Need Advice

[[kn...]]

I am on a diazepam taper.  My taper history is up to date on site, but long story short, I originally crossed over from Klonopin and Ativan to 60 mgs of diazepam and started down from there.  I am a long time benzo patient (30 years).  I started 2.5 years ago and am currently down to 4mg.  My previous provider left about a month ago and myself and numerous others are awaiting the arrival of his successor in the coming month. Before my Dr. moved on, he OK'd me for oral solution if I wanted it.  I was doing badly at the time, having been non functioning for nearly five months and just opted for another round of 2 mg pills (somewhat clueless at that point).  I've stabilized now to the point where I'm ready to move on and need another Rx, this time the oral variety so that I can micro dose.  Chopping up pills has led to cuts that have practically killed me. In lieu of not having a psychiatric provider, and not being able to obtain an appt. with any of the other ones, I've turned to the nursing triage team for help.  They've been nice enough on the phone, but after 3 weeks and several phone calls back and forth, it's doubtful that they're going to do anything in my favor.  So... since I want to move on (down that is), the question is how to go about it.  My previous provider told me that I could make a .5mg cut, and then take a full dose each day on an alternating basis.  In plain terms 3.5 one day; 4 the next, and so on.  He was certain that after 10-18 days, I'd be OK to make another 5mg cut.  I seriously doubt if this will work. It sounds dangerous to me and I'm afraid it could promote kindling.  The other thing I could do would be to see my primary care provider (I can get an appt much sooner), explain the situation and beg for a new Rx of oral solution.  Again, the question is what would you guys do?  

[[Li...]]

Hello @[kn...].

I agree with your assessment of your previous provider’s advice.  I vote for Door #2 — ask your primary care provider for help.  

Is this a new provider or someone with whom you already have a relationship?  If new, we could provide you with a suggested slow tapering schedule from the recently published Maudsley Deprescribing Guidelines to share with them.  The schedule shows a switch from tablets to liquid at 10mg and below.

[[Ma...]]

I too would see you PCP. But I would 1st call and find a compound pharmacy that can give you the oral solution of your same brand.

It will be so much easier then trying to cut, especially the lower you go.

[[Li...]]

Hello @[Ma...].  Thanks for lending a helping hand to @[kn...]. I’m sure he appreciates it as do I.

I agree with you about the liquid.  Fortunately, my understanding is that he lives in the US where a 5mg/5mL (1mg/1mL) oral diazepam solution is available via prescription.  Many of our US members have used this to taper successfully. 

PS to @[kn...] … apologies if I’m (re)stating the obvious but If you decide to go the PCP route, please be sure to use the right language to describe your situation.  Per our discussion on your other thread, you were not and are not ‘addicted to’ or ‘hooked on’ the benzodiazepines you’ve taken over the years.  Instead, you have been a compliant patient who took these medications exactly as prescribed and become physiologically dependent on them.  Based on the history you’ve shared with us, you also developed tolerance.  (This is why you had to keep increasing your dose plus add a second benzodiazepine.)