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Struck out with doctor, need advice


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Hello,

 

I am presently dependant on Phenazepam, at 0.87mg/day. Phenazepam is a benzodiazepine from Russia, reported to be about 10 times as potent as valium, and which has a 60-hour half life. I just saw a psychiatrist who specializes in anxiety, to see if he'd Ashton me, but he was not comfortable with the idea and referred me here: http://www.kolmac.com/

 

I have an appointment to have an evaluation there tomorrow, but, I'm not hopeful based on what they said that they will

a) cross me over to valium and then allow me to withdraw from it at a reasonable rate

b) not require me to take other drugs during the "detoxification"

 

Since I don't know either of those things for sure, I am going to go see them tomorrow, bring my Ashton literature, and try to have an open mind. However I'm aware that saying "I've been taking an unscheduled chinese benzodiazepine that I've gotten on the internet, and want you to script me valium for the next six months" is going to sound like the epitome of drug-seeking behavior, so I'm not confident that I'm going to have much luck there. So, as I see it, this will leave me with three choices:

A) buy more phenazepam and stay on it until I die (BAD. DON'T WANT TO DO)

B) try their "detox" protocol and see what happens

C) taper directly off phenazepam, and resume seeing a cognitive behavioral therapist that I'd been seeing before, and hope that she will agree to work with me as I taper myself off this wonderfully (terribly) legal benzodiazepine.

 

I'm nervous about B, because I've read so many negative stories about non-Ashton detox protocols, especially those which use other substances to "cover" the benzo withdrawal.

 

So, I have two questions for this forum:

1) - is my skepticism about B above warranted? If the clinic flat out tells me, "you don't need to spend 6 months coming off benzos, we will get you off in a month and give you other drugs to help", is it the opinion of the forum that I would be better served by C?

 

2) - assuming that I do proceed with plan C above, this is the taper that I have worked out, and I'd like to know if it seems reasonable.

 

0.87mg - 10-14 days

0.78mg - 10-14 days (10% reduction)

0.7mg  -  10-14 days (10% reduction)

0.63mg - 10-14 days (10% reduction)

0.51mg - 10-14 days (20% reduction)

0.41mg - 10-14 days (20% reduction)

0.32mg - 10-14 days (20% reduction)

0.26mg - 10-14 days (20% reduction)

0.18mg - 10-14 days (30% reduction)

0.13mg - 10-14 days (30% reduction)

0.09mg - 10-14 days (30% reduction)

0.06mg - 10-14 days (30% reduction)

0.04mg - 10-14 days (30% reduction)

0.03mg - 10-14 days (30% reduction)

0.02mg - 10-14 days (33% reduction)

0.01mg - 10-14 days (50% reduction)

 

Total: 100% reduction, 160-224 days

 

Basically, I'm trying to follow Ashton as well as I can, pretending this is the same as starting from 8.7mg diazepam, which I think it basically is. Keep the cuts to 10% for as long as is practical, then slowly move up to larger % cuts (as Ashton does).

 

Thoughts? I have my phenazepam as a raw powder, and I have a milligram-accurate scale, so I believe that I can get the appropriate doses fairly exactly by dissolving it in ethanol or glycol.

 

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[b5...]
a) cross me over to valium and then allow me to withdraw from it at a reasonable rate

 

I would see about the Valium c/o firstly.

 

You did to come off the Benzo gradually. I wouldn't recommend a detox.

 

0.87mg - 10-14 days

0.78mg - 10-14 days (10% reduction)

0.7mg  -  10-14 days (10% reduction)

0.63mg - 10-14 days (10% reduction)

0.51mg - 10-14 days (20% reduction)

0.41mg - 10-14 days (20% reduction)

0.32mg - 10-14 days (20% reduction)

0.26mg - 10-14 days (20% reduction)

0.18mg - 10-14 days (30% reduction)

0.13mg - 10-14 days (30% reduction)

0.09mg - 10-14 days (30% reduction)

0.06mg - 10-14 days (30% reduction)

0.04mg - 10-14 days (30% reduction)

0.03mg - 10-14 days (30% reduction)

0.02mg - 10-14 days (33% reduction)

0.01mg - 10-14 days (50% reduction)

 

It seems reasonable to me. We can only work with what we have.

Though, you may have to slow it down some at the end Likely, but I would go with tapering over a detox, if the doc will not give you Valium.

 

0.87mg - 10-14 days

0.78mg - 10-14 days (10% reduction) - 10.3448%

0.7mg  -  10-14 days (10% reduction) - 10.2564%

0.63mg - 10-14 days (10% reduction) - 10%

0.51mg - 10-14 days (20% reduction) - 19.0476%

0.41mg - 10-14 days (20% reduction) - 19.6078%

0.32mg - 10-14 days (20% reduction) - 21.9512%

0.26mg - 10-14 days (20% reduction) - 18.75%

0.18mg - 10-14 days (30% reduction) - 30.7692%

0.13mg - 10-14 days (30% reduction) - 27.7778%

0.09mg - 10-14 days (30% reduction) - 30.7692%

0.06mg - 10-14 days (30% reduction) - 33.3333%

0.04mg - 10-14 days (30% reduction) - 33.3333%

0.03mg - 10-14 days (30% reduction) - 25%

0.02mg - 10-14 days (33% reduction) - 33.3333%

0.01mg - 10-14 days (50% reduction) - 50%

 

S#

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The vast number of members who join having first tried a detox facility seem to agree that a rapid detox does not work in the long run.  Not having been through it, I have no personal perspective to offer.  I think you could taper off directly using the schedule you posted as a guideline.  Since Phenazepam has a half life of 60 hours, it is longer acting than Klonopin which many members have tapered off of and is usually favored over Valium by US docs.
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Hmm, interesting, phenazepam isn't even on the controlled schedule here in the USA as it doesn't exist and no one thought to stick it on there anyway. Auto-scheduled analogs only apply to Schedule 1 and 2.. anyways..

 

With a half-life of 60 hours, (it's 10 times as potent as Valium like you said -- best guess at least -- making it equivalent in potency to Ativan,) it should be perfectly suitable to directly taper off of.

 

The Ashton Schedule applied to phenazepam would look like this (7-14 days each) -

 

0.90

0.80

0.70

0.60

0.50

0.40

0.30

0.20

0.10

0.05

 

But Ashton didn't design her Valium taper schedule with titration in mind, it was fixed to cut pill sizes. So it probably goes a bit faster at the end than it should.

 

Anyways, it looks fine, you are probably going lower than you need to. 0.05mg = 0.5mg diazepam. The range of opinions on jumping points is all over the place though, you'll hear them all, though Ashton's is to stop at 1.0 to 0.5mg (diazepam.)

 

I'd pretty strongly advise you to get on Valium anyway, 'cause god only knows the trustworthiness of those pills you are getting. And it's generally a better idea if you aren't likely to have issues with depression and sedation, though I have no idea of the pharmacological profile of phenazepam, i.e. what benzos it's binding affinities are similar to.

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[b5...]

I would suggest Valium as well if you can get it.

 

The titrating will work over detox, but to compare a Valium taper to a Titration plan.. to me doesn't work.

There are margin of errors in titrating.. where Valium does not have a +/-.

I use Margin of Error to express getting more of or less than the dosage amount in either water or milk, therefore you would be getting around the same dosage, yet no doubt... there is a margin of error.

 

Does anyone have any idea what the equivalent dose is? In the sparse literature I can find on phenazepam, the equivalency is listed as 1:10 some places, and 1:20 others. I'm thinking I might hedge my bet and try to c/o to 10mg valium and taper from there, in the hopes that it might be enough of an updose to level out the tinnitus and other s/x that are driving me nuts.

Again-

If the ratio is 1:10 - 3.5mg of Valium is needed.

If the ratio is 1:20- 7mg of Valium is needed.

 

But going to 10mg is where you stated you wanted to start from before, that would work.. however, it is a bit of an increase, but it's up to you how you taper.

Hopefully you can get Valium.

:thumbsup:

 

S#

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The titrating will work over detox, but to compare a Valium taper to a Titration plan.. to me doesn't work.

There are margin of errors in titrating.. where Valium does not have a +/-.

I use Margin of Error to express getting more of or less than the dosage amount in either water or milk, therefore you would be getting around the same dosage, yet no doubt... there is a margin of error.

 

I assume you mean dry-cutting Valium, there are people titrating Valium just the same because they can't get 2mg pills, like you.. and possibly this guy. Dry-cutting is PROBABLY more accurate than titrating (I've had quite a bit of crumble and imperfection cutting pills, even with a pill-cutter..) assuming you are only cutting them in half down a score... which is only possible with the 2mg tablets. And also assuming that the benzo doesn't form into solution with the fat in milk, if it does, and you are good at titrating, there is almost no margin of error to be had. Who knows.

 

Anyways I think the point is here that you should do your best to get a Valium substitution but if you can't a titration of that mysterious benzo is totally possible and doable and by far the second best option.

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Just to clarify, getting exact doses of phenazepam isn't an issue, because I do not have it as pills, I have it as a raw powder (confirmed 99.9% pure by NMR), and I used a milligram-accurate scale to measure out 100mg and then diluted that into 229ml of 95% Ethanol, which means that 2ml gives me exactly 0.87mg. I know ethanol should be avoided during withdrawal, but my feeling is that 2ml of it is only 10% of the alcohol in a single alcoholic beverage, so that part doesn't worry me that much.

 

I agree that it would be better from a safety standpoint to crossover to FDA approved valium, but that just doesn't seem to be an option. I have a history of drug issues, so no one is going to want to give me valium unless I lie to them about my history, and the one psychiatrist I've seen so far told me flat out that I should go to a drug treatment clinic, and gave me the # of a place that clearly does some kind of rapid-detox taper.

 

The only margin of error is in my own handling of the equipment, and I think I've pulled that off pretty well. Since it's a raw powder which is soluble in ethanol, the accuracy issues you have with water titration are not there.

 

In addition to the psychiatrist I saw, I did attempt to contact everyone on the "benzo wise doctor list" for my area (near Washington, DC), and none of them actually appear to be people that are benzo-wise doctors (one receptionist told me, "I don't know how we got on that list"). If anyone has any recommendations for a doctor than I'd love to call them, but, my primary care doctor is unable to help me in this regard and I don't have infinite time and money to drive around seeing different psychiatrists. During my previous benzo taper I was able to explain the situation to the PCP I grew up with and he tapered me off, but, I now live 400 miles from when I did, and making that trip once a month isn't a real option even if he'd help me again (which is questionable).

 

I'm not trying to be difficult, and really appreciate everything everyone has said and will continue to listen, but at this point I think a direct taper off the phenazepam is my best option. It does mean that I'll take something like another ~70mg (total, according to my math) of my sketchy Chinese-manufactured powder, but, that's significantly less than I've already taken, so even if it is contaminated with something terrible (doubtful, in light of the NMR), the amount I have yet to take is less than what I've already put through me.

 

I know it was completely idiotic of me to ever muck with phenazepam given my history with drugs and benzos, but, all I can do is put one foot in front of the other, get off, and this time STAY OFF.

 

So, it really will be a taper and not a titration, in terms of accuracy. My plan is to dilute the ethanol by 10% at every cut point. I'm going to carefully track how much I take and periodically reconcile that against the amount of solution remaining to make sure I'm not inadvertantly allowing it to concentrate over time (ethanol loves to evaporate, but I have it in a sealed container and am planning on only going into the container once every 5 days, to fill a 10ml oral syringe which I will keep in the fridge, dosing 2ml a day.

 

I know that compared to a real ashton taper this is sketchy and unscientific as all get out, but, it seems like the best option unless someone knows a doctor that I don't. Miraculously I do have a cognitive behavioral psychologist who is willing to work with me through this even knowing I'm taking an unapproved and unprescribed benzodiazepine, so, thank god for small favors I guess.

 

Thanks again. Any further advice is appreciated.

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What's NMR?

 

Using that single at least consistent powder for your entire taper, dissolved in Ethanol, it's probably as good as a Valium taper. Go for it.

 

Well, I just wonder about the shelf-life of that highly concentrated solution you've got there?

 

(I don't know, I've moved around plenty, and usually just telling the doc that you moved and were on benzos results in getting a script, not all that difficult.)

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i think they'd ask for my medical history, and I have no medical history showing i've been on benzos recently.

 

shelf life is a bit of a concern but i have the solution in a dark jar and i'll keep it in a cool place. i'd freeze it, but i'm worried about phen falling out of solution if I do.

 

NMR is "Nuclear magnetic resonance spectography", which is some fancy lab analysis to find out what is in a given sample of something. The person I bought the phen from, had sold some to someone who had access to such equipment, and they tested it and verified that it was 99.5% pure (or maybe 99.9, can't remember), and that the only impurity was something inert and nontoxic that is also a common byproduct of pharmaceutical manufacture, and even used in some binding agents in pharmaceutical pills. I know the person I bought it from to some extent, and he showed me where he is buying it from, and it is indeed a Chinese lab but it's a fairly reputable looking lab in that pretty much everything they make is stuff that's designed for the pharmaceutical industry (unlike some fly-by-night Chinese "labs" that basically exist to make quasi-legal 'research chemicals' destined to be sold as designer drugs in foreign markets).  I'm not trying to imply any of this is good, I wish to God I'd never tangled with it, but it's a less distressing situation than it could be.

 

My symptoms seem worse today, which I'm hoping is just in my head/incidental, and not an indicator that my previous dose when I was taking it off of blotter paper was higher than I thought. I'll just have to stick with it a couple days, and updose slightly if it "feels" like more than a 10% cut.

 

I'm sure there's a lesson here about not importing unapproved medications and then dosing them inaccurately for a long period of time. For what it's worth, I was not trying to have fun or get high, as much as find relief from crushing anxiety that was being exacerbated by life circumstances. Cheerfully, life circumstances are a lot better now, so if I can just get the hell off benzos and stay off forever, I should be good :-/

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well, day 3 of my 0.87mg via solution and no real change in sx, so perhaps my dose estimation was correct. Will probably make 10% cut next week.

 

Tinnitus still annoying as hell; is there any thought that would be better if I did a valium c/o, or does it not matter much?

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Valium c/o is generally thought only to help with the interdose w/d -- w/d between dosing. As your benzo has a 60 hour half-life, it's doubtful it would really make a difference at all IMHO.

 

Though there is "some anecdotal evidence high-potency benzos are harder to taper / quit." Or something.

 

Good luck! Never got the tinnitus myself... yet.. but unlikely.

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well, i just don't know what to do. The T is not at the level it was when I was tapering too fast, but it's still dominating my life to the extent that I'd literally rather just be on benzos forever than deal with it.
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I guess these things come and go in waves. T was barely an issue yesterday, worse today. Maybe I'll start a buddy blog.
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I'm glad you got a break from the tinnitus, we had a member who reinstated because she couldn't stand it anymore.  We never heard from her again, I wonder what became of her sometimes.  I hope you can find a way to deal with it, I had it but it was minor compared to what I've heard about here.

 

A Buddie blog would be a good idea if you're up for it.  ;)

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