Forced Taper Due to State Law

[[Vi...]]

Withdrawal / Taper Advice / Support

Clonazepam: 3mg; daily, for 7+ years

Forced to cut 1mg and started taking 2mg daily, six days ago.

[[Pa...]]

Hello Victor III, welcome to BenzoBuddies,

 

It looks like you were on 3 mg, and you’re on 2 mgs now, are you being forced to reduce to 1 mg now?  Sorry for the confusion, just trying to understand your situation, and what you mean by the state law.

 

We’ll help you all we can, we typically suggest reducing by about 5-10% every couple of weeks but letting your symptoms guide you can be very helpful. 

 

I’ll provide some links to help you get started on the forum but please let us know a little more about your situation.

 

Pamster

Colorado Consortium Benzodiazepine Deprescribing Guidance

 

Planning Your Withdrawal (Taper)

 

Withdrawal Support (during your taper)

 

Ashton Manual symptom list

[[Li...]]

Would you feel comfortable sharing the state where you are located so we can research this for you?  I am unaware of any such state-level legislation.

 

More importantly, is your prescriber aware of the US Food and Drug Administration’s 2020 Black Box Warning regarding rapid dosage reduction of clonazepam?

 

The continued use of benzodiazepines, including clonazepam tablets, may lead to clinically significant physical dependence. The risks of dependence and withdrawal increase with longer treatment duration and higher daily dose. Abrupt discontinuation or rapid dosage reduction of clonazepam tablets after continued use may precipitate acute withdrawal reactions, which can be life-threatening. To reduce the risk of withdrawal reactions, use a gradual taper to discontinue clonazepam tablets or reduce the dosage (see DOSAGE AND ADMINISTRATION and WARNINGS).

 

Source:

DailyMed - CLONAZEPAM tablet

https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=8069b1a0-7c06-4252-b44e-e2eef065d9b8

[[Vi...]]

Hi. Sorry for the short introduction, and after proofreading this, sorry for the long explanation of my situation.

I’ve been on 3mg/daily clonazepam for 7+ years.  I picked up my refill and it was reduced to 2mg/day.  I called my doctor’s office, found out there was no mistake on the refill and scheduled an appointment immediately.  At the appointment I was told that my drs license was under review and their entire clinic wasn’t willing prescribe any more than 2mg/day for benzodiazepines.  I’ve had the same doctor for 15+ years and said doctor has been the only prescriber of the clonazepam.  For what it’s worth, it’s a large clinic.

 

I explained to my doctor that a 33% reduction in the med would more than likely interfere with my ability to work.  We’ve tried tapers in the past, starting at .25mg, and always adding an anti-depressant.  After more than a handful of attempts, my Dr. agreed that the anti-depressants weren’t helpful and staying on clonazepam alone was the best route.

 

My Dr prescribed the following meds to “help with the withdrawals.”

 

* Trazodone 100mg tablet - take 1 tablet at bedtime

* Hydroxyzine - 25mg tablet - take 1 tablet three times daily as needed

* Clonidine - 0.1 tablet - take 1 table twice a day

* Ondansetron 4mg tablet - take 1 tablet daily for nausea

 

Not feeling comfortable with the situation I made an appointment with another Dr that listed “medication management” in their bio.  At that appointment I was told that there was a statewide crackdown on primary care physicians and the amount of benzos they’re allowed to prescribe.  This Dr mentioned they used to work at an addiction clinic a while back.  They said the meds my Dr prescribed to help with the withdrawals would greatly help.  I just need to figure out which ones to take and when.

 

Feeling defeated and being talked to like I’m some kind of pill junkie was rather unsettling.  I took the next 5 days to prioritize what I needed to get done in my personal life and for work before starting the forced taper of ~33%.  6 days ago I went from 3mg to 2mg of clonazepam at bedtime.  I have an appointment with a psychiatrist on May 18th, but I was told that even they’re hesitant to prescribe my regular dosage.  If I have to tough it out until then, I’m not certain I’d even consider going back to 3mg.

 

The last 6 days I’ve spent pretty much in bed.  I have not taken Clonidine.  The idea of it messing with my blood pressure and causing more dizziness and having to taper off that isn’t appealing.

I’ve taken trazadone 3 nights to help sleep - each dose I broke the pill in half and took 50mg

I’ve taken 1 pill of hydroxyzine at bedtime.  The next day I was really out of it and felt worse. Dried out and dizzy.

 

I realize it might not have been the new meds, but how do I know what’s working?  What, if any meds, actually help with this?  The last 6 days have been really crappy and today I felt like I was going to pass out.  I got really dizzy out of nowhere, had to lay down and close my eyes, accompanied by a tingling sensation in my brain - if that makes sense?

 

I’m forcing myself to eat 3 healthy meals a day.  Drinking plenty of water.  I’m in pretty good shape and would like to continue at home exercising - light and easy, but I don’t feel safe with withdrawal symptoms I’m experiencing.

 

Any advice on the meds I have to help with the quick taper?  Thoughts on a state regulating the amount of benzos being prescribed?  Is there any risk of a seizure with a 1mg taper?  Any general advice would be greatly appreciated.

 

 

[[Vi...]]

Would you feel comfortable sharing the state where you are located so we can research this for you?  I am unaware of any such state-level legislation.

 

More importantly, is your prescriber aware of the US Food and Drug Administration’s 2020 Black Box Warning regarding rapid dosage reduction of clonazepam?

 

The continued use of benzodiazepines, including clonazepam tablets, may lead to clinically significant physical dependence. The risks of dependence and withdrawal increase with longer treatment duration and higher daily dose. Abrupt discontinuation or rapid dosage reduction of clonazepam tablets after continued use may precipitate acute withdrawal reactions, which can be life-threatening. To reduce the risk of withdrawal reactions, use a gradual taper to discontinue clonazepam tablets or reduce the dosage (see DOSAGE AND ADMINISTRATION and WARNINGS).

 

Source:

DailyMed - CLONAZEPAM tablet

https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=8069b1a0-7c06-4252-b44e-e2eef065d9b8

 

Iowa

 

I’m guessing my Dr. is unaware.  When the triage nurse returned my call about a med question, they told me that going from 3mg a day to 2mg shouldn’t have any side affects.  I politely told them that they’re entitled to their own opinion, but that isn’t the case.  They continued to tell me that it wasn’t a big deal.  I then asked that they keep their opinions to themselves.  A couple hours later I received a call from a different nurse, telling me that my Dr prescribed an additional medication - Clonidine, and I could pick it up from the pharmacy.  This seemed weird because I wasn’t asking for another med.  I believe the previous nurse sensed that I was upset and worried.

[[Vi...]]

Pamster

Colorado Consortium Benzodiazepine Deprescribing Guidance

 

Planning Your Withdrawal (Taper)

 

Withdrawal Support (during your taper)

 

Ashton Manual symptom list

 

Thank you!  I will comb through those links and the forum.  I did show the Ashton Manual to my Dr several years back, but they were not comfortable prescribing that much diazepam.

[[Li...]]

A search of current Iowa code on controlled substances (see link below) did not yield results regarding limitations on benzodiazepine prescribing.

 

If you wish to to learn more, I suggest you contact that state board of pharmacy at:

 

Iowa Board of Pharmacy

https://pharmacy.iowa.gov/

 

It sounds like your doctor may have gotten on the radar screen of the clinic or the state medical board for his prescribing practices.  You can find out more about the status of his license by contacting:

 

Iowa Board of Medicine

https://medicalboard.iowa.gov/

 

My best guess is the reluctance to prescribe you are encountering is not due to a state law but rather increased public awareness/concern regarding benzodiazepine use as well as (perhaps) a growing awareness of the 2020 FDA black box warnings for benzodiazepines.

 

Link:

 

Iowa Legislature - Code Section Listings - Chapter 124 - Controlled Substances

https://www.legis.iowa.gov/law/iowaCode/sections?codeChapter=124&year=2023

 

Edit: updated link

[[Vi...]]

Interesting.  Thanks for digging up those links.  Not sure if calling would help with anything.  The second Dr I went to was at different clinic.  They said every single med they prescribe is being watched.  I had a very open conversation about my situation and brought all of my new medications with me.  Even suggested that they request my patient file from my prescribing Dr, but they weren’t willing to work with me.  They said that they aren’t prescribing benzos to new patients with anxiety.  Being forced to taper with a big cut is very disappointing.

[[Nu...]]

I am so sorry that you're in this position. Have you tried to see if there are any benzo aware docs through the Benzo Info Coalition's website? (benzoinfo.com).

 

It's easy for them to put the heartache and struggle off on you. Absolutely against the hippocratic oath, IMO. They're benefit against yours.

[[Vi...]]

Thank you very much for the kind words. I wasn’t aware of that website and will definitely look into that. This forum is a great resource filled with understanding and kind individuals.

[[Re...]]

I am so sorry that you're in this position. Have you tried to see if there are any benzo aware docs through the Benzo Info Coalition's website? (benzoinfo.com).

 

It's easy for them to put the heartache and struggle off on you. Absolutely against the hippocratic oath, IMO. They're benefit against yours.

 

Here is the link for you: https://www.benzoinfo.com/doctors/

 

Also, you might contact Josef Witt-Doerring benzo wise doctor for advice.

 

https://www.wittdoerringpsychiatry.com/

 

One other resource is SafeTaper and Dr. Lepp

 

https://www.safetaper.com/about

 

While they may not be able to treat you, they may have resources you can utilize.

 

I am so sorry that your doctor did this. It is horrific what these doctors do to patients. Adding in other meds can complicate things down the road, as you might get stuck on them and be unable to taper off after benzo wd. Take it from someone who has had a nightmare experience with that. It doesn't happen to everyone, but it can happen. Plus, the additional side effect profiles are risky for some people.

 

 

[[Ju...]]

This is happening in Arkansas too, which is why I’m here 👍🏻