For good or bad (and I understand often bad), pain management and especially with oxy is under heightened scrutiny. There really is that whole situation of managing your chronic conditions while dealing with the fact you are likely addicted to the meds you've been taking. So, the idea of changing is, I'm sure, terrifying. We get psychologically wrapped up in our routine and it works, so why wouldn't we? I understand how you are feeling. I think the best you can do is to try what they are asking. And if it doesn't work, there will be the time of re evaluation. Totally stinks to have a month or a bit longer that may not be like you usually are in terms of keeping the chronic issues at bay. But they are saying you have to so I would try to fight the fear and try with an open mind. Chronic pain patients are being taken off meds around the country. Xanax is a little bit different. Xanax is not really a treatment for insomnia. It really just numbs you. There definitely better treatments for insomnia than that. That one may be harder to continue for an insomnia diagnosis. But you do need proper pain management. Trazadone is usually a good choice for insomnia. I'm sorry that isn't working for you. Maybe the dose can be tweaked. I'd say it is unlikely you'll get put back on xanax with this doctor. Again, try to be open minded as to 'what else' you can do.
I doubt your doctor wants to fire you. Most doctors really do want to help you. hugs
Conversion from one opiate to another is never a 1:1 conversion. Even in pain management practices, when converting from one opiate to another there is a reduction in dosage with the new medication. Cross tolerance issues are considered, since even in long term chronic pain patients- they typically need less of the new medication to achieve equal or better pain control using a lesser dosage. The new opiate uses different receptors and that’s why. Secondly, in order to avoid side effects , accidental overdose , drug interactions -a new medication is reduced.
A typical reduction is 20-30% of the previous dose- so it appears your doctor is doing the conversion exactly right.
Xanax is not recommended for use with opiates, since both cause sedation and respiratory suppression. I’m not surprised they don’t want you taking the amount of opiates you are on and the Xanax as well.
Trazadone can be titrated up in dose safely and effectively if the current dose is not working.
I’m still battling this. I had an appointment with my doctor & we discussed all of the alternate meds which are covered by my insurance. We settled on one (which required a PA) and they outright rejected it - at least in the dosage necessary to replace my current regimen. I’m in a situation that is untenable and think the only way to reconcile it is to file a complaint with my state’s insurance commissioner. I’ll be doing that very soon. I thank all of you for your suggestions and comments.
Btw, I’m no longer taking Xanax and have switched to Lunesta. I don’t sleep well but I’m at least no longer taking a benzodiazepine.