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Kaiser Permanete's guidelines in the management of chronic BZD patients


[Fi...]

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For better or worse, this appears to be the most recent Kaiser Permanente's Guidelines & Protocols to "minimize practice variation in the management of patients on chronic benzodiazepine therapy to improve

patient safety and increase both patient and provider satisfaction."

 

According to wikipedia, Kaiser Permanente is the largest managed care organization in the U.S. (1)

 

 

https://wa.kaiserpermanente.org/static/pdf/public/guidelines/benzo-zdrug.pdf

 

I don't know how Kaiser Permanente's guidelines compare with your experience & knowledge but I thought I'd toss it out there for your consideration. best wishes

 

(1) https://en.wikipedia.org/wiki/Kaiser_Permanente

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Wow, this is way better than I thought it would be! Since it is current, this might be a better thing to print out and bring to a doctor! 10% every 2-4 weeks! That's better than parts of the Ashton schedules!
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I like this very much. My only qualm with it is what if a patient cannot do the 10% in 2-4 weeks and takes YEARS to get off the drug? What then? Would a doctor recognize individual patients' needs for much slower tapers over a long period of time and okay it? That's something I in particular would worry about. This isn't once size fits all by any means.

 

But they're definitely on the right path here!!

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Wow, this is way better than I thought it would be! Since it is current, this might be a better thing to print out and bring to a doctor!

 

Great idea!  I'm printing this out & sharing it with my doctor this Friday. 

 

Another interesting nugget...

 

"Switching to diazepam in patients aged 65 and over is not recommended, as case reports suggest that it may be associated with delirium. For older adults, lorazepam, oxazepam, and temazepam are the safest

options because they don’t have metabolites that can accumulate. Of these, lorazepam is the best in

terms of dosing options—available as 0.5, 1, and 2 mg tabs, and as 2 mg/mL oral solution." (pg. 11)

 

Thanks for sharing, Fi!

 

xo,

sierra  :smitten:

 

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This article is a very important tool for patients in countering the arguments made by doctors who are pushing rapid withdrawal, are denying the patient’s symptoms, or who are dismissive of recommendations made by Benzo awareness groups. I had a great deal of difficulty convincing my doctor that I was not completely under the influence of fringe groups who plastered the internet with exaggerated stories to undermine evidence based medicine. He did not even find Dr. Ashton credible. My husband, who is a pediatrician, became frustrated with his attitude, and found this article which he then forwarded to my doctor. Kaiser is well respected. His attitude toward me changed immediately. Because so many people are going through the difficult process of getting their providers to allow them to safely withdraw, I hope very much that someone has a way of moving this to an information site where more people will view it. I would do it myself, but I don’t know how. Esperanza
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Lorazepam (patients aged 65 and over)

Switching to diazepam in patients aged 65 and over is not recommended, as case reports suggest that it

may be associated with delirium. For older adults, lorazepam, oxazepam, and temazepam are the safest

options because they don’t have metabolites that can accumulate. Of these, lorazepam is the best in

terms of dosing options—available as 0.5, 1, and 2 mg tabs, and as 2 mg/mL oral solution.

 

I don't believe this at all. Ativan is a VERY POTENT drug and should be discontinued slowly. It causes a great deal of anxiety.

 

Well, there are some things I just don't agree with, but someday they'll hopefully get it right...

 

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[21...]

Lorazepam (patients aged 65 and over)

Switching to diazepam in patients aged 65 and over is not recommended, as case reports suggest that it

may be associated with delirium. For older adults, lorazepam, oxazepam, and temazepam are the safest

options because they don’t have metabolites that can accumulate. Of these, lorazepam is the best in

terms of dosing options—available as 0.5, 1, and 2 mg tabs, and as 2 mg/mL oral solution.

 

I don't believe this at all. Ativan is a VERY POTENT drug and should be discontinued slowly. It causes a great deal of anxiety.

 

Well, there are some things I just don't agree with, but someday they'll hopefully get it right...

 

Sad. My best friend’s mother has been on 6 mg of Ativan since her stroke a few years ago. Her mom is in her 90s. Hopefully she won’t ever have to suffer from getting off the drug.

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I haven’t heard about the reasoning of “they don’t have metabolites that can accumulate” but I’m inclined to listen and would like to investigate a little more. It makes sense with the longer half-life. Maybe those mean similar things? I’d like to know more.
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I wonder what would be a good way to present this material to the Dr.  In the past I attempted to give my Dr. a copy of the Ashton manual. He just looked at it for a minute and said "this is not reliable information.  Prior to that, I offered the material to the P.A. and she wouldn't even take it from my hand.  She warned me not to be getting information off the internet! :nono:
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I wonder what would be a good way to present this material to the Dr.  In the past I attempted to give my Dr. a copy of the Ashton manual. He just looked at it for a minute and said "this is not reliable information.  Prior to that, I offered the material to the P.A. and she wouldn't even take it from my hand.  She warned me not to be getting information off the internet! :nono:

 

This angers me greatly.  I'm sorry, arizona.  People in those positions should not treat patients this way.  This is what causes the problem.  Shame on your Dr and the PA.  I would look for another Dr.

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[21...]

I wonder what would be a good way to present this material to the Dr.  In the past I attempted to give my Dr. a copy of the Ashton manual. He just looked at it for a minute and said "this is not reliable information.  Prior to that, I offered the material to the P.A. and she wouldn't even take it from my hand.  She warned me not to be getting information off the internet! :nono:

 

I’m so sorry. That’s ridiculous and utterly infuriating. 😡

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Lorazepam (patients aged 65 and over)

Switching to diazepam in patients aged 65 and over is not recommended, as case reports suggest that it

may be associated with delirium. For older adults, lorazepam, oxazepam, and temazepam are the safest

options because they don’t have metabolites that can accumulate. Of these, lorazepam is the best in

terms of dosing options—available as 0.5, 1, and 2 mg tabs, and as 2 mg/mL oral solution.

 

I don't believe this at all. Ativan is a VERY POTENT drug and should be discontinued slowly. It causes a great deal of anxiety.

 

Well, there are some things I just don't agree with, but someday they'll hopefully get it right...

 

Sad. My best friend’s mother has been on 6 mg of Ativan since her stroke a few years ago. Her mom is in her 90s. Hopefully she won’t ever have to suffer from getting off the drug.

 

At her age, it's best to stay on the drug, even up the dose if they have to. Interdose withdrawals with that drug are terrible!! I'm sorry she's on so much.

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I wonder what would be a good way to present this material to the Dr.  In the past I attempted to give my Dr. a copy of the Ashton manual. He just looked at it for a minute and said "this is not reliable information.  Prior to that, I offered the material to the P.A. and she wouldn't even take it from my hand.  She warned me not to be getting information off the internet! :nono:

 

This angers me greatly.  I'm sorry, arizona.  People in those positions should not treat patients this way.  This is what causes the problem.  Shame on your Dr and the PA. I would look for another Dr.

 

Shame on them both!!!

 

I read a success story from drew 28 today. He said this: At this time I had the interweb and searched my symptoms.  Benzo buddies came up along with the Ashton Manual.  I literally cried at my computer.  I was validated for the first time that it just wasn't all in my head.  I was so excited to get on with the taper that I printed out a copy of the Ashton Manual and brought it to my doc.  He literally said "what does this old bag know" and threw it in the garbage. I was shocked but not surprised.  I kept my mouth shut as I needed him for the drugs. 

 

This is the blatant ignorance we're up against. And of course the pills are needed so people don't say anything. Doctors could refuse to prescribe the pills. The problem is that they have so much power on their side - attorneys, money, the pills - that it would be difficult to sue. VERY angry about this!!!

 

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[21...]

Lorazepam (patients aged 65 and over)

Switching to diazepam in patients aged 65 and over is not recommended, as case reports suggest that it

may be associated with delirium. For older adults, lorazepam, oxazepam, and temazepam are the safest

options because they don’t have metabolites that can accumulate. Of these, lorazepam is the best in

terms of dosing options—available as 0.5, 1, and 2 mg tabs, and as 2 mg/mL oral solution.

 

I don't believe this at all. Ativan is a VERY POTENT drug and should be discontinued slowly. It causes a great deal of anxiety.

 

Well, there are some things I just don't agree with, but someday they'll hopefully get it right...

 

Sad. My best friend’s mother has been on 6 mg of Ativan since her stroke a few years ago. Her mom is in her 90s. Hopefully she won’t ever have to suffer from getting off the drug.

 

At her age, it's best to stay on the drug, even up the dose if they have to. Interdose withdrawals with that drug are terrible!! I'm sorry she's on so much.

 

I agree.

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I encourage those of you who've been mistreated by your doctors to file a formal complaint.  If in the US, contact your state's medical board. 

 

As an example, here's California's:

http://www.mbc.ca.gov/Consumers/Complaints/

 

By doing so, you may help protect future patients from this type of abuse. I believe, it's also important for your recovery & empowering to take a stand against these bullies. 

 

xo,

sierra  :smitten:

 

 

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Thanks for posting this. I am going to add it to our site. Not ideal, but better than expected - appears they got the limited effectiveness right, the conversions right, but some of it was off.

 

It may prevent making new messes, but not sure it cleans up the current ones effectively.

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I agree with you MsAtomicBomb.  I wonder if Benzo Info Coalition would be interested in/willing to create and post an “addendum” to these guidelines that those of us who are tapering can share with our docs? 
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Yes, I agree, Libertas! I think it would be a good idea! How about it, MAB?

 

Otherwise doctors are going to follow this, and some of it is definitely off.

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