

No, they've been conned into thinking BZDs are evil by people like you, and by drug company reps pushing antidepressants. Everything can be evil when misused. Aspirin kills about 2,000 Americans every year, about the same number as heroin, and is the reason for about 20% of kidney transplants. But when used wisely it also saves many lives. Similarly, for many anxiety sufferers BZDs would be a better option than antidepressants.

Ian

Ahh, I see.  It's a big conspiracy.  A guy who does some internet reading, who doesn't work in the field has got it all figured out.  It couldn't have anything to do with real dangers associated with BZD use including dependence and addiction (in those genetically predisposed).  It couldn't have anything to do with the family practitioners of this country seeing patients abusing and selling their benzo prescriptions.  It's merely "guys like me" convincing intelligent educated men to believe something that is completely false.  And it's "guys like me" who effectively just want to torture patients?  Are all my patients lying to me?  Are these people with benzo addiction who have given up house, home, families and even sold themselves to use just making it up?  Or maybe I am making it up eh?  How about those opiate addicts who like to use benzos to potentiate the opiates?   

Can I ask you something?  Why does Xanax have a street value?  Why does Valium have a street value? Just misunderstood anxiety patients who are looking for relief because their docs are torturing them?  Or maybe "guys like me" have convinced the world that they are good drugs to abuse and have created a market.   

While it's true that everything including water can cause harm when misused...not everything causes euphoria.  And anything that can cause euphoria will be abused, misused, and people can become addicted to it. 
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Offline insights

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Re: Afraid, doctor lowered my Xanax script and said nothing?
« Reply #12 on: June 29, 2014, 02:16:47 AM »
Can I ask you something?  Why does Xanax have a street value?  Why does Valium have a street value?

Mostly, because it is used by drug addicts to moderate the effects of the drugs, or help them cope with withdrawals, not usually to supply the unmet needs of anxiety sufferers, though it could be argued that many addicts became addicts because the drugs relieved an unrecognized disorder. There would be few of them posting here at AZ, but I find it interesting that you appear to be lumping the BZD street drug issues together with BZD in the anxiety community.

Most of those taking these meds for anxiety do not abuse their benzodiazepines. Indeed, the evidence is that most reduce their doses over time. To quote possibly the most zealous anti benzodiazepine campaigner of them all, "Given the number of people who are prescribed benzodiazepines, relatively few patients increase their dosage or engage in drug-seeking behavior.....Abuse is frequently associated with adolescents and young adults who take benzodiazepines to obtain a high. This intoxicated state results in reduced inhibition and impaired judgment. Concurrent use of alcohol or other depressants with benzodiazepines can be life-threatening. Abuse of benzodiazepines is particularly high among heroin and cocaine abusers. Approximately 50 percent of people entering treatment for narcotic or cocaine addiction also report abusing benzodiazepines." Benzodiazepine : Rational Use Of Benzodiazepines, Prof C. Heather Ashton.

I doubt that many genuine anxiety sufferers sell their benzodiazepines, but that street BZDs come mostly from illicit drug users gaming doctors, both to get BZDs for their own use and to sell to buy illicit drugs.

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And anything that can cause euphoria will be abused, misused, and people can become addicted to it.

Yes. But in this case they can also help people when nothing else will. Most of those prescribed antidepressants don't take them long enough to get any benefit because they can't tolerate the side-effects. Of those that do, about a third derive no benefit from them, another third do not get full relief. How do you propose they be helped? Therapy? Sure, it can be highly effective. but for many Americans it is about as accessible as the Moon. Plus, just as with antidepressants, therapy doesn't work for everyone, and there seems to be a large overlap with those not helped by antidepressants.

So how do the medical zealots then help these people? What answer do they have? Usually, none, IME. They often just leave their patients to to fend for themselves, resulting in many leading miserable lives. The zealots don't care that in fixing one problem they make life miserable for many others as has happened in Britain where benzodiazepines are almost impossible to obtained from NHS doctors. This has lead to deaths among those who unable to get adequate relief for their anxiety give up on living, something which will only get worse as the push there against antidepressants gains more and more traction and the number of available therapists proves inadequate.

And while I have your attention, maybe it is time you leaned about the difference between addiction and dependence, which is knowledge you seem to be unable to process. Perhaps this will help, it's mainly about opiates, but is just as applicable to benzodiazepines: Definitions Related to the Use of Opioids for the Treatment of Pain: Consensus Statement of the American Academy of Pain Medicine, the American Pain Society, and the American Society of Addiction Medicine (PDF).

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline ShawnW

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Re: Afraid, doctor lowered my Xanax script and said nothing?
« Reply #13 on: June 29, 2014, 04:42:58 AM »
Insight, you keep creating a straw man so that you can shoot it down.  The fact is this, I never said BZDs are bad drugs or that most or any within this community would abuse or sell them.  You have given every indication that you believe their abuse potential to be low/none and my responses are to those thoughts alone.  I haven't speculated on this community.  I speak as an addictionologist concerned with misinformation and medical advice being given about the safety of a drug without the context of medical/family/addiction history of the patient.  It is harmful.

Did you know when I worked as a family practitioner I prescribed BZDs?  Hmm...interesting for a "anti-benzo zealot".  I believe them to be the right thing for certain anxiety patients.  In many individuals they are not abused.  So, the picture you are trying to paint isn't accurate.  I don't believe them to be dirty or evil drugs.  I'm not trying to extrapolate upon this community unlike yourself.  I want some people who have an addiction history, or a strong family history of addiction to understand these drugs are not without risk for them. 

But, you have never addressed my concerns about your statements.  Do you believe BZDs are safe for lets say a recovering alcoholic to take for their anxiety?  If so why?  If not why?  And do you have any legitimate medical references for your beliefs?

As for why the BZDs have street value being withdraw related or to moderate other drugs...I would agree.  But, that isn't the only reason they have street value.  I treat primary BZD addiction where that is their only drug of choice.  Are they lying to me?  While issues with substance abuse are often polysubstance abuse, BZDs are the second most common addiction I treat right behind opiate addiction.  Anything that causes euphoria can and will be abused.  That's addiction 101. 
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Want to know how to address your anxiety?
http://www.anxietyzone.com/index.php/topic,93402.msg521266.html#msg521266

Offline ShawnW

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Re: Afraid, doctor lowered my Xanax script and said nothing?
« Reply #14 on: June 29, 2014, 05:07:19 AM »
PS- I passed my ASAM boards, have you?  Obviously, you don't have any idea about anything related to addiction.

Since we are discussing articles here is one for you...

http://www.samhsa.gov/data/2k11/WEB_TEDS_028/WEB_TEDS-028_BenzoAdmissions.htm

That is an even handed article that matches what I see in our treatment center.

Take home messages...

1) Benzo admissions tripled from 1998-2008
2) While benzos are usually taken with other drugs, 5% reported that being their only drug of choice.
3) 12.9% reported that BZDs were their primary drug of choice.
4) That physicians need to screen patients for those who are predisposed to addiction.
5) A significant portion of BZD admissions also have concurrent psychiatric diagnosis (which accounts for many on this board)

Everything fits what I am saying...use caution as these drugs are not without risk.  People do abuse BZDs alone AND with other drugs.  If you have a history of addiction or a strong family history these drugs propose a much higher risk for that population.  And just because you have a primary psych diagnosis doesn't mean addiction to these medications shouldn't be a concern.

Now, if you say that these conclusions are merely the brainwashing of doctors by "the man", then I don't think we have anything else to discuss.
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My insight, thoughts, experiences or advice that may be posted in this forum are not meant as a substitution for the advice of your physician.

Want to know how to address your anxiety?
http://www.anxietyzone.com/index.php/topic,93402.msg521266.html#msg521266

Offline insights

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Re: Afraid, doctor lowered my Xanax script and said nothing?
« Reply #15 on: June 29, 2014, 09:03:12 AM »
I believe them to be the right thing for certain anxiety patients.

I don't believe you do. If you did you wouldn't be calling them "addictive" drugs without qualification. The only time you add a qualification about their use, as in the above, is when challenged, otherwise it is a lot of inflammatory statements, much of which have little to do with the great majority of anxiety patients. It is something I see often from the zealots. Again, the great majority of anxiety patients do not abuse benzodiazepines, don't escalate their dose, nor do they sell them on the street.

Quote
But, you have never addressed my concerns about your statements.  Do you believe BZDs are safe for lets say a recovering alcoholic to take for their anxiety?

Probably, not, though that would be a case by case judgment. I don't know the history of everyone that comes here, and I'm no more going to interrogate them than you do. The appropriateness of BZDs is something that their doctors will have to decide, not me, and not you.

Quote
Anything that causes euphoria can and will be abused.  That's addiction 101.

What is also "addiction 101" is that addiction is about more than just the drug. It is a psychosocial phenomenon in addition to a chemical one. To quote from the ASAM definitions article I linked to earlier regarding opiates, "Addiction, unlike tolerance and physical dependence, is not a predictable drug effect, but represents an idiosyncratic adverse reaction in biologically and psychosocially vulnerable individuals....Addiction is a primary chronic disease and exposure to drugs is only one of the etiologic factors in its development." But your attention is just on the drug. You're like the guy with a hammer who loses sight of the big picture and only sees nails sticking up.

Most people taking BZDs for anxiety disorders do not experience euphoria and drugs that don't produce euphoria are also abused. Aspirin for example which can be truly addictive to the point that some will return to it time and again even though doing so damages their bodies and will ultimately cause their death.

You want me to attach warnings every time I mention BZDs? Well stiff cheese, sonny, it ain't going to happen, just as I don't list all the potential hazards of antidepressants or therapy whenever I write about them. That is something their doctors should be doing. Being the gatekeeper on the suitability of a med is the most fundamental part of their job.

Ian
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NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

Offline NeverAgain2

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Re: Afraid, doctor lowered my Xanax script and said nothing?
« Reply #16 on: June 29, 2014, 09:13:17 AM »
I believe them to be the right thing for certain anxiety patients.

I don't believe you do. If you did you wouldn't be calling them "addictive" drugs without qualification. The only time you add a qualification about their use, as in the above, is when challenged, otherwise it is a lot of inflammatory statements, much of which have little to do with the great majority of anxiety patients. It is something I see often from the zealots. Again, the great majority of anxiety patients do not abuse benzodiazepines, don't escalate their dose, nor do they sell them on the street.

Quote
But, you have never addressed my concerns about your statements.  Do you believe BZDs are safe for lets say a recovering alcoholic to take for their anxiety?

Probably, not, though that would be a case by case judgment. I don't know the history of everyone that comes here, and I'm no more going to interrogate them than you do. The appropriateness of BZDs is something that their doctors will have to decide, not me, and not you.

Quote
Anything that causes euphoria can and will be abused.  That's addiction 101.

What is also "addiction 101" is that addiction is about more than just the drug. It is a psychosocial phenomenon in addition to a chemical one. To quote from the ASAM definitions article I linked to earlier regarding opiates, "Addiction, unlike tolerance and physical dependence, is not a predictable drug effect, but represents an idiosyncratic adverse reaction in biologically and psychosocially vulnerable individuals....Addiction is a primary chronic disease and exposure to drugs is only one of the etiologic factors in its development." But your attention is just on the drug. You're like the guy with a hammer who loses sight of the big picture and only sees nails sticking up.

Most people taking BZDs for anxiety disorders do not experience euphoria and drugs that don't produce euphoria are also abused. Aspirin for example which can be truly addictive to the point that some will return to it time and again even though doing so damages their bodies and will ultimately cause their death.

You want me to attach warnings every time I mention BZDs? Well stiff cheese, sonny, it ain't going to happen, just as I don't list all the potential hazards of antidepressants or therapy whenever I write about them. That is something their doctors should be doing. Being the gatekeeper on the suitability of a med is the most fundamental part of their job.

Ian

Hear, hear!

Fight "Med Madness". 
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Offline ShawnW

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Re: Afraid, doctor lowered my Xanax script and said nothing?
« Reply #17 on: June 29, 2014, 10:43:52 AM »
I believe them to be the right thing for certain anxiety patients.

I don't believe you do. If you did you wouldn't be calling them "addictive" drugs without qualification. The only time you add a qualification about their use, as in the above, is when challenged, otherwise it is a lot of inflammatory statements, much of which have little to do with the great majority of anxiety patients. It is something I see often from the zealots. Again, the great majority of anxiety patients do not abuse benzodiazepines, don't escalate their dose, nor do they sell them on the street.

Quote
But, you have never addressed my concerns about your statements.  Do you believe BZDs are safe for lets say a recovering alcoholic to take for their anxiety?

Probably, not, though that would be a case by case judgment. I don't know the history of everyone that comes here, and I'm no more going to interrogate them than you do. The appropriateness of BZDs is something that their doctors will have to decide, not me, and not you.

Quote
Anything that causes euphoria can and will be abused.  That's addiction 101.

What is also "addiction 101" is that addiction is about more than just the drug. It is a psychosocial phenomenon in addition to a chemical one. To quote from the ASAM definitions article I linked to earlier regarding opiates, "Addiction, unlike tolerance and physical dependence, is not a predictable drug effect, but represents an idiosyncratic adverse reaction in biologically and psychosocially vulnerable individuals....Addiction is a primary chronic disease and exposure to drugs is only one of the etiologic factors in its development." But your attention is just on the drug. You're like the guy with a hammer who loses sight of the big picture and only sees nails sticking up.

Most people taking BZDs for anxiety disorders do not experience euphoria and drugs that don't produce euphoria are also abused. Aspirin for example which can be truly addictive to the point that some will return to it time and again even though doing so damages their bodies and will ultimately cause their death.

You want me to attach warnings every time I mention BZDs? Well stiff cheese, sonny, it ain't going to happen, just as I don't list all the potential hazards of antidepressants or therapy whenever I write about them. That is something their doctors should be doing. Being the gatekeeper on the suitability of a med is the most fundamental part of their job.

Ian

Ian,

I don't know how many words you put into my mouth, but I must admit you are determined to defocus the conversation.  I have been stating you must look at the history since the first time we discussed this topic.  You on the other hand have made no attempt to do so in any of your conversations with individuals on this board.  This is merely hocus pocus change the focus in order to preserve your stance.

You admit that BZDs are "probably" not safe for an alcoholic.  Great.  That's all I needed to see in print.  You are correct they are not safe in this population.  I could care less what you believe about my philosophy or medical knowledge.  We have gotten somewhere so this discussion wasn't a total waste of my time.

The only population I am concerned about are those with a predilection towards addiction.  Statistically, that is probably around 10% of the posters on this message board.  When you have been giving your medical advice to people on this board (totally unqualified to do so btw) I have not seen you once ask about a persons history of addiction.  So, the fact that you admit that these are probably not safe in those with tendencies towards addiction is a step in the right direction.
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My insight, thoughts, experiences or advice that may be posted in this forum are not meant as a substitution for the advice of your physician.

Want to know how to address your anxiety?
http://www.anxietyzone.com/index.php/topic,93402.msg521266.html#msg521266

Offline ShawnW

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Re: Afraid, doctor lowered my Xanax script and said nothing?
« Reply #18 on: June 29, 2014, 10:46:55 AM »
PS- I passed my ASAM boards, have you?  Obviously, you don't have any idea about anything related to addiction.

Since we are discussing articles here is one for you...

http://www.samhsa.gov/data/2k11/WEB_TEDS_028/WEB_TEDS-028_BenzoAdmissions.htm

That is an even handed article that matches what I see in our treatment center.

Take home messages...

1) Benzo admissions tripled from 1998-2008
2) While benzos are usually taken with other drugs, 5% reported that being their only drug of choice.
3) 12.9% reported that BZDs were their primary drug of choice.
4) That physicians need to screen patients for those who are predisposed to addiction.
5) A significant portion of BZD admissions also have concurrent psychiatric diagnosis (which accounts for many on this board)

Everything fits what I am saying...use caution as these drugs are not without risk.  People do abuse BZDs alone AND with other drugs.  If you have a history of addiction or a strong family history these drugs propose a much higher risk for that population.  And just because you have a primary psych diagnosis doesn't mean addiction to these medications shouldn't be a concern.

Now, if you say that these conclusions are merely the brainwashing of doctors by "the man", then I don't think we have anything else to discuss.

I guess this SAMHSA report made a small crack to where you are teachable?  If not, I hope others at least learned something from the report.

BTW-How many people need to go to treatment for aspirin addiction?  That is such an odd argument.  How many people would sell themselves for aspirin?
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My insight, thoughts, experiences or advice that may be posted in this forum are not meant as a substitution for the advice of your physician.

Want to know how to address your anxiety?
http://www.anxietyzone.com/index.php/topic,93402.msg521266.html#msg521266

Offline NeverAgain2

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Re: Afraid, doctor lowered my Xanax script and said nothing?
« Reply #19 on: June 29, 2014, 11:08:41 AM »
Shawn W....

If I missed it I'm sorry, but where in your bio is your mention and proof that you are a medical doctor?

And, are you on this forum to offer advice to people or to seek it yourself -- or both?

I am not trying to be confrontational here, but, as you know, anybody can come onto the internet and pose as anything.  I think you can see from some of my posts where I stand on the issue of Benzos, so I won't take up any truck with you about that.  But, really, who are you?  I know Ian is a layman, so his advice is taken into consideration from that perspective.  You are a doctor, so you say, and it would be helpful to know your pedigree, experience, reason for postings, and current practice, so as to lend credibility.

Thanks.
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