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Can my doctor just take me off of my benzodiazepine cold turkey?
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Can my doctor just take me off of my benzodiazepine cold turkey?

I've been on benzodiazepines for years now. I started on Ativan when I was younger then when I got older I was on Xanax for a few years, my highest dosage was 6mg a day. I was put on Suboxone about 3 years ago and they had no issues prescribing both. A couple months ago, all of a sudden, they said I can't be on both and how dangerous it is. So they put me on Klonopin, 1mg once a day. I've been doing that routine for months now. All of a sudden he cut me off cold turkey, no plan to ween off or even put me on a non benzo to help my anxiety. My panic attacks and anxiety is extreme by the way. We argued and I even tried talking to the head of the staff at this place. The doctor said he felt I was getting addicted to it and that it wasn't helping me so he didn't give me another script, just sent me on my way. He said id be fine and I wouldn't experience withdrawals because I'm on a low dose, even though he's had me on it for months and the doctor there begie him has me on Xanax for years. Everywhere I've read say that this is the worse idea possible, that no matter the amount you take, you just don't kick someone on benzos to the curb. Anyways, I'm starting to feel the symptoms of withdrawal, I've been through it before. I have to something cause today it's just going to get more severe. Two things, a) is it even illegal what he just did to me & b) what should I do now? Go to the ER, hope they help and find a new doctor ASAP? I'm pretty nervous and scared, my anxiety is obviously worse now and I have no idea what do?

Thanks for listening,,,
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480448_tn?1403547723
Hello and welcome!  I too am sorry for what you're going through.

It IS actually true that there is a very strong contraindication between benzos and Suboxone.  It's extremely rare that a doctor/clinic would ever be willing to prescribe them concurrently.  I worked in a Sub clinic for a while and I can tell you first hand that benzos are a deal breaker for someone seeking out Suboxone maintenance.  Of course there is the occasional exception, but in MY experience, it was a HUGE no no.  Anyone seeking out Suboxone maintenance who was on a benzo needed to be off of it completely before the clinic would accept them.  

That being said, your doctor obviously already HAS been aware of both medications and has continued prescribing them to you, which definitely makes it seem very unfair to abruptly cut you off.  

If I may ask, what are you taking Suboxone for?  Do you have a history of opiate addiction?  It goes without saying that doctors are frequently uncomfortable prescribing a med that is commonly abused to a person with a history of drug or alcohol abuse.  However, that should have been something that was discussed and considered a long time ago, not after years of being on benzos.  I'm just trying to make some sense out of this for you.

Another issue I could see that would make sense as to why the doctor seems to be in such a hurry to stop the benzo is that perhaps he has concerns about you abusing it?  Have you ever run out early, asked for early refills?  Were you a compliant patient, making it to all of your appointments, without a lot of cancellations or "no shows"?  If any of the above issues have come up for you, I can see the concern from the doctor's point of view.  In no way am I saying it's OKAY, just saying I would understand.

I think your best recourse is to try to find another doctor who will help you either continue the script under supervision (with the understanding that you're on the Suboxone) or one who will help you gradually taper off.  You're absolutely correct that, even with a low dose, you've been on benzos long enough that you should not just abruptly stop.  I don't agree with your doctor at all in that regard.

Does this same doctor also prescribe your Suboxone?  If not, perhaps the Suboxone doctor can make some recommendations of doctors who would be okay prescribing you the benzo while you're on the Suboxone?  Or in the least, again, help you properly and safely wean off the Klonopin.  I'm assuming if you have been seeing two different doctors, that your Sub doc was aware of the benzo and okay with it?  

Please keep in touch with us and let us know what you find out.  Fingers crossed you find a resolution very quickly.

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Avatar_m_tn
It certainly should be illegal, because not only is he pushing you into withdrawal from an addictive drug you've been taking regularly, he's also putting you at risk of seizure as benzos are also an anti-seizure medication.  That's why you do this with a psychiatrist who you determine knows how to do this, not general docs who seem to be pretty clueless too often about such matters.  I would contact the pharmacist and have him or her contact your doctor with the proper protocol, and I would also contact the doctor's office and, if you have to, threaten the doctor with disciplinary complaints if he doesn't learn the safest method to do this.  Since he knows this drug is addictive, according to what you reported he said to you, he's even worse than the typical clueless doc, he's knowingly causing you potential suffering.  And I'd find another doc as quickly as possible.  It was sounds like they took you off the Xanax cold turkey, because switching from one benzo to another doesn't necessarily prevent withdrawal -- a slow taper from one before starting the other, given the drugs are very different, is the much wiser course of action.  Sorry for your predicament.
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Avatar_m_tn
And I should have added, just because benzos are addictive doesn't mean they aren't your best solution, though taken as needed is much better than taking them regularly to avoid addiction and tolerance.  And I'd also like to know what the difference is between Xanax and Klonopin if one shouldn't take benzos with suboxone, as they're both benzos -- maybe there is one, but it would be nice to know, I'd think.
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Avatar_f_tn
Sorry I should have been more clear. This wasn't my pcp but my phycatrist. They supposedly switched me to klonolin bc it doesn't last as long as inst as addictive as Xanax supposedly but I don't see how?

Thanks for your concerns.
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480448_tn?1403547723
Hello and welcome!  I too am sorry for what you're going through.

It IS actually true that there is a very strong contraindication between benzos and Suboxone.  It's extremely rare that a doctor/clinic would ever be willing to prescribe them concurrently.  I worked in a Sub clinic for a while and I can tell you first hand that benzos are a deal breaker for someone seeking out Suboxone maintenance.  Of course there is the occasional exception, but in MY experience, it was a HUGE no no.  Anyone seeking out Suboxone maintenance who was on a benzo needed to be off of it completely before the clinic would accept them.  

That being said, your doctor obviously already HAS been aware of both medications and has continued prescribing them to you, which definitely makes it seem very unfair to abruptly cut you off.  

If I may ask, what are you taking Suboxone for?  Do you have a history of opiate addiction?  It goes without saying that doctors are frequently uncomfortable prescribing a med that is commonly abused to a person with a history of drug or alcohol abuse.  However, that should have been something that was discussed and considered a long time ago, not after years of being on benzos.  I'm just trying to make some sense out of this for you.

Another issue I could see that would make sense as to why the doctor seems to be in such a hurry to stop the benzo is that perhaps he has concerns about you abusing it?  Have you ever run out early, asked for early refills?  Were you a compliant patient, making it to all of your appointments, without a lot of cancellations or "no shows"?  If any of the above issues have come up for you, I can see the concern from the doctor's point of view.  In no way am I saying it's OKAY, just saying I would understand.

I think your best recourse is to try to find another doctor who will help you either continue the script under supervision (with the understanding that you're on the Suboxone) or one who will help you gradually taper off.  You're absolutely correct that, even with a low dose, you've been on benzos long enough that you should not just abruptly stop.  I don't agree with your doctor at all in that regard.

Does this same doctor also prescribe your Suboxone?  If not, perhaps the Suboxone doctor can make some recommendations of doctors who would be okay prescribing you the benzo while you're on the Suboxone?  Or in the least, again, help you properly and safely wean off the Klonopin.  I'm assuming if you have been seeing two different doctors, that your Sub doc was aware of the benzo and okay with it?  

Please keep in touch with us and let us know what you find out.  Fingers crossed you find a resolution very quickly.

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Avatar_f_tn
I had an opiate addiction about 3 1/2 years ago but have been clean since. I've been on Suboxone for a little more than 3 years now and like I mentioned I've been on benzos for even longer. At the time Suboxone was just coming out and replacing methadone, so they put me on both Suboxone and Xanax. We'll later down the road, doctors started realizing it was a bad combo but if guess they chose to ignore it.

I never missed an apppoinment in the last year. I've passes all my monthly drug tests. I went to every group therapy required. I told him my anxiety was worse and he wasn't helping me. He had me on 5 medications (Suboxone, Xanax/Klonopin, Paxil, Risperdal & Neurontin). This crazy combination was used to treat my depression, anxiety and prior opiate addiction. I told him I was tired of feeling like a zombie, unable to be a father to my son, etc. I told him I'd rather focus on my anxiety than my opiate issue from 3 years ago. I asked if I could be weaned off the Suboxone so I could be on a more efficient dose of Klonopin, I went from 6mg a day to 1mg of Klonopin a day. The doctor before my current one, he was at the same practice, had me on the Xanax and it worked, it helped my panic attacks and anxiety. This 1 klonopin a day doesn't help much when I have numerous attacks at unknown times.

Anyways, I wanted to updated you. I had emergency appointment this morning with the "head phycatrist". He basically told me that they can no longer help me and that he feels the doctor can't treat me anymore and that I need dual therapy. He gave me a two weeks worth of klonopin and told me to call another doctor to see for treatment. He said I needed to go to this specific place that would help me more. I asked him several times through the meeting if they will help me get off the suboxone and benzos, he said yes I know them down there, blah blah blah. Soon as I got home I called this place and the first thing they said was "we car accept you because your on a benzo and that your most recent doctor needs to wean you off first". I'm extremely upset because he lied to me, he just told me what I wanted to hear. He basically said you have a months worth of Suboxone and two weeks worth of Klonopin, bye bye. But yes the current doctor was prescribing everything.

Here is where the issue gets worse. My insurance isn't good and isn't widely accepted so I don't have a vast choice of docs to choose from. I can probably find a new Suboxone doctor before my months script ends. I do have an appointment next month with my current doctor but he will only be giving me Suboxone. I'm completly own my own with getting of the benzo. I tried calling over ten doctors today and none where able to treat me because I'm on both meds. So I don't know what do. If I go back next month and I test positive for benzos I'll probably not get my medicine. I just wanted to get weaned off the suboxone and Klonopin now I'm force to be on them longer. My only hope is that my PCP will help me get of the kpins while I find some doctor that is ok with it while I'm getting of the suboxone.
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Avatar_m_tn
Nursegirl's answer is way better than anything I can say, but I did want to comment on the klonopin vs. Xanax thing.  Klonopin lasts a lot longer in the body than Xanax, which has a pretty short period of activity.  You seemed to indicate the doctor said the opposite, but I may have misunderstood.
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Avatar_f_tn
All I remember him saying was that they have different times that they kick in, one kicks in faster than the other and that one of them lasts shorter than other. He then said klonopin was less addictive than Xanax. I just got another voicemail from them saying that I won't withdrawal, that's it's not physical issue but a mental issue and I'm in no danger.
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Avatar_f_tn
I know my body. I called over ten Doctors yesterday to try and get in and they wouldn't see bc they are scared of me being on a benzo. It's all a scheme. If the 1mg or Klonopin isn't an issue than why can't they see more for one last visit to get me off of BOTH meds before they just ship me off with no other doctor lined up.
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480448_tn?1403547723
Thanks so much for the additional info.  It really sounds like you're getting the shaft, and that's a darn shame.  I'm so sorry you're going through this.  

I find it SO irresponsible that after prescribing you this regimen for so long, that the doctor is just deciding to give you a very short taper and sending you on your way.  The info about the contraindication between both meds has been around long enough that there's no excuse for the doctor not to know about it.  Add to that that doctors have to be specially licensed/educated to prescribe Suboxone (not just any doc can), there's even less of an excuse for him "not knowing".  It's not like this is brand new info.  It's unfair that NOW, after all this time he decides to become "uncomfortable" with prescribing both medications.

I wish I had better advice for you, but the only thing I can think of is to make another appointment with your doctor, and show him the list of ALL the doctors you called (including the one HE recommended) who won't take you as a patient.  Explain to him that you have no problem weaning off the medications, but you want to do it more gradually, not a 2 week turbo taper.  I would also express to him that you're in disagreement with his stance about you not going through w/ds.  You absolutely will.  I would explain that you're very uncomfortable with the way this is happening, you feel as though you're being left out to dry, and with you being a compliant patient who OBVIOUSLY hasn't had any problems taking the meds concurrently, there's no reason he shouldn't be able to help you with a slower, more deliberate taper.

If you're refused again, I would file a complaint with the medical board.  I'm the first person to defend doctors on their (sometimes harsh) decisions regarding prescribing narcotic medications, but this situation just isn't ethically correct.  He has no LEGAL obligation to continue treating you, which is unfortunate, but ethically and morally, it's just so wrong.  It makes me SO angry.

I sincerely hope you make some progress with this guy.  If you could just manage to wean off one or the other med, you would have lots of options moving forward.  The problem, is, neither are super easy to get off.  The Suboxone would probably be rougher and would take longer.  How much Suboxone are you currently taking?

I guess one other option would be to look into an inpatient detox to help you get off the Klonopin or Suboxone in a more controlled environment.  Have you considered that?  Perhaps making some phone calls to a few facilities would be a good idea, just to see what they would be able to do for you.

Please keep making phone calls, be the squeaky wheel.  Let us know what's going on.  My fingers are crossed for you.
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480448_tn?1403547723
I wanted to add that it would be extremely unethical for your doc to discharge you from his care with the knowledge that you are not able to find a doctor to follow up with, including, and most importantly, the doctor HE referred you to.  That would be an important factor to mention if you get to the point of filing a complaint against him.

What state are you in hon?
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Avatar_f_tn
I'm in Pennsylvania. He called my house at 9pm tonight. I tried telling him that I would ween off the suboxone too and if he could please ween me off the klonopin properly. He said you need to remain on Suboxone and that it would be a bad idea to go off of it at this moment. He won't let his doctors treat me anymore but his has the balls to say I need to remain on it somewhere else. The head doctor at this place who I'm talking about here said I needed to go to a specific facility to get treatment. I called that place yesterday and I was told I had to be off all medications before I could be treated. I called him back and told him that. He said I just have you a two weeks supply of Klonopin, he gave me a schedule on how taper off I'm two weeks. Like you said above that seems like way to fast. I mentioned that 2 weeks seems like a short time to kick a long time habit. He then repeated again that tapering off Klonopin at my dose will not cause withdrawals. He was like emotionally it might be hard but I will be fine physically. There office just gave me a months worth of Suboxone, I just picked it up. I don't understand why his office can't ween me of the Suboxone, they refuse to ween me off and say I need it still but won't treat me anymore.

I talked to my PCP he said he could see me next month and help me ween off the Klonopin properly. He even wrote me a script of Klonopin to help me until in see him. My PCP even feels this is not a good idea.

So I'm in a dilemma right now. I found a doctor, my PCP to ween me off of my benzos. I'm on 16mg of Suboxone a day or 2 strips. I have a months worth now just recently got it but now I have no way to been weened off that. I called over 10 Suboxone clinics, none of them would take me because of the benzos. They all said call back once your weened off.  I talked to head doctor of the place I was getting my Suboxone and a Klonopin from. I told him I found a doctor to help me get off the klonopin I just eked your help to get off the suboxone. You'd figure that since he put me on it that he would at least take me off. He said no, believes that weening off both at once would be dangerous. This place he wants me to go to is once a week and I would be there for 2-4 hours each week, drug test where the girl stands I'm the bathroom with you, group therapy and then you got to wait for the doctor to come in and give you suboxone. This happens every week. Ask you have to be clean off everything you can't even have alcohol in your system. I've clean from drugs for over 3 years and now I'm forced to goto a facility for hardcore users just because they don't want to treat me anymore?

I'm a single father with a 3 year old that had autism. He has therapy a few times a week and other treatments. I have to be there for him I can't go to this new place and have my son miss his speech classes and so forth. It's a 30-40 minute drive from my house also. So let me recap to you what this doctor office, the place that has been treating me for more than a year now wants me to do.

1) make an appointment at this new facility and tell them I want to be seen in two week(I've been there before by the way).
2) start tapering off my Klonopin, ween off of it in two weeks.
3) continue taking my Suboxone
4) once the two weeks is up and my klonopin is gone I'm suppose go to this new place to get Suboxone and drug treatment. I'd have to go at least once a week. It's bad there.
5) once I'm at the new doctors I talk to them about weening off and see what they say.

That is basically the plan he laid. He only talks to me over the phone now, I tell him how I've felt and how this plan can't work and he simply refuses to work with me. He has an answer for everything I say, he is set on his ways and there is no compromise. I even told him this too... I called this new place and like I said I can't be on Klonopin they won't even take me. We'll I've heard that benzos can be in your urine for a while. I told this that if I have any trace of Klonopin in my system they won't take me in. He said he would call then and explain my situation to them to see if they would give me a pass if it shows up in my system which it obviously will.

How do I file a complaint against this practice. I've done everything I can on my side with this place. They just don't care. I'm going to continue calling Suboxone doctors tomorrow to try and find one that will help me with my suboxone while I ween of the klonopin from my PCP, that's my only chance to get through this. I've been clean for a long time but this is stress I can't take and hopefully I don't make a mistake and relapse.
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Avatar_m_tn
Filing a complaint probably won't get you anywhere, because doctors regulate themselves, but it's still important to do so.  Most likely the place is the state branch of the AMA, but there might be a regulatory agency within state government that also might get involved.  The American Psychiatric Association also regulates.  But it's limited what you can accomplish absent significant harm.  I has this problem with a psychiatrist and it led to great harm; I should have sued and filed complaints to protect others but I didn't, so I hope you do (you can't sue unless you suffer a lot, and I don't expect or want that to happen now that you've found a PCP who understands.  By the way, klonopin is not less addictive than other benzos -- it might in fact be harder to quit for those who have been on it a long time, which you really haven't, fortunately, compared to people like me who were put on it years and years ago without being told anything about the negative side of it.  You at least have the sense to know.  Good on you for having the sense to question your psychiatrist, who sounds like a fool.
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Avatar_f_tn
Yeah I found a PCP who will help get off the benzo, that was the easy part. Now I got to a find a suboxone doctor who sulk treat me and get me off of that. But it's nearly impossible to find a doctor who will see me now because I'm on benzos. I have one last doctor I can try and then I'm screwed. My current doctor, the *******, wants me to start we weaning off today. About a few years on benzos in general and year of that has been on klonopin and now I'm suppose to somehow wean off of it in just 2 weeks. This isn't going to be fun.
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Avatar_f_tn
I haven't spoke to you in a while, I just wanted to update you. After a bunch of meetings at the doctors office and causing a nightmare for them, one of the doctors there agreed to give me a month worth of Klonopin and gave me a taper schedule to get off of it.

0.25 3x day for 1 week
0.25 2x a day for 1 week
0.25 1x at night every day for 2 weeks and then stop

I'm about to be on week 4 soon, I'm now down to a 0.25 at night. The day time is horrible, I have nothing for my anxiety, so it's been rough. Do you agree with this? The 2 weeks at the end doesn't make sense to me? Won't I get withdrawals taking a pill for 2 weeks then just stopping? How is this tapering off? Do you think my dosage is low enough that withdrawals wont happen, is it now just more of an emotional/mental "withdrawal"?

Also, do you know how long benzos stay in your system for a urine test? I go to the same doctors office for my Suboxone treatment. The doctor that cut my cold turkey of Klonopin isn't happy that one of his colleagues gave me months supply and was willing to help. He said he'd cont treating me with Suboxone as long as my next visit that I have no Klonopin in my system. I'm glad he still wants to "help" but I'm not getting the proper treatment I know I need. I need something for my Anxiety and he just keeps  throwing me on anti-depressants that don't help with my panic attacks and axiety. This situation never gets better, I've been dealing with therapy for years now and I just get thrown around from person to person.
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480448_tn?1403547723
Hi there!  SO glad you came back to update us!  I'm glad to see you made SOME progress, but like you said, it isn't much, they're still in a hurry to get you off the Klonopin.

The taper schedule they devised is definitely a bit on the fast side, but you should be okay with that schedule.  I'm not saying you will feel perfect, because you will probably have some rebound anxiety, along with some other w/d symptoms, but they won't be nearly as severe as what you were looking at initially, and also, this taper greatly reduces the risk of seizures for you.

As far as the Sub doc goes, it sounds like he too is being unreasonable.  How long will it have been after your last dose of Klonopin before you go in and see him and take your tox screen?  It's impossible to say if it would be out of your system for sure or not, and Klonopin has a longer half life, so it is normal for a person to test + for it a good bit after they would if taking the shorter acting benzo cousins, like Xanax.

Here's my advice to you my friend.  This whole process has been a complete nightmare, due to NO fault of your own sadly.  You're dealing with a bunch of docs who want to put the hammer down abruptly on a situation THEY themselves caused.  To add to that, you've been a compliant patient, doing everything that had been asked of you.  I would REALLY recommend, once you're totally off the Klonopin, and know it won't be present in a tox screen, ditch ALL of these docs and start over brand new, okay?  Even if you manage to jump through all of their ridiculous hoops, they don't deserve your business.  Truly.

I'm curious, you said you made a big stink, what kind of action did you take?  Good for you by the way!!  Drop in and update us when you can, I was really glad to see that you posted!  I often wondered how it ended up turning out for you!!
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Avatar_f_tn
Good to hear from you again! I'm already feeling "shaky" from the tapering off, I feel it's mostly in my head, the benzos have been a crutch for me so long, I'm scared to almost not have it anymore. Just knowing that it's there would calm me down. But your right, I do need to get off the klonopin for good and then try and find a new facility to treat my for my problems. I'm going to try and find a suboxone doctor that'll treat me once I'm off the suboxone, I do want to get off of that too. My current doctor feel I should remain on it, I requested that I wanted to get off. I understand they don't want to taper me off both the klonopin and the suboxone at the same time, but once im off the suboxone he should have no issue. Once I'm off the suboxone, my docotor options open up more. Now, I can't find anyone because I'm on a benzo and suboxone, it's so dangerous I'm a big liability basically.

My last dose of klonopin is this Thursday night. I've been taking a .25 (quarter) at night for what is going to be the last 2 weeks coming up. He wants me to be off of it, he knows that I'm on it currently and tapering off. I told him after my last appt that I'd call him and leave a voicemail with the last date that I'd be on it.

I made a HUGE stink :( It was days of constant phone calls and showing up at the office. I went up myself at first, several times to talk to staff there, basically saying that this is irresponsible, dangerous, etc. Basically said If I end up in the ER, I'm going to sue. I told them I'm on two dangerous medications. I'm no doctor, but I know a practice has to have pretty damn good reason to "kick" you out. Saying that "We don't feel  that we can help you anymore, we have reached our potential with you", to me, doesn't sound like a legal or legit reason for them to release me. Maybe I'm wrong though? I called about 15 practices and none would take me because I'm on both of those meds. They all said I should be tapered off and once that is done I can call them back. I told this to my current doctor, gave him everyone I called, told him if you could find a place that'll take me off of your hands, I'll be more that happy to leave. I finally got a meeting with the head therapist there, he oversees everything. He said he has "connections" and know a place that would treat me for both, told me he'd call them and get back to me. 3 days go by, nothing. I call him back, he says he is still trying to get a hold of them. In the meantime he gave me a 2 weeks script of klonopin to cover me until I go to this new place. I already called the place, I knew they wouldn't take me, but I let him keep trying. I finally got a hold of my doctor and he said that they wont take me in, the must of changed the rules. That was after he acted like a big shot, saying he knew people down there, yada yada yada. He tried telling me to just taper of the 2 week script he gave me. I said I wanted an emergency meeting, had my family on the phone with me. He agreed to let me come in and see one of the docs. The one I met agreed that I should at least be able to taper off but told me that my doctor is going to be pissed and wont agree with it. He gave me a months worth to taper of with it. It's better than cold turkey but I wish it was done more professionally, it seems rushed and all the crap I went through makes me not want to even go back, they are joke. I just saw my doctor last month, he wasn't happy that his colleague gave me more klonopin, he didn't say anything bad but you could tell he wasnt happy. Probably was quiet because I had people with me. Anyways, he was like I didn't do this because harsh or mean I just don't like prescribing benzos in general let alone together with suboxone. He's like whatever you decide to do from here is fine with me, if your off of klonopin by next month I'd be happy to treat you for suboxone. I'd wanted to knock him out when he said.

Sorry for my usual rambling, I've been up all night, the little one is sick. Anyways, as always, thanks for listening :)
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