Tapering from Bromazolam and Alcohol

[[bv...]]

Hi all. I'll try to just keep this simple and ask for strategies to taper. I may or may not have the opportunity to transition to valium and follow the Ashton Method, but it's very unlikely, so I'd appreciate any advice as to which RC benzos or any method really to safely taper off of the Bromazolam and alcohol.

 

Alcohol I've detoxed from in the past week and a half, but I've been self medicating with it for about 7 years, approximately 7 drinks a night on average. I was prescribed clonidine and clorazapate dipotassium. That was as of two weeks ago.

Along with this, I've been using Bromazolam drop solution for the past two years or so, using about 3-5mgs a day.

I have been considering flubromazepam or desalkyldiazepam(gidazepam)due to half lives, but I don't know how to properly do this.

 

Please, can I get some help? Suggestions? Anything. 

If there's any more information needed, I'm an open book.

Thank you.

[[Co...]]

Hello @[bv...]. Welcome to BenzoBuddies.

As you probably appreciate, the use of benzodiazepines in combination with alcohol is dangerous. And tapering them requires special consideration. As you also probably appreciate, benzodiazepines are used in alcohol detox to help protect against the risk of seizure.

I am not familiar enough to make suggestions in your situation. But given the potential dangers, you should talk with your doctor. I understand that tapering alcohol is difficult and often unsuccessful. And if you intend to quit alcohol abruptly, it is essential that you have a professional overseeing this for you. And since you take clonidine, you have other medical considerations too.

My instinct is that you would withdraw from alcohol under supervision, and then taper off your benzodiazepines. Again, though, I think your withdrawal should be undertaken with professional supervision.

What I suggest is that you get the professional medical help I think you require, and we can help support you with the more psychological aspects of your withdrawal.

Good luck, bvould. Please keep us updated.

[[bv...]]

4 hours ago, [[C...] said:

Hello @[bv...]. Welcome to BenzoBuddies.

As you probably appreciate, the use of benzodiazepines in combination with alcohol is dangerous. And tapering them requires special consideration. As you also probably appreciate, benzodiazepines are used in alcohol detox to help protect against the risk of seizure.

I am not familiar enough to make suggestions in your situation. But given the potential dangers, you talk with your doctor. I understand that tapering alcohol is difficult and often unsuccessful. And if you intend to quit alcohol abruptly, it is essential that you have a professional overseeing this for you. Ad since you take clonidine, you have other medical considerations too.

My instinct is that you would withdraw from alcohol under supervision, and then taper off your benzodiazepines. Again, though, I think your withdrawal should be undertaken with professional supervision.

What I suggest is that you get the professional medical help I think you require, and we can help support you with the more psychological aspects of your withdrawal.

Good luck, bvould. Please keep us updated.

Thank you for your input. I actually already detoxed from alcohol, and I've been off of it for the past two weeks. I have an appointment with a pharmacologist (not psychiatrist) tomorrow to discuss tapering protocols specifically for the benzos. I was in the ER for what appeared to be benzo withdrawals on Sept 30th, and I was fortunate to have an attending physician that recognized and understood that I do need specialized tapering regime for the Bromazolam dependency.

Previous doctors and psychiatrists have attempted to force me to taper rapidly or quit cold turkey with only medications to manage physiological symptoms, placing me at risk of more serious withdrawal symptoms like seizures. Of course, that was not acceptable so I have been reading into the Ashton Method in order to be informed and have an educated conversation about tapering with the physicians I have worked with over the past year or so, but unfortunately all of them until now have not taken me seriously and simply instruct me to go to rehab. 

 

I think if there's anything I can ask now is if anyone might have also been through a taper or detox from Bromazolam specifically. I have read that it is uniquely challenging.

 

I'm glad to have found this community, and I will stay connected and hope to support anyone else.

[[Co...]]

Hi @[bv...]. In which country do you live? Bromazolam is an unusual benzodiazepine. I am not aware of its legal use in any country. Has it been prescribed for you? The 'RC' suggest that is has not, of course.

From what I read, it is supposedly similar to Xanax, but much less potent. But then again, all benzos are pretty similar.

If your source is illicit, how can you be sure of the actual dose and the actual active ingredients? I suppose, though, whatever the true dose (and drug), a gradual taper is the way to go.

How do you measure out 3-5mg?

[[Es...]]

@[Co...]

Here is a Critical Review Report on Bromazolam. On page 11, you have a list of countries where it’s being used.

Here is a comparison of bromazolam to diazepam which is quite succint. Maybe it could be useful. Googled it cause I was curious about the med myself, first thought it was “bromazepam“ misspelled, but no.

Welcome @[bv...], well you certainly set a precedent here.

Paula

[[Co...]]

29 minutes ago, [[E...] said:

Here is a Critical Review Report on Bromazolam. On page 11, you have a list of countries where it’s being used.

But that does not list licit use: 'none found'.

Quote

15. Licit production, consumption and international trade
No information was found.

 

[[bv...]]

5 hours ago, [[C...] said:

Hi @[bv...]. In which country do you live? Bromazolam is an unusual benzodiazepine. I am not aware of its legal use in any country. Has it been prescribed for you? The 'RC' suggest that is has not, of course.

From what I read, it is supposedly similar to Xanax, but much less potent. But then again, all benzos are pretty similar.

If your source is illicit, how can you be sure of the actual dose and the actual active ingredients? I suppose, though, whatever the true dose (and drug), a gradual taper is the way to go.

How do you measure out 3-5mg?

I purchase a 1gram of the powder substance, send it for lab testing, and then make a solution usually of 10mg/ml. Using a syringe, I can measure per cc what I'm consuming.

The source is "grey market"; not illicit per se, but also not approved. It is not bromazepam, which I think is used in a few other countries, but not in the USA.

5 hours ago, [[E...] said:

@[Co...]

Here is a Critical Review Report on Bromazolam. On page 11, you have a list of countries where it’s being used.

Here is a comparison of bromazolam to diazepam which is quite succint. Maybe it could be useful. Googled it cause I was curious about the med myself, first thought it was “bromazepam“ misspelled, but no.

Welcome @[bv...], well you certainly set a precedent here.

Paula

Yes, but you might be surprised how common this and other designer benzos have become online. Bromazolam took over after etizolam was scheduled in the US. 

I'd say it's about 70% as potent as alprazolam, but with a longer half life. 

Reddit and tripsit are good sources for active insight into this substance.

 

[[bv...]]

I should add the website psychonaut as a source of information as well.

[[Co...]]

1 hour ago, [[b...] said:

I purchase a 1gram of the powder substance, send it for lab testing, and then make a solution usually of 10mg/ml. Using a syringe, I can measure per cc what I'm consuming.

The source is "grey market"; not illicit per se, but also not approved. It is not bromazepam, which I think is used in a few other countries, but not in the USA.

Ah. I see. I suppose that's reasonably safe then. But it is illicit in some jurisdictions. I think I read earlier that it is illegal in Canada for example.

1 hour ago, [[b...] said:

Yes, but you might be surprised how common this and other designer benzos have become online. Bromazolam took over after etizolam was scheduled in the US. 

I'd say it's about 70% as potent as alprazolam, but with a longer half life. 

Reddit and tripsit are good sources for active insight into this substance.

As a heads up: although you are free (and even encouraged) to be honest about your situation here, most of our members obtain their medications through their doctors and legitimate sources. So please be circumspect in describing how your source your medication.

How do plan to proceed? Given that you have powder, I suppose you can taper pretty much at whatever rate suits you best. Will you be tapering off with any input from a doctor or pharmacist?

[[bv...]]

2 hours ago, [[C...] said:

Ah. I see. I suppose that's reasonably safe then. But it is illicit in some jurisdictions. I think I read earlier that it is illegal in Canada for example.

As a heads up: although you are free (and even encouraged) to be honest about your situation here, most of our members obtain their medications through their doctors and legitimate sources. So please be circumspect in describing how your source your medication.

How do plan to proceed? Given that you have powder, I suppose you can taper pretty much at whatever rate suits you best. Will you be tapering off with any input from a doctor or pharmacist?

I fully understand. I'm very careful not to reveal sources or methods; I'm just being as transparent as possible about my situation and answering questions as they are asked. I will be extra cautious.

The main reason I ended up resorting to these alternative benzos is because I went about three years with severe, debilitating panic disorder that was treatment resistant with standard non-narcotic psychiatric medications. Doctors refused to prescribe me even minimal amounts of say Xanax or Ativan just for the panic attacks. I always thought that if there wasn't an institutional resistance to prescribing them along with therapy, I wouldn't be where I am at now. I had to turn to alcohol at first, then eventually discovered Xanax. Then things gradually developed to this point.

 

Tomorrow I have an appointment with a pharmacologist (not psychiatrist) to explore tapering. I am hoping we can go forward with the Ashton Method by getting me on a stabilizing dose of Valium and starting a tapering schedule from there with medical supervision combined with therapy and outpatient treatment. Fingers crossed.

 

As a side note, I am running out of my Bromazolam, and my means of obtaining it is becoming riskier and untenable. Simply put, I just want off them. So I'm very desperate to work with a medical professional on this. I don't know a proper taper schedule with Bromazolam, and I am very hesitant to utilize other designer benzos to do so despite the many anecdotes on how to use them to do it. At this point I am just using a fixed dose and only redoing when symptoms become unbearable, but it's extremely risky to be doing this alone, especially in the environment I live in where people have become desensitized to suffering and addiction.

 

Edited October 4, 2023 by [bv...]

[[Co...]]

7 hours ago, [[b...] said:

I fully understand. I'm very careful not to reveal sources or methods; I'm just being as transparent as possible about my situation and answering questions as they are asked. I will be extra cautious.

Thank you.

7 hours ago, [[b...] said:

The main reason I ended up resorting to these alternative benzos is because I went about three years with severe, debilitating panic disorder that was treatment resistant with standard non-narcotic psychiatric medications. Doctors refused to prescribe me even minimal amounts of say Xanax or Ativan just for the panic attacks. I always thought that if there wasn't an institutional resistance to prescribing them along with therapy, I wouldn't be where I am at now. I had to turn to alcohol at first, then eventually discovered Xanax. Then things gradually developed to this point.

There is, of course, a general shortage of talk therapy in most countries (due to to cost) unless you can afford to pay for it yourself. That's been a huge driver in proscribing medications when talk therapy might be as good or better option.

7 hours ago, [[b...] said:

Tomorrow I have an appointment with a pharmacologist (not psychiatrist) to explore tapering. I am hoping we can go forward with the Ashton Method by getting me on a stabilizing dose of Valium and starting a tapering schedule from there with medical supervision combined with therapy and outpatient treatment. Fingers crossed.

Sorry, you did already mention that - I misremembered - that you have an appointment with a pharmacologist to explore how you will taper. I will keep my fingers crossed for you on the possibility of talk therapy and medical supervision. How does that work with your personally sourced bromazolam? Are you hoping they will prescribe another benzodiazepine? Or - which would be surprising to me - are they willing to work with your own sourced medication?

7 hours ago, [[b...] said:

As a side note, I am running out of my Bromazolam, and my means of obtaining it is becoming riskier and untenable. Simply put, I just want off them. So I'm very desperate to work with a medical professional on this. I don't know a proper taper schedule with Bromazolam, and I am very hesitant to utilize other designer benzos to do so despite the many anecdotes on how to use them to do it. At this point I am just using a fixed dose and only redoing when symptoms become unbearable, but it's extremely risky to be doing this alone, especially in the environment I live in where people have become desensitized to suffering and addiction.

Assuming that you are using your own bromazolam for your taper, have you properly worked out your taper schedule so that you do not run out? How long will it take you to complete your taper?

What suspension medium do you use for your liquid? Is there any waste? I just wish to be sure you have enough bromazolam to complete your taper.

[[bv...]]

4 hours ago, [[C...] said:

Thank you.

There is, of course, a general shortage of talk therapy in most countries (due to to cost) unless you can afford to pay for it yourself. That's been a huge driver in proscribing medications when talk therapy might be as good or better option.

Sorry, you did already mention that - I misremembered - that you have an appointment with a pharmacologist to explore how you will taper. I will keep my fingers crossed for you on the possibility of talk therapy and medical supervision. How does that work with your personally sourced bromazolam? Are you hoping they will prescribe another benzodiazepine? Or - which would be surprising to me - are they willing to work with your own sourced medication?

Assuming that you are using your own bromazolam for your taper, have you properly worked out your taper schedule so that you do not run out? How long will it take you to complete your taper?

What suspension medium do you use for your liquid? Is there any waste? I just wish to be sure you have enough bromazolam to complete your taper.

I have been seeking talk therapy in the classical version, i.e. psychoanalysis. I just click with that better, but I cannot afford it, and my HMO only does evidence based models like CBT and DBT in "focused" sessions that last at maximum eight weeks total. It's ridiculous for a variety of reasons.

As for tapering from Bromazolam, it's kind of being forced due to the limited supply I have of it, and I can't say I'm truly tapering from it yet. So if for example on average I'm using 3mg a day, I'm taking 1mg spaced out as long as possible until symptoms start to emerge and become overwhelming, then I'll take another 1mg, and so on. However, I'm still taking about 3-5 mg total a day, so again I'm not really tapering as of yet. If anything I am maintaining. Again, I'm afraid to start a true taper until I'm a safer place with some oversight (I will be moving to be with family and closer to AA groups I was a part of in the past, and where there is better access to urgent and emergency services).

I'm hoping after today's appointment I will transition to valium per Ashton Method, and I think a safe baseline to start from would be be 30 to 40 mgs daily, then the 5-10% decrease every two weeks from that, utilizing other meds for blood pressure control, anti seizure meds, and sleep aids, multivitamins etc per what's discussed today. If the response I get will be another "here's two weeks of Ativan and some clonidine", I will likely have to resort to other designer benzos that's are known amongst that community to be excellent for tapering due to their half lives, but that's a last resort.

I use propylene glycol as the medium. It's that or ethanol. Technically there is waste when I send 5mg for lab testing, and I'm not sure how much might get wasted during the heating and mixing process. I have to assume it's not a perfect mixture everytime, but also I know there isn't too much variability or that it's not getting lost to any significant degree.

 

 

[[Co...]]

20 hours ago, [[b...] said:

I have been seeking talk therapy in the classical version, i.e. psychoanalysis. I just click with that better, but I cannot afford it, and my HMO only does evidence based models like CBT and DBT in "focused" sessions that last at maximum eight weeks total. It's ridiculous for a variety of reasons.

Yeah. Unfortunately, it seems to the be the same in most or all countries. 

20 hours ago, [[b...] said:

As for tapering from Bromazolam, it's kind of being forced due to the limited supply I have of it, and I can't say I'm truly tapering from it yet. So if for example on average I'm using 3mg a day, I'm taking 1mg spaced out as long as possible until symptoms start to emerge and become overwhelming, then I'll take another 1mg, and so on. However, I'm still taking about 3-5 mg total a day, so again I'm not really tapering as of yet. If anything I am maintaining. Again, I'm afraid to start a true taper until I'm a safer place with some oversight (I will be moving to be with family and closer to AA groups I was a part of in the past, and where there is better access to urgent and emergency services).

My suggestion is that when your situation is safer and it will allow, you stabilise at the lower end of what you might take for a day. So, 3mg rather than 5mg. Or maybe in the middle. But if this were me, I would avoid going to 5mg as my starting point when on some days I manage well enough on 3mg.

20 hours ago, [[b...] said:

I'm hoping after today's appointment I will transition to valium per Ashton Method, and I think a safe baseline to start from would be be 30 to 40 mgs daily, then the 5-10% decrease every two weeks from that, utilizing other meds for blood pressure control, anti seizure meds, and sleep aids, multivitamins etc per what's discussed today. If the response I get will be another "here's two weeks of Ativan and some clonidine", I will likely have to resort to other designer benzos that's are known amongst that community to be excellent for tapering due to their half lives, but that's a last resort.

Yes. Switching to Valium sounds like good option given your problems sourcing your present medication. And it might be the only doctors will work with in a meaningful way (they might well be leery of proving taper support for an illicit supply of medication/drug which is not even licensed there).

How much supply of bromazepam bromazolam do you still have left? Assuming that you are given a prescription of a limited amount of Ativan or similar, you could first taper the bromazepam bromazolam. Anyway, hopefully it will not come to this.

20 hours ago, [[b...] said:

I use propylene glycol as the medium. It's that or ethanol. Technically there is waste when I send 5mg for lab testing, and I'm not sure how much might get wasted during the heating and mixing process. I have to assume it's not a perfect mixture everytime, but also I know there isn't too much variability or that it's not getting lost to any significant degree.

That should work. And yeah, avoiding ethanol is probably sensible for you (and is probably less reliable anyway).

I would not worry unduly about the mixture being 'imperfect'. Your suspension medium should allow you to create pretty-reliable results. And certainly better than pill-splitting (particularly when diving pills into amounts smaller than a half). It is probably even more reliable then the delivered dose from whole pills (I forget the allowed deviation from nominal dose - 10%, perhaps).

Please let us know how your appointment went today.

[[bv...]]

7 hours ago, [[C...] said:

Yeah. Unfortunately, it seems to the be the same in most or all countries. 

My suggestion is that when your situation is safer and it will allow, you stabilise at the lower end of what you might take for a day. So, 3mg rather than 5mg. Or maybe in the middle. But if this were me, I would avoid going to 5mg as my starting point when on some days I manage well enough on 3mg.

Yes. Switching to Valium sounds like good option given your problems sourcing your present medication. And it might be the only doctors will work with in a meaningful way (they might well be leery of proving taper support for an illicit supply of medication/drug which is not even licensed there).

How much supply of bromazepam do you still have left? Assuming that you are given a prescription of a limited amount of Ativan or similar, you could first taper the bromazepam. Anyway, hopefully it will not come to this.

That should work. And yeah, avoiding ethanol is probably sensible for you (and is probably less reliable anyway).

I would not worry unduly about the mixture being 'imperfect'. Your suspension medium should allow you to create pretty-reliable results. And certainly better than pill-splitting (particularly when diving pills into amounts smaller than a half). It is probably even more reliable then the delivered dose from whole pills (I forget the allowed deviation from nominal dose - 10%, perhaps).

Please let us know how your appointment went today.

Just to clarify, the substance is Bromazolam, not bromazepam. Many mix up the two. 

The appointment ended with the results I anticipated: take clonidine, 2400mgs a day of gabapentin, and go to a detox. They did not condone continuing the Bromazolam at all. Nor were they open to switching me to a prescription benzodiazepine. 

In terms of what I have left, approximately a week and a half. It will take me another month to get an appointment with another psychiatrist/addiction specialist due to insurance issues and the fact I'm moving soon to a different county in my state.

Temporarily, I will have to seek out more Bromazolam and begin a solo taper. The best I can imagine is to try and follow the Ashton Method as closely as possible, or taking the bare minimum as needed, as you mentioned. 

Edited October 4, 2023 by [bv...]

[[Co...]]

11 hours ago, [[b...] said:

Just to clarify, the substance is Bromazolam, not bromazepam. Many mix up the two.

Oops. I edited my last post to correct for that.

11 hours ago, [[b...] said:

The appointment ended with the results I anticipated: take clonidine, 2400mgs a day of gabapentin, and go to a detox. They did not condone continuing the Bromazolam at all. Nor were they open to switching me to a prescription benzodiazepine.

I suppose the concern is that you would 'abuse' the prescription for a benzodiazepine. What about a GP? Perhaps even a prescription for just a couple of weeks worth at a time if necessary?

11 hours ago, [[b...] said:

In terms of what I have left, approximately a week and a half. It will take me another month to get an appointment with another psychiatrist/addiction specialist due to insurance issues and the fact I'm moving soon to a different county in my state.

Temporarily, I will have to seek out more Bromazolam and begin a solo taper. The best I can imagine is to try and follow the Ashton Method as closely as possible, or taking the bare minimum as needed, as you mentioned. 

That's an unenviable situation. If you should approach a GP, perhaps explain that you have already quit alcohol via detox, and are very motivated to quit your grey-market use of bromazolam with the GP's help. And to do this, you need short-term repeat prescriptions for a benzodiazepine, and the doctor can reduce the dose over time. You would like to finish the taper over x-months. Is there any mileage in this?

[[bv...]]

On 05/10/2023 at 04:11, [[C...] said:

Oops. I edited my last post to correct for that.

I suppose the concern is that you would 'abuse' the prescription for a benzodiazepine. What about a GP? Perhaps even a prescription for just a couple of weeks worth at a time if necessary?

That's an unenviable situation. If you should approach a GP, perhaps explain that you have already quit alcohol via detox, and are very motivated to quit your grey-market use of bromazolam with the GP's help. And to do this, you need short-term repeat prescriptions for a benzodiazepine, and the doctor can reduce the dose over time. You would like to finish the taper over x-months. Is there any mileage in this?

They already know I've detoxed from alcohol; they gave me the Rx to manage that for the past 2.5 weeks knowing I have my limited Bromazolam to assist with that. I'm clear off the alcohol. From their own assessment, that's how it was determined that now it's withdrawal from benzos I'm dealing with, but their recommendation remains go to rehab.

What you suggested is what I've been trying to explain for years. It's just a different philosophy and modality with my healthcare provider (Kaiser). I will continue to seek medically supervised taper in an outpatient setting, but in the meantime I will just do my best to follow the Ashton method.

Edited October 6, 2023 by [bv...]

[[Co...]]

Good luck @[bv...]. I hope you find the medical help you desire and deserve. Irrespective, we will support you here.

[[Th...]]

I’m sorry Kaiser is being so regressive about this. So many places/people still don’t understand that BZDs aren’t like other drugs where you can go to rehab, safely cold-turkey through it, and have the physical dependence pass quickly. 

I don’t have any practical advice but I genuinely hope you’re able to taper off in a way that is safer, and that you’ll be able to find more knowledgeable care providers after your move.