Posted by Cam W. on June 8, 2001, at 9:22:03
In reply to Happen to be lurking around, Cam?, posted by grapebubblegum on June 8, 2001, at 1:02:33
Grape Gummer (GBG was too boring) - I use to think like your doctor. It is the people that keep increasing the dose that you remember. I tended to forget the bipolar patients taking one or two diazepam, oxazepam, clonazepam, or alprazolam daily for years and years (I, and many of my pdoc colleagues) find that people with bipolar disorder tend not to abuse benzodiazepines. We all do remember the ones who consistently come into the pharmacy 2 weeks early to get a month's worth of benzos, even with increases in dose. I tend to remember people who are in my face more often, than the ones who come in once a month to pick up their prescriptions, with no extra work involved (ie phone the doc to authorize early refills; the five calls from the patient in the next 2 hours to see if the doc called, although I said I would call when the doc called back; the excuses for being out early - "they fell in the sink while I was doing dishes"; "I was having a 'ginger ale' with a friend and he started fighting with me and spilled the ginger ale all over my pills"; "my friend came over and looked in my medicine cabinet, saw my Ativan and said, 'You don't need these', and crushed them under his heel"; "I left them in my pocket and washed them for the 3rd time this month". - All are true "stories").
Many times I think that there is almost a psychological thing about taking a certain number of pills a day, that equates into feeling better, with some people. This may be why some people do increase their dose. This, and the fact that the tolerance to the psychomotor effects makes it feel like the benzos are not working as well as they did.
I guess it also depends on whether one is using the drug for anxiety or whether they are using it for escape. "Escapers" tend to increase the dose. The anxiety, for them, may not be as critical as being able to "get away" for a while. I also find that those that use them for escape often use other drugs for escape, as well (eg. opiates, alcohol, pot, coke, etc.). Perhaps we should routinely do drug screens before putting people on benzos; although the praticality of this would be questioned.
As for your doc. I would be hesitant in writing benzos for patients, if I were a doc. After all, it would be my name on the prescription (and the license); and it would be me that would be called for that early refill (often by both the pharmacy and the patient). It would also be me that would be called if the person was caught selling the drug with my name on the label; and me that would be called if the person showed up in emerg, after overdosing on a drug that I gave. These are the people that I would equate with benzo use, not the 4 or 5 times more of my patients that take their benzos as directed (or less than directed) month after month, year after year.
I guess it comes down to whether one can tell if a person that one is writing that prescription for will use it for anxiety, or if that person will begin to abuse the drug. I know that I cannot tell the diffrence beforehand.
This is probably one reason why SSRIs are preferred over benzos. Also, SSRIs are safer in overdose, especially in polydrug overdoses; I believe SSRIs attack the " biochemical cause" of the anxiety more directly; and SSRI prescriptions are not monitored as closely as benzo prescriptions.
- Cam
poster:Cam W.
thread:65576
URL: http://www.dr-bob.org/babble/20010605/msgs/65758.html