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Thoughts on suggested rapid detox plan of addiction specialist I saw


[CS...]

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I’m aware that many (including Ashton and the founder of this website, Colin), feel that a rapid detox is inadvisable unless absolutely necessary because it increases your risk of a protracted syndrome.

 

Though I’ve only taken Klonopin as prescribed, have never taken more than prescribed, and certainly don’t consider myself a psychological addict (just physically dependent), I recently had a long appointment with an Addiction Specialist who told me that he has a lot of knowledge and experience in getting people off benzos after long-term use.  He says that he’s also knowledgeable about benzo withdrawal symptoms.  He’s familiar with Ashton, and does do slow tapers after a switch to Valium.  He does, however, say that he does not agree with Ashton’s ideas (though I’m not sure in what way).  And I can’t say that I had a lot of confidence that he was particularly comfortable or knowledgeable doing what he called “an Ashton style” taper.  Even though it is something that he says he does, if I did a Valium taper I don’t think I’d want to do it with him.

 

I can’t say how good he is.  All I can say is that he came recommended.  And his education is very impressive.

 

Undergraduate from Harvard.

Medical School, Columbia.

1st Residency in Psychiatry, Payne Whitney (which is part of Cornell).

2nd Residency in Psychoanalysis from NYU.

A Fellowship in Addiction Psychiatry/Substance Abuse from NY Presbyterian/Cornell Weill.

And he's a Clinical Assistant Professor, Dept. of Psychiatry, at NYU.

 

He’s in his early 60s and has been practicing addiction medicine for over 30 years.

 

He has a suggested way of getting me off 20 years of prescribed Klonopin (the last 13 years 2 mg daily) that I’d really like some thoughts on.

 

First, a 5 day taper while taking phenobarbital.  This would be outpatient.

 

Then he follows that with a 4 drug cocktail for 2 weeks to help prevent post-acute withdrawal syndrome.  He actually referred to it as sub-acute, but said it was the same thing.

 

The 4 medications are Baclofen, Gabapentin, Buspar, and Robaxin.

 

When I mentioned that Ashton has said that Buspar was shown to have no value in withdrawal, he said that was because it wasn’t used together with these other drugs.

 

Finally, he said if the above doesn’t work he recommends a Flumazenil IV (intravenous).  He said it’s an antagonist which quickly resets GABA receptors.  It’s a backup plan.  Only a worst case scenario.  Desperate measures only if things aren’t going well.

 

I never asked if the phenobarbital was only to prevent seizures or if it would also help ease the symptoms of this extremely fast 5 day taper.

 

So…  first, does anyone know if along with preventing seizures phenobarbital would also help ease the symptoms of this 5 day withdrawal?  Which could be hell if it doesn’t.

 

Has anyone heard of anything at all like using a 2 week drug cocktail after a rapid detox to help prevent protracted syndrome?

And what about his mixture of drugs for the 2 weeks?

 

Gabapentin (Neurontin) is an anti-seizure med, and also for neuropathic pain.

 

Methocarbamol (Robaxin) is a central nervous system depressant with sedative and musculoskeletal relaxant properties.

 

Baclofen is also a central nervous system depressant and skeletal muscle relaxant.

 

Buspirane (Buspar) is an anti-anxiety med that is not chemically or pharmacologically related to benzodiazepines, barbiturates, or other sedative/anxiolytic drugs.

 

Any opinion on this “last resort” Flumazenil IV to quickly reset the GABA receptors?

 

I am certainly terrified at the idea of doing anything like this, but it seems like the main reason so many people are so against a really fast taper like this is because of the protracted hell you put yourself at higher risk for if you come off really fast.  He claims to have this 2 week drug cocktail that reduces the risk of protracted withdrawal syndrome in the same way a slow taper would.

 

Oh, and he also recommends a book called “Brain in Balance,” if that means anything to anyone.

 

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Let me tell you this about benzo withdrawal.. It makes even the smartest people seem stupid. We're like 30 years behind when it comes to benzos. I can't imagine how it was for the first valium and librium addicts smh. We just don't know how it works even slow tapers don't always work.
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[f3...]

I'd have this guy put it in writing that there would be no withdrawal symptoms or stipulate the length and severity of the withdrawal symptoms.  And a guaranteed, money-back result.  I'll bet he won't do it.  If I'm right, I would seriously wonder about the track record of this benzo detox regime of his (if one exists).  Is this guy going to stand with you if this drags out for 18 months like many withdrawals do???  Again, will he put that in writing?

 

I've been in this forum for a few years and I'm not sure if I've ever seen a rapid detox go well for a person who was dependent on a benzo.  I think most people end up reinstating within a year.  I suppose it's possible that this guy's got something special up his sleeve, but if he does why hasn't he shared it with his fellow doctors to alleviate the suffering of others.  That, to me, is something a physician is ethically compelled to do.

 

I think everybody here wishes there was some kind of rapid and painless detox for benzo withdrawal.  If you decide to go ahead with this, and if it works well for you, please be sure to report back to us.

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I think you already know the rapid detox Are not working ,just don’t do it,do a very slow taper increases your healing process.
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Most of doctors out there don’t know what really works and what doesn’t work when it comes to benzo withrawal and the majority of them are denying it they don’t believe it could last a long time

If you are a long term user it’s very risky to do a rapid taper

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[f3...]
btw - how do you know you are physically dependent?  Have you tried to reduce and had bad symptoms?  I'm just curious.  Seems to me that a fair number of the people who try detoxing tried to stop on their own, but the withdrawal symptoms were too strong and they reinstated.  So they reached out to a detox center to try to do what they felt that they couldn't do on their own.  I think that if these people had tried to do a nice slow taper, that at least some (and maybe most) of them would have succeeded (on their own).
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flumazenil doesnt heal the receptors - it just knocks benzos out of the receptors. 

 

people will freak with me writing this but i didnt taper because the meds started having a paradoxical reaction for me and while i went through 5 months of extreme hell -  i was healed at month 6 and have remained so - about to post a 2nd success story with even more details about why i believe i healed so fast.  i am back to my corporate career 50 hours a week so don't have much time to be on BB any more so my 2nd success story will outline what i did and then i will be stepping away.

 

i personally don't think a cocktail of meds will do much - it may hold off the onslaught of initial symptoms but i don't think they are going to heal the brain - its like people who transition over to CBD - they haven't healed - they are just finding a decent bandaid for the symptoms

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btw - how do you know you are physically dependent?  Have you tried to reduce and had bad symptoms?  I'm just curious.

 

In one way I just meant it in the sense that it's a given.  Anyone who has been taking Klonopin daily for 20 years (the last 13 years 2 mg a day) is physically dependent on it.  Meaning that I can't stop taking it abruptly without experiencing withdrawal symptoms.  I have to wean myself off to avoid withdrawal symptoms.  I think the term physical dependence has different interpretations, but that's one way that I meant it.

 

No I have not yet tried to reduce my dose.  But 7 months ago I entered into an often severe tolerance withdrawal.  I've reached a point of tolerance so extreme that I'm experiencing truly nightmarish withdrawal symptoms from it.  That's the other reason I called myself physically dependent.

 

If I tried to explain why I've concluded that I'm in tolerance withdrawal it would take me several thousand words.  I don't know that I have a short version.

 

And I would love to hear more thoughts from others on what this doctor has proposed.  And of course I appreciate the responses that I got already.  Thanks.

 

 

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'Anyone who has been taking Klonopin daily for 20 years (the last 13 years 2 mg a day) is physically dependent on it.''

 

I'm not so sure. My point: if you are not kindled, haven't tapered yet (I'm not sure how to interpret your tolerance withdrawal) there is a good chance that something close to a 'cold turkey' will work out reasonably well. You may suffer, it may be dangerous. Mental anxiety and worry can make things worse.

 

I wouldn't recommend it, but what's the alternative ? 2 mg a day is not low, it is not very high either. Klonopin can be a drug that is very difficult to taper. A switch to diazepam from K can be very problematic. Tapering isn't everything.

 

I think that the other drugs (pheno may dampen withdrawal symptoms for some time, it has a long half life) are mostly placebo. Gabapentin could dampen WD symptoms, depending on your individual reaction and dose, possibly baclofen might help but I have my doubts, methocarbamol is a carbamate chemically related to carisoprodol but I don't know what it would do, I'd say that buspar is psychological.

 

It's a gamble. What's the alternative, a slow taper ? Being tolerance W/D  isn't a good starting point, and I don't know how fast you could taper. Do you know of any other drugs that could help you with sleep, anxiety or whatever your issues might be ?

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[f3...]

btw - how do you know you are physically dependent?  Have you tried to reduce and had bad symptoms?  I'm just curious.

 

In one way I just meant it in the sense that it's a given.  Anyone who has been taking Klonopin daily for 20 years (the last 13 years 2 mg a day) is physically dependent on it.  Meaning that I can't stop taking it abruptly without experiencing withdrawal symptoms.  I have to wean myself off to avoid withdrawal symptoms.  I think the term physical dependence has different interpretations, but that's one way that I meant it.

 

No I have not yet tried to reduce my dose.  But 7 months ago I entered into an often severe tolerance withdrawal.  I've reached a point of tolerance so extreme that I'm experiencing truly nightmarish withdrawal symptoms from it.  That's the other reason I called myself physically dependent.

 

If I tried to explain why I've concluded that I'm in tolerance withdrawal it would take me several thousand words.  I don't know that I have a short version.

 

And I would love to hear more thoughts from others on what this doctor has proposed.  And of course I appreciate the responses that I got already.  Thanks.

 

No need for 1000 words.  If you've experienced tolerance withdrawal, there's no doubt that you've become tolerant.  I'm pretty sure I was also experiencing tolerance withdrawal the last several months that I was sucking down Ativan.  I only asked because there are people who take these drugs for 20 years, but don't get physically dependent on it.  Good physiologies, I guess.

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One more comment on methocarbamol. I looked, briefly.

 

https://www.sciencedirect.com/topics/veterinary-science-and-veterinary-medicine/methocarbamol

 

'The skeletal muscle relaxant methocarbamol has proved to be very useful in the management of severe muscle fasciculations, tremors and seizures associated with a variety of toxicologic agents (Gwaltney-Brant, 2002).'

 

'The exact mechanism by which methocarbamol works is unknown but it is thought to act centrally to block nerve impulses in the brain stem, spinal cord and subcortical levels of the brain'.

 

K has a strong effect on the spinal cord and the brain stem.

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Wow, it’s funny when people on this forum try to compare themselves to others and think there in the same boat. Doing damage with benzos not for an extended time (years)would be a cakewalk compared to lengths that myself and others are recovering in this forum.I applaud success stories but try to understand that you cannot compare your journey to someone who’s been on this crap 9 plus years!
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[f3...]

Wow, it’s funny when people on this forum try to compare themselves to others and think there in the same boat. Doing damage with benzos for under year would be a cakewalk compared to lengths that myself and others are recovering in this forum.I applaud success stories but try to understand that you cannot compare your journey to someone who’s been on this crap 9 plus years!

 

Depends on one's physiology from what I see.  Some folks take these drugs for many years without becoming tolerant.  Some take them for just weeks or months and become dependent.

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Well said,So I shouldn’t be wondering what I have done wrong since I’m at 9 months and suffering?Thats my point we’re all different but as I’m learning from this forum and Dr Ashton studies. Why my Rapid detox with drugs set me into hell. How my Dr in the Unit(which is one of the best in the west) very experienced (supposedly world renowned)addiction specialist took me off Librium(which they gave me the first evening)immediately and didn’t discuss tapering.A month later a Dr discussed tapering and I felt I’ve gone to far to go back.

Csharp-Do your research and May the Force be with you...

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Anyone who take these drugs for more than 7 days they start to create dependency upon them I don’t think there’s a human could be able to take benzo for 20+ years and don’t have dependency on them they might not have tolerance and they might be able to taper it in a couple of weeks and come off but doesn’t mean they are not dependent they just didn’t hit tolerance yet
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Had I been on Klonopin or on any other benzodiazepine daily since the late 90's, there is no way and no how I would be attempting a rapid  detox. 

 

Why would people be taking their benzodiazepines on a daily basis for years if the brain and body did not become so habituated and adapted to them? There is no way I'd be taking these medications on a daily basis if I could take them as needed or better yet, drop them entirely,

 

I'd suggest watching this video to debunk some of the myths associated with benzo withdrawal that can potentially help you get more informed.

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Had I been on Klonopin or on any other benzodiazepine daily since the late 90's, there is no way and no how I would be attempting a rapid  detox. 

 

Why would people be taking their benzodiazepines on a daily basis for years if the brain and body did not become so habituated and adapted to them? There is no way I'd be taking these medications on a daily basis if I could take them as needed or better yet, drop them entirely,

 

 

 

 

 

 

 

Agreed

 

 

 

 

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This is just my opinion base on what I heard from people if you are experiencing tolerance it’s so much safer for you to taper slowly you probably going to experience 2 to 3 years of withrawal and then you are coming out of it but if you cold turkey that you probably going to experience 5 to 7 years of withrawal before you find some relief it’s just base on what I heard from people but everyone different

Wish you luck

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The cocktail of drugs he offered you might and only might help you to be able to handle the anxiety and pain of the withrawal but they couldn’t be able to help you make this process any shorter than it is but if you slowly taper you give your GABA receptors the best chance to up regulate and make the whole things shorter and easier for you
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Gabapentin helped me get off of 1.3mg of Ativan, but I had to very slowly raise Gabapentin while very slowly dropping ativan. When I was on around 1.83mg of Ativan, I was on 0mg Gabapentin. Now, I am on 0.5mg Ativan, but I got up to 900mg Gabapentin, which is not a low dose. Some of us are very sensitive to these reductions. And I have agreed with my doctor to lock my Gabapentin to 900mg. I have a feeling it would not help at all if I went higher with it.

 

Buspar helped me a bit with anxiety and actually helped me ease the taper from 0.6mg Ativan to 0.5mg Ativan. But the relief I got from Buspar has been extremely mild. Buspar will do nothing for neurological/muscular/skeletal symptoms from benzo withdrawal symptoms. In the end, I felt that 30mg of Buspar a day was causing me some unwanted dizziness, so I dropped it down to 25mg a day and the 20mg a day where I am staying right now.

 

But from my experience, Gabapentin and buspar *might* be useful as adjuncts in the taper, but they are too weak to oppose the compensatory mechanisms that occur during cold turkey withdrawal or rapid detox.

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  • 4 weeks later...

I just came across this post from a forum member, FaithSpot, posted on May 1, 2018.

 

http://www.benzobuddies.org/forum/index.php?topic=201265.20.  It's reply #22 and I've copied it below.  That's just a month before the post I started this thread with.

 

"Ok. So I met with the new Addiction Psychiatrist. He said the Ashton protocol will take a very long time and that he has a better method. This is the plan: I currently take 1.5 mg of Kolonopin. He said to take 1 mg of Kolonopin with 30 mg of Phenobarbitall for two days. Then take .5 mg of Kolonopin and 22.5 mg of Phenobarbital  for just one day. Then stop the Kolonopin. Then take 15 mg of Phenobarbital for seven days. Then stop the Phenobarbital. Then start taking Robaxin, baclofen, Gabapentin and Buspar in certain doses and with a certain tapering schedule. Then I may have to take flumazenil after all these meds are completed if I have protracted symptoms.

 

This all comes from the “Brain in Balance” Book.

 

Any thoughts please?"

 

That is almost identical to the protocol the Addiciton Psychiatrist I saw recommended to me.  A very fast rapid detox using phenobarbital, followed by the same 4 drug cocktail.  And then flumazenil if there are any difficulties.  And both of these doctors recommended the book "Brain In Balance." 

 

I never went back to the doctor I saw because I find this method very scary.  But it was interesting to see that this method is not something that the Addiction Specialist I saw came up with on his own.  It may come directly from this book "Brain In Balance."  It's still scary, and certainly isn't something I'm drawn to trying.  But it may have more credibility than I thought.  For whatever that's worth.

 

 

 

 

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No.  I would never Cold Turkey.  Aside from everything else you could actually die.

 

I still don't trust this phenobarbital then 4 drug cocktail method.  I was just really shocked when I saw a post about another addiction specialist who had the exact same protocol as the addiction specialist I met with.  I mean, a quick phenobarbital taper followed by the exact same 4 drug cocktail -- Gabapentin, Robaxin, Baclofen, and Buspar.  And then flumazenil if things go badly.  And both of these addiction specialists mentioned the exact same book "Brain In Balance."  This method must come from this book.  I wonder how many other psychiatrists are using the method from this book.  Believe me, it doesn't make me want to do it.  It truly scares the hell out of me, and I don't trust it or them.  But unless this is one crazy coincidence, it would sure seem that this method from "Brain In Balance" is something that has caught on, at least with addiction specialists.  It doesn't mean that it's at all credible though.

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No.  I would never Cold Turkey.  Aside from everything else you could actually die.

 

I still don't trust this phenobarbital then 4 drug cocktail method.  I was just really shocked when I saw a post about another addiction specialist who had the exact same protocol as the addiction specialist I met with.  I mean, a quick phenobarbital taper followed by the exact same 4 drug cocktail -- Gabapentin, Robaxin, Baclofen, and Buspar.  And then flumazenil if things go badly.  And both of these addiction specialists mentioned the exact same book "Brain In Balance."  This method must come from this book.  I wonder how many other psychiatrists are using the method from this book.  Believe me, it doesn't make me want to do it.  It truly scares the hell out of me, and I don't trust it or them.  But unless this is one crazy coincidence, it would sure seem that this that method from "Brain In Balance" is something that has caught on, at least with addiction specialists.  It doesn't mean that it's at all credible though.

 

 

 

Yes they actually might get it from the same book that’s possible

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