Posted by yxibow on June 7, 2009, at 3:17:02
In reply to Re: What's your favorite version of generic Valium?, posted by rollingthunder on June 6, 2009, at 22:15:41
> My Pdoc said that heroin users have told him that certain benzos are harder to get off of than heroin.
All benzodiazepines in the end with mapped out equivalencies (http://www.dr-bob.org/tips/bzd.html, chart #1) share the same similar properties as the first one created in the lab more than 50 years ago, chlordiazepoxide, Librium.
They share four subtransmitter properties -- sedative, hypnotic, anxiolytic and anticonvulsant.
All benzodiazepines exhibit these properties -- it is just some have more affinity -- e.g. midazolam (Versed) has sedative affinity, clonazepam (Klonopin) has anticonvulsant affinity, temazepam (Restoril) has hypnotic affinity, and Xanax has anxiolytic affinity...
...that is more than other ones in this class.
There are additional GABA subreceptors which get more complex, such as those that are targeted by pseudobenzodiazepines such as zolpidem (Ambien).
Well, I don't know about the chronic heroin user who is more than just physiologically addicted, but is also psychologically addicted, that is the key to getting off it (if you want to, and is certainly a good idea considering needles, a life that is in shambles. etc).
Yes, intense heroin withdrawal (a la Trainspotting), basically is a week or so of absolute and complete hell, psychosis, dysphoria, and beyond the pale diarrhea.......(opiates are anti-diarrhea medications, such as the OTC loperamide (Imodium), which basically does not cross the blood-brain barrier probably >99%, and the prescribed Lomotil (diphenoxylate/atropine)....
...and when withdrawn, -some- will cause reverse arrest of diarrhea.
As for benzodiazepines, it is entirely (well heroin too I imagine) dependent on the person, their biochemical makeup, etc.There are still people who are on Librium or Valium since the 1960s and are not particularly habituated.
However, this is probably not the norm -- I am partially habituated but caught in a catch 22 where I still need to take Valium because it helps with my symptoms but I cant "feel it". Going off of it or the Seroquel would put me at risk of relapsing into a bad area...
...this is a double catch 22 because I wish I could "zero out" and start over again.... but that is a story for me, not part of this discussion and it would take months of possible psychosis, etc...
....Xanax does basically nothing for me, and Ambien or Lunesta is not usable at sub dangerous doses.
So with that all said... I became semi-habituated after about four years. But my load of Valium was large, for a specific reason, from specific literature. It is now a bit more than half of what I used to take.
The drug that is hardest to get off than heroin though is nicotine (cigarettes, etc.) And that's not just a repetition of mantras, it is pretty true. A small number of people can smoke for a few months and never do it again.Large numbers of people though go through years of attempting to quit, patches, psychological interventions, etc.
There are people who can't quit smoking when they are at the point of having a tracheotomy and smoke through it with emphysema, cancer, etc, to be graphic.
But yes, the saying that one should be on one no longer than four weeks probably holds some water, but sometimes say, klonopin is the only agent that helps someone with social anxiety disorder get out of the house.It would be better to transfer to an SSRI such as Paxil or other agent but sometimes that doesnt work.
There really is no good answer, in summary as to how long until habituation. It just is something that unfortunately comes from knowing that your benzodiazepine doesn't appear to give you a "buzz", say, any more after taking it, for example.
I would say though that the use of short half life benzodiazepines for long term use is not the best idea and could lead to more issues, such as Xanax and Ativan. They lend themselves to PRN (as needed) use, more.
There are definitely more dangerous benzodiazepines, not because of publicity, but because of the possibility of mixing with other medications, and these are typically the ones stronger on hypnosis -- such as flunitrazepam (Rohypnol, still available in some parts of the world), triazolam (Halcion), and a few others.And yes, some are harder to get off of, but typically, the procedures to remove them are similar... I'm not going to into the controversial, alternative, and not mentioned in the psychiatric community particularly, the "Ashton Methodd"....
... the basic evidence based psychiatric method is about 10% reduction per week, more or less if it can be managed, until it is discontinued.
The thing is -- the benzodiazepine will always be there, and it is, when payed attention to properly, one of the least.... can't find the word... adverse medications in psychiatry.
So since it is already there, there's no shame in taking enough time so one isn't losing so much functionality of reducing or eliminating it. But also there's no need of following someone's regimen -- it should be up to the patient; after all they are the ones with the withdrawal effects.
So that is a very long answer to your comment.
-- tidingsJay
poster:yxibow
thread:899521
URL: http://www.dr-bob.org/babble/20090531/msgs/899782.html