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Have you changed from the cut and hold method to microtapering?


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Hi Hope.

 

First let me say good job there getting off the K. I know how hard this is for each of us, so again I say congratulations to you. I hope you feel good in every way and I mean it.

 

Well, the "chastisement" was a while back on a thread that I hesitate to mention on this open thread as I did get rather upset, and openly say I don't want everyone to review it again.

 

I can PM you, but it would only be to refresh your memory as I really don't desire to reopen it. We essentially settled the matter, and upon reflection, I should not have been as pushy as I was about any particular method of tapering.

 

As far as the term "micro tapering" I've heard it around for awhile and have absolutely no idea who "coined " the term or if it "belongs " to anyone at all. I'm glad that BB supports ideas of tapering that work which I felt that would be the case. And I also have no doubt that some fairly "odd" ideas have been floated.

 

And of course, to provide a modicum of success and common sense, that cannot be supported.

 

Well, I will PM you just for the heck of it, but as you told me then "it's pretty much water under the bridge." (Paraphrase there).

 

Intend

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Thanks RG

 

I am not one to cause problems but I seem to have yet again I get involved and wham I am in the thick of it, so a lesson to be learnt keep :-X then I don't know what is happening, just  get on with what I am doing and how I personally feel is best for me, put it this way I did c/t and ended up in a hospital for 4 months to be put back on the benzo I stopped ::)

 

DD

 

DD,

 

You have not caused any problems, don't think that. 

 

There is much confusion about the term Microtapering.  I myself am confused as well. I know very little about Jana and her website/method of withdrawal.  The reason we say we do not support her specific brand of tapering is because we don't feel we can address this without better information.

 

Colin will strive to clear up misunderstanding and confusion.

 

In the interim, know that if your method works for you, it really dosen't matter what you call it.  We are here to support and encourage you in your journey to be benzo free.

 

pianogirl

 

Hi DD,

 

I'm also not aware of any problems you've caused. As far as I know we have been discussing various taper methods as well as confusion relating to the term "microtapering".

 

 

Thanks RG

 

I am not one to cause problems but I seem to have yet again I get involved and wham I am in the thick of it, so a lesson to be learnt keep :-X then I don't know what is happening, just  get on with what I am doing and how I personally feel is best for me, put it this way I did c/t and ended up in a hospital for 4 months to be put back on the benzo I stopped ::)

 

DD

 

You haven't caused any problems ;). You just do what works for you, it's all trial and error. We need each other through this process. :mybuddy:

 

You're making progress :thumbsup:.

 

RG

 

This is absolutely right. When I got to the lower doses I decided to give titration a try. It didn't work for me for various reasons. So, I then tried a jeweler's scale. It worked much better for me. Some would say that my taper was slow. It averaged a 6% drop every two weeks. There was one point that I held for several months. That's what I felt comfortable doing and it's what worked for me.

 

 

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Thank you all for your replies it is a load off my mind and  I may sleep better knowing that all is settled well I do hope so :), we all know it is a difficult thing that we are doing and hopefully with a good outcome of which none us know until we take that final dose.

 

I shall go and feed my kitties.

 

DD :smitten:

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To be honest, I think it's this thread that is causing most of the confusion, rather than people previously being confused about the MT term. I know I’m speaking for a lot of people, but I think the majority of people here view microtapering as simply meaning doing a very small daily cut – period. Micro means very small, and taper means cut – so to do a microtaper just means doing a very small cut.

 

Before I read this thread I wasn’t confused about anything and had absolutely no idea who Jana is (still don’t, and frankly don’t care), but if she has a specific method for doing this, and it provides the end result of a relatively painless taper to zero, then good for her. Isn’t that the aim of this forum after all – for people to find whatever method works for them to get themselves off benzos for good?

 

However, if she has a patent pending on this process (don’t know anything about that), good luck with that, because I can’t really imagine it’s anything that different to what a lot of people are already doing without her input. So how is she going to prove that her method is any more unique than TRAP, Ashton, or the dozens of different tapering methods that people are already using. I’m not really sure how she will be able to prove any kind of “ownership” of the method, because I’m sure I have read the term on sites other than BB, and I’ve never been to Jana’s site and have no idea who she is. If it is some kind of "titration" method, that is certainly nothing new. It's been used for other meds for years.

 

There is no “perfect” way of tapering. Everyone has a different method. Even those people who are doing the same kind of method are using different doses, and that’s the way it should be because we are all different.

 

We’ve been getting told for a few weeks now that Colin is going to address this MT terminology (I have read this on a couple of threads now), but so far I don’t think I’ve seen anything. I’m sure he’s very busy, but if he really wants to reduce the use of this term, I think he will have his work cut out for him because for a lot of people it has become part of benzo vernacular.

 

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MICRO meaning small and minute.  It comes from the ancient Greek word, "micros" meaning tiny.

 

Used in words for centuries:

 

We have microbiologists, microscopes, microwave, micromanage, microphone, microprocessor, microbe, microcosm, and microgram to name a few.

 

It's one millionth of a gram, (μ) a prefix in the SI and other systems of units denoting a factor of 10−6 (one millionth), early set-theoretic database management system, a programming language, a Thai rock band, the first car company from Sri Lanka, a novel written by Michael Crichton and Richard Preston, the name of a Japanese professional wrestler, and a Greek electronic music group.

 

TAPER from the Old English "tapor", a modification of the Latin papyrus. First Known Use: before 12th century.  Becoming smaller, leaner, slimmer like a burning candle.  Used to describe decreasing the amount of or use of substances for centuries.

 

These are two common words with long rich histories. Combining the two is self-explanatory and not a new invention.

 

Let it be spoken, let it be so.

 

Ibbletupthoktutektu Vrrrrobilite Ptui

 

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Actually,

 

When I read the term "micro tapering," I don't assume that anyone is using a very specific method at all other than they are making very small cuts in their dose.

 

And I'm not really clear why that in and of itself should be a problem if it works for them. There are a lot of folks here who do prefer much bigger cuts as their body is more comfortable that way. And others prefer shorter holds or longer holds.

 

So if someone wants to literally pulverize a pill and weigh it out and apportion it into many small doses to be taken over a period of time, and those doses are "micro" or " very small in comparison with others of it's kind," (several online dictionaries used for this definition) and the taper is going well, why is this unsupported?

 

Or perhaps they are titrating their benzo, but withdrawing very small (micro if we use the same term) amounts, and they feel comfortable doing that, why is that unsupported?

 

I have not ever heard that anyone is trying to get BB to endorse a very specific method of tapering at all, but having said that, I acknowledged being chastised for endorsing specific methods. That was probably a mistake for me to say as I know we all can and will try different methods to get off benzos, and some will work while others will not and other folks may be fortunate enough to have several methods work for them.

 

So this subject seems to have caused confusion among members and administrators. I even hesitate to use the word "method" here because it does clearly mean a particular and systematic procedure for accomplishing a task. But IMO, using tiny cuts or micro cuts doesn't seem like such a "bad" idea if the person is comfortable doing that.

 

Trying to get all this "compartmentalized" into supported and unsupported seems hard to me. Well, I may get chastised again, but I'm in favor of what works for people. I totally understand why people are getting mixed up between the terms titration and micro tapering. Perhaps the coming clarification will help that. I'm clear on the difference, but understandably, many may not be at all. I think that clarification is needed so the confusion can stop.

 

Ok, I've surely rambled a bit here. This is really my honest opinion. I just think people should try and be supported in what works for them w/o that necessarily saying folks must follow any particular procedure in order to get that support.

 

Intend

 

To me MT presents a problem, if the method is presumed better than all the other alternatives. MT is a way to go, but it is clear to me that people using this method experience lots of problem too. A while ago MT was hyped a lot, as the only smart way to get off benzos. Like other ways of getting off, it has advantages and disadvantages, and as long as we agree on that, I do not see a problem with using MT as a way to wean.

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Morning Noolie

 

It is 3.42 am here in the U.K.

 

I for one have been daily cutting at 3.8 mg of V and that started October 17th last year, I am almost at 2 mg nothing to celebrate in my book, I have had w/d sxs like any other BB. Luckily mine have not been so bad as others but saying that I am taking other meds that may and I mean may be helping my w/d sxs that I can not say one way or another.

 

I did the cut and hold for a brief period I would say around 5 weeks and again that was complicated as I need to reduce another med as I was having liver issues with it, and therefore again I could not say which method was the right one.

 

This is all I can say again does it matter which way is better, my psychiatrist wanted me to do a 20% taper off my other med, she also suggested that I do a take one miss one taper with the Valium, is that the correct way. And this was at the same time that my family doctor said that I was to taper both the Valium and my other med at the same time. ::)

 

When I spoke to my MIL who was on a benzo,  she said it was Librium but is unsure as it was along time and she is almost 83 and she was on it for 12 years as she can recall and took it upon herself to come off them.  Like a lot of us have and she did the take one miss one method as back then there was no other way, and then there were no such things as computers.

 

To be honest I don't care which way I taper a s long as I eventually get there that is my goal, I will just make the most of the good days and deal with the bad as best as I can.

 

In case you are wondering why I am this early I have just been to the bathroom as I had part of my bowel removed and unfortunately I ate something late last night and this is what happens I am woken up because I need to go. :-[

 

DD

 

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Morning Noolie

 

It is 342 am here in the U.K.

 

I for one have been daily cutting at 3.8 mg of V and that started October 17th last year, I am almost at 2 mg nothing to celebrate in my book,...

 

 

DD-That's almost a 50% reduction in 3 months.  I'd consider that something to celebrate!

 

I started about the same time, and have dropped from 9 to 6.4, (about 30%) and I'm pretty pleased about that.

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Morning Noolie

 

It is 3.42 am here in the U.K.

 

I for one have been daily cutting at 3.8 mg of V and that started October 17th last year, I am almost at 2 mg nothing to celebrate in my book, I have had w/d sxs like any other BB. Luckily mine have not been so bad as others but saying that I am taking other meds that may and I mean may be helping my w/d sxs that I can not say one way or another.

 

I did the cut and hold for a brief period I would say around 5 weeks and again that was complicated as I need to reduce another med as I was having liver issues with it, and therefore again I could not say which method was the right one.

 

This is all I can say again does it matter which way is better, my psychiatrist wanted me to do a 20% taper off my other med, she also suggested that I do a take one miss one taper with the Valium, is that the correct way. And this was at the same time that my family doctor said that I was to taper both the Valium and my other med at the same time. ::)

 

When I spoke to my MIL who was on a benzo,  she said it was Librium but is unsure as it was along time and she is almost 83 and she was on it for 12 years as she can recall and took it upon herself to come off them.  Like a lot of us have and she did the take one miss one method as back then there was no other way, and then there were no such things as computers.

 

To be honest I don't care which way I taper a s long as I eventually get there that is my goal, I will just make the most of the good days and deal with the bad as best as I can.

 

In case you are wondering why I am this early I have just been to the bathroom as I had part of my bowel removed and unfortunately I ate something late last night and this is what happens I am woken up because I need to go. :-[

 

DD

 

Please do not view my comment as coming down on slow tapers, or extra slow tapers. If I did that I would be guilty of the exact same thing that I criticize the MT ® hype of doing. My whole point is that we are indeed individuals, dealing with the most individual syndrome I have ever come across, and to some 10% cutting works better than titration, quick tapers work better than slow tapers, and this is exactly my point - we have to find our individual taper plan.

 

Personally, I made the wrong decision to accept Lyrica as a weaning aid (it only helped 1 month, then I was in too heavy benzo withdrawal to taper off), but I know others who did benefit from other medications (Parker, Stillbelieving).

 

There is no miracle taper method, only the ones that suit us, and the ones that do not.

 

I am very sorry that you feel bad, but I am glad that you are able to go lower now, even though it is very hard.

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To me MT presents a problem, if the method is presumed better than all the other alternatives. MT is a way to go, but it is clear to me that people using this method experience lots of problem too. A while ago MT was hyped a lot, as the only smart way to get off benzos. Like other ways of getting off, it has advantages and disadvantages, and as long as we agree on that, I do not see a problem with using MT as a way to wean.

 

I certainly hope there aren't too many people who presume that a daily taper is the only smart way to go. The thing I have noticed, from a minority of people on both sides, is a "them and us" attitude. If someone has had a negative experience with one particular form of tapering, they can sometimes post quite a negative attitude towards that particular type of taper, which is very unhelpful and misleading to other people.

 

I personally didn't do well on the cut and hold method, but am doing extremely well on a daily reduction method, but I have never posted anything negative about cut and hold (other than explaining my own experience) - well at least I hope I haven't, because I fully understand that everyone's taper has to be individual. As long as your dose is reducing with some kind of regularity, and with as few s/x as possible, then that is the right taper.

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Thanks Noolie and DP

 

Well I do hope it has been sorted none of us are going to get away with w/d sxs either way we go, I have now a big decision to make so I will go and ponder.

 

DD

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To me MT presents a problem, if the method is presumed better than all the other alternatives. MT is a way to go, but it is clear to me that people using this method experience lots of problem too. A while ago MT was hyped a lot, as the only smart way to get off benzos. Like other ways of getting off, it has advantages and disadvantages, and as long as we agree on that, I do not see a problem with using MT as a way to wean.

 

I certainly hope there aren't too many people who presume that a daily taper is the only smart way to go. The thing I have noticed, from a minority of people on both sides, is a "them and us" attitude. If someone has had a negative experience with one particular form of tapering, they can sometimes post quite a negative attitude towards that particular type of taper, which is very unhelpful and misleading to other people.

 

I personally didn't do well on the cut and hold method, but am doing extremely well on a daily reduction method, but I have never posted anything negative about cut and hold (other than explaining my own experience) - well at least I hope I haven't, because I fully understand that everyone's taper has to be individual. As long as your dose is reducing with some kind of regularity, and with as few s/x as possible, then that is the right taper.

 

I couldn't agree more. Deciding on a taper method is a very personal thing. No one should be chided for their choice. If this is happening anywhere on the forum, please use the Report this Post feature to let the team know about it.

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Hi all,

 

It seems that there is more than a little confusion between 'titration' and 'microtapering'. Some people believing them to be synonymous, while others use 'microtapering' to refer to a method patented by Jana Hill. I'll try to specify the differences (as I understand them), add my thoughts about 'microtapering', and how members might best avoid confusion between the two terms.

 

First of all, all taper methods are really just one method: the gradual reduction of dose. The differences are just a reflection of some people requiring or preferring a more smooth taper plan. A 'smooth' plan is not necessarily better. It is more complicated, and some people actually prefer to make slighter larger cuts (where they grin and bear it for a few days), and then 'enjoy' a less symptomatic period until their next cut. Others prefer the (perceived) control of (near) daily tiny cuts, but for others this might be 'obsessive' and counterproductive. The point is, we are individuals, with differing needs and personality traits. Choose a method that best suits you and your situation.

 

All we mean by 'titration' at BenzoBuddies is making up a liquid from benzodiazpine pills, enabling smaller cuts than can be achieved by pill-splitting. As with pill-splitting, members will adjust their taper plan according to their needs and how they react.

 

Hill seeks to systematise what already commonly occurs with people titrating their benzodiazepines in an effort to minimise withdrawal symptoms. Hill also emphasises that patients should stabilise their dosing regimen before commencing their taper plan (this practice is already common), and that they can and should correct their taper rate according to how they react (this too is already common, and - frankly - common sense).

 

It seems that Jana Hill (for some reason in the name of 'Julian Hill') has a provisional patent  (I understand this means that she has a year to further investigate the patent before applying for a full patent, but her ideas are protected in the interim): TREATMENT TOOL AND METHOD OF GRADUAL WITHDRAWAL FROM BENZODIAZEPINE DEPENDENCY. Hill used to call her method 'dual titration' (or was that another method - I do not not know for sure because the details were 'secret'). I carried out a few searches for 'dual titration' a few years ago for an explanation - nothing turned up. Beyond those few cursory searches, I made no inquiries regarding her method. If the details are 'secret', I'm sure I can't be bothered to dedicate time and effort trying to work out what it is supposed to be about. Not least because I assumed it to be 'obvious' and/or flawed.

 

Now that I read the details of the method, I see several problems with the patent application. I don't think there is anything in her patent that is not subject to Prior Art objections. I also believe there is nothing in it that is non-obvious to a Person having ordinary skill in the art. There are also many errors and misunderstandings within the patent application.

 

Hill repeatedly describes a 20:1 potency ratio between clonazepam and diazepam. This ratio is used by Ashton expressly for the purposes of 'substitution' - it is not cited by Ashton (or any other authority of which I am aware) as being a 'therapeutic equivalent'. I am not aware that Ashton has explained why substitution and therapeutic equivalent doses are not the same, but I have a few ideas (that's another topic - I've probably already written about it elsewhere). Another, much more important and basic error in Hill's patent is the description/graph of 'steps' when cutting the dose of diazepam by pill-splitting (the usual method). The graph depicts abrupt drops following pill-splitting cuts to dose, but since diazepam (if we include its active metabolites) has a relatively long half-life, there is no direct corresponding drop in blood levels following a cut in dose. When the patient makes a cut to their dose of diazepam, blood levels gradually decrease over many days or a week or two before blood levels reflect the new dosing regimen. This is why Ashton switched her patients over to diazepam; it has in-built 'microtapering'!

 

Hill also attempts to claim that those utilising her method will benefit from even blood levels - another error. There are many reasons why blood levels fluctuate. Hill addresses some of these (some foods we ingest, and some some medicines affect how we metabolise benzodiazepines, affecting blood levels). Avoiding grapefruit juice is sensible for anyone tapering off or regularly taking benzodiazepines and many other drugs (Hill did not discover this). Some other foods will affect metabolisation of benzodiazepines, but to a much lesser extent. As for...

 

4. The method of claim 3, wherein the pre-taper plan includes removing any foods, drugs, and other environmental exposure affecting CYP450 enzyme activity that metabolizes the benzodiazepine.

 

...getting patients off other medicines that affect the metabolisation of benzodiazpines: this is very problematical (Hill is not a doctor). In any case, if other meds are affecting benzodiazepine blood levels (by affecting the same metabolisation pathways, but are taken regularly), this is probably not a great issue (though, a doctor would need to decide this). After all, it is great fluctuations in blood levels that are to be avoided - regular ingestion of another medicine would probably have relatively few destabilising effects upon blood levels of benzodiazepine.

 

Another problem with Hill's method is that it takes no account of variability in dose between individual pills that might be used for titration. The dose between one pill and another might vary by a few percent and upwards, more across batches, and much, much more across brands (according to FDA standards, a drop of up to a 36%, or an increase of up to 56% between two brands).

 

I also note that Hill suggests the use of quite specific amounts of grapefruit juice to correct a dosing error, without mention of the magnitude of the dosing error, or, worse, the direction of the error. In any case, such 'corrections' using grapefruit juice are completely unnecessary and potentially dangerous.

 

[0039] Ethanol can be used to make a solution of Diazepam or Alprazolam. The amounts to create a useable solution are about 0.19 mL ethanol per 1.0 mg of Diazepam, 1.6 ml ethanol per 1.0 mg Alprazolam. Water can be added to the ethanol solutions to produce the right strength. Water is a suitable solvent for Chlordiazepoxide. A strength of 1.0 mg Chlordiazepoxide to 40.0 mL water allows a reduction of 0.125 mg in 5.0 mL of the benzo-water solution. Water may be used which is warm to the touch to make aggregated Chloriazepoxide crystals more available for dissolving in water. If an error occurs in mixing or using the liquid preparation, the use of about 1.0 to 3.0 ounces grapefruit juice has been shown to reverse the problem, and can be done one time for each episode. GFJ reverses the effects of CYP enzymes because GFJ is a CYP 450 inhibitor.

 

Taking grapefruit juice will increase blood levels of benzodiazepine quite significantly, but there is no way of determining to what extent. Since benzodiazepines can potentially result in liver toxicity (I certainly had blood tests to check my liver function when taking 4.5mg clonazepam per day), and many other medicines are affected by grapefruit juice, it is best to avoid grapefruit juice altogether when taking benzodiazepines and many other drugs. If you take any other medicines that potentially majorly affect benzodiazepine metabolisation/absorption, especially if the drug is taken intermittently, this will potentially disrupt a 'smooth' benzodiazepine taper plan. Though, it should go without saying that medicines should not be dropped without consulting a doctor.

 

Within reasonable limits, a dosing error with a short half-life benzodiazepine results in a very temporary increase or decrease in blood levels and should not cause great concern (the error is quickly self-correcting). Conversely, a dosing error with a long half-life benzodiazepine (such as diazepam) does not result in a corresponding increase or decrease blood levels. Even a missed dose will not result in much of a drop in blood levels. And, because of the strong accumulation effects associated with long half-life drugs, a one-off mistaken increase in dose has very minimal effect upon diazepam blood levels (the higher dose would need to be taken for a while for blood levels to increase significantly).

 

If members wish to follow a titration method, which allows them to make (near) daily tiny reductions to dose, that still adds up to a taper plan with an overall taper rate that results in a reasonable time frame for completion, this is a perfectly acceptable thing to do. All I suggest is that you do not unnecessarily complicate the situation. And, unless you do not have access to 2mg diazepam tablets, you almost certainly do not need to titrate diazepam (it has in-built 'micro tapering'). This brings me to the following entries in the patent detailed description:

 

[0024] Based on reports from actual patient cases, there is a very narrow dosage interval that is acceptable and which causes no symptom escalation. The treating physician can use a minimum number as a starting reduction, and it should prevent symptom escalation. That number may be below the standard reduction of 0.05 mg and a reduction of 0.01 mg Diazepam or equivalent may be more appropriate. Degree of symptoms indicates time to use the smaller numbers. By making the dosage cut at regular intervals (e.g., every day), and by doing this for a predetermined time (e.g., two weeks), the dosage cut can be monitored at maintained at acceptable levels. Then, that dosage cut can be increased by another known amount, wait for the predetermined time (e.g., three days to two weeks the patient's determined Benzo symptom lag period), and if all is well with the patient, another increase can be employed. When an increased cut causes a rise in symptoms, a previous acceptable dosage cut can be used again.

 

[0025] This pattern of increasing the daily dosage cuts by very small increments allows finding the optimal daily cut for any individual. In an example, an optimum dosage can be found in the range of +/-0.00125 mg of Clonazepam and +/-0.0125 mg of Diazepam. The determined daily dosage reduction allows the benzo-dependent patient to continue at this rate until the daily dose falls close to 5.0 mg diazepam or 0.25 mg of clonazepam. At this or near dosage, the daily reductions usually must be made smaller.

 

I cannot stress how unnecessary it is to taper off at such incredibly slow rates (100 days to reduce your dose by 1mg diazepam). And worse, reduce the taper rate even further when the daily dose falls below 5mg diazepam per day. Let's extrapolate the total period for a diazepam taper, starting at 20mg/day. 20 to 5mg, typically (as suggested in the patent details) would be tapered at a rate of 1mg every 100 days. That's 1,500 days. If we assume that the final 5mg is tapered at half this rate, that's 1mg every 200 days. So, a total of 2,500 days to quit 20mg diazepam - that's nearly 7 years!. Of course, some people take much larger doses than 20mg diazepam.

 

It is also worth pointing out that it is beyond pointless trying to measure a clonazepam dose to an accuracy of +/-0.00125mg. Since we should expect the dose of individual pills to vary by at least a few percent (of the same brand and batch), there is no point in attempting to accurately measure a dose by at least one order of magnitude greater than which we can expect between the stated and actual dose of an individual pill. Our blood levels of benzodiazepine vary no matter how accurately we might attempt to measure our dose.

 

If an individual wishes to taper off at such an incredibly slow rate, this is their choice, and I will not criticise them for following such a plan, but I will point out how long it will take and that following this kind of taper plan is completely unnecessary. What is certain to me is that the promotion of such a taper regimen as somehow optimal is very wrong and does a great disservice to those seeking help with quitting benzodiazepines.

 

As for BenzoMicroTaper™ (yes, Hill really has trademarked the term), until I find an older example for the use of term, I will credit Keith64 for coining the phrase. BenzoMicroTaper, trademarked or not, does not provide protection from use by an entity (BenzoBuddies in this case) already using the word/phrase.

 

Having said this, because Hill has attempted to usurp ordinary language as a trademark, and the potential for confusion this now causes members at BB, please refer to 'Hill's Micro Taper', or 'Hill's method', or 'dual titration' (or similar) when describing Hill's patented system. Although Hill's micro taper system does not vary significantly from any other titration system - and titration is just an extension of pill-splitting - using the term 'microtaper' (by itself) will cause confusion for members.

 

I know my general comments about titration might be disconcerting to some (limitations in expected accuracy, etc.). However, to reassure you, it is the overall picture that matters. Titration, in the broad, does offer a more gradual taper profile (particularly for shorter half-life benzodiazepines). Just let's not get tied up in knots with unrealistic exactitudes. We cope with variances in blood levels all the time (because of differences in dose between pills, the foods we eat, other medicines we take, small mistakes in dosing, inconsistencies in when we take the drug (time of day), and inter-dose drops in blood levels). It just goes to show that our brains are resilient and adaptable.

 

I did not start out with the intention of writing a diatribe about 'microtapering'. My understanding was that it is just another titration system. However, having read the recently patented details, the expectation that those following Hill's method will typically take many years to quit, and noting the many errors contained with the patent/method, I thought I should detail some of my objections. I wish to make clear that members are free to discuss Hill's method (irrespective of my feelings on the matter), but should expect attempts at 'promotion' of the method to be met with strong rebuttals. The basics of Hill's method are hackneyed, and some of the specifics flawed, pointless, or even dangerous.

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Thank you Colin

 

As I appear to be the first to reply, I myself have been daily cutting since 3.8 mg. I am now at 2.0 mg and I have been daily cutting using tablets and liquid and will probably now use all liquid.

 

I have been mainly cutting .02 mg and sometimes .01 mg, I am confused now as to what to do safely I like others have hit a wall so to speak  mine between 6 to 8 days,

 

So what I am asking is those that are daily cutting is it not recommended and is it possible to go back to cut and hold and how much should one drop there dose as I can not find  a taper chart unless I am looking in the wrong place.

 

DD

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Hello dd58,

 

There is nothing wrong with titrating your dose, making daily cuts. I am just suggesting that you keep an eye on the overall taper rate. 100 days to drop 1mg Valium is unnecessarily slow.

 

Since you are already following a successful method (titration), a method that works for you, why change it? Especially as you are pretty close to the end. I would just question validity of tapering off at the rate suggested by Hill. Since Hills suggests a rate slower than 100 days per 1mg Valium (at doses below 5mg/day), and you are at a dose of 2.3mg, this means it would take you more than 230 days to complete your taper. If we assume a rate of something like 200 days per milligram Valium (this would seem like a reasonable interpretation of Hill's patent), this would translate to the remainder of your taper taking 460 days (15 months) to complete. Following the Ashton protocols, you probably would be off in 3-5 weeks (though mileage will vary). It should be remembered that, on the whole, Ashton's patients were tougher cases. There should be no expectation by our members that they need to follow taper plans lasting much longer than the ones devised by Ashton for her patients.

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Thank you Colin

 

What if I decided to go back to cut and hold, when do I cut and at how much % wise as I am now on 2.0 mg of Valium, as I have other meds to taper aswell.

 

DD

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I cannot stress how unnecessary it is to taper off at such incredibly slow rates (100 days to reduce your dose by 1mg diazepam). And worse, reduce the taper rate even further when the daily dose falls below 5mg diazepam per day. Let's extrapolate the total period for a diazepam taper, starting at 20mg/day. 20 to 5mg, typically (as suggested in the patent details) would be tapered at a rate of 1mg every 100 days. That's 1,500 days. If we assume that the final 5mg is tapered at half this rate, that's 1mg every 200 days. So, a total of 2,500 days to quit 20mg diazepam - that's nearly 7 years!. Of course, some people take much larger doses than 20mg diazepam.

 

16. The treatment tool of claim 10, wherein an initial dosage reduction is a selection of one of about 0.05 mg Diazepam and about 0.0025 mg Clonazepam.

 

.05 daily = 1mg every 20 days.

 

 

 

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Thank you Colin

 

What if I decided to go back to cut and hold, when do I cut and at how much % wise as I am now on 2.0 mg of Valium, as I have other meds to taper aswell.

 

DD

 

Hello dd58,

 

If you are happy with your present system, there is no reason to go back. It is not 'wrong' to titrate Valium, it is just unnecessary (although it might be useful for those without access to 2mg Valium tablets).

 

Assuming there are no pressing medical requirements to quit particular meds, it makes sense to quit one medicine at a time. If you make changes to more than one of your meds at the same time, it probably will be difficult to determine which changes are responsible for withdrawal symptoms you might experience. It also makes sense to have your body cope with just one set of changes at a time.

 

Are you experiencing problems with titration? One simple approach to take with titration is decide how long you wish to taper a pill, make up a liquid using that pills each day to a number of milligrams equal to the number of days you wish the taper to last, and reduce the dose taken each day by 1ml.

 

For example:

 

Daily dose: 2mg

Pill dose: 2mg

Desired taper time for the pill: 30 days

 

Create 30ml of liquid using a 2mg pill, drink 29ml (from 30ml) on the first day; 28ml from 30ml on the second day; reducing the dose, cumulatively, by 1ml each day. Of course, this is just an example.

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16. The treatment tool of claim 10, wherein an initial dosage reduction is a selection of one of about 0.05 mg Diazepam and about 0.0025 mg Clonazepam.

 

.05 daily = 1mg every 20 days.

 

I see that, yet:

 

[0024] Based on reports from actual patient cases, there is a very narrow dosage interval that is acceptable and which causes no symptom escalation. The treating physician can use a minimum number as a starting reduction, and it should prevent symptom escalation. That number may be below the standard reduction of 0.05 mg and a reduction of 0.01 mg Diazepam or equivalent may be more appropriate. Degree of symptoms indicates time to use the smaller numbers. By making the dosage cut at regular intervals (e.g., every day), and by doing this for a predetermined time (e.g., two weeks), the dosage cut can be monitored at maintained at acceptable levels. Then, that dosage cut can be increased by another known amount, wait for the predetermined time (e.g., three days to two weeks the patient's determined Benzo symptom lag period), and if all is well with the patient, another increase can be employed. When an increased cut causes a rise in symptoms, a previous acceptable dosage cut can be used again.

 

And:

 

[0025] This pattern of increasing the daily dosage cuts by very small increments allows finding the optimal daily cut for any individual. In an example, an optimum dosage can be found in the range of +/-0.00125 mg of Clonazepam and +/-0.0125 mg of Diazepam. The determined daily dosage reduction allows the benzo-dependent patient to continue at this rate until the daily dose falls close to 5.0 mg diazepam or 0.25 mg of clonazepam. At this or near dosage, the daily reductions usually must be made smaller.

 

Emphasis is mine.

 

Frankly, I found the patent ill-conceived and ill-constructed.

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Hi Colin

 

Me again I am afraid :D

 

I have liquid Valium and 2 mg tablets, I have also started to taper off lithium it was added to Remeron as the Remeron was not working as a anti depressant, I am holding on the taper of lithium although I was told it would be okay by pdoc to do two at once as Lithium is non additctive.

 

DD

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