Quick Taper Question

Why do doctors often prescribe a different benzo to taper off a benzo?  Does it have to do with short/long acting types?  Is it better to taper off a long acting because there is a smaller chance of between-dose withdrawal?  I'm a nurse looking to help benzo victims (after being one myself.)

Many people who are taking short-acting benzos (e.g. ativan) will switch to a longer-acting benzo (e.g. valium) to help minimize the therapeutic variability of the drug in your bloodstream (during the course of the day).  That's pretty much the only reason for switching that I can think of.  You can also dose multiple times per day with a short-acting benzo if you don't want to switch to a longer-acting one.

First of all, thanks for posting as a nurse. A lot of people would love to hear from the perspective of someone in the medical field. We understand you can't diagnose or give specific medical advice (or we should know that ) I don't actually know how it works for nurses or doctors on here. We've got other health care professionals as members, so you're in good company. That's probably something you should ask the admin about just to be safe. They have rules for things I never would have even thought of, and they are all there to protect you.

 

I read that you were having a hard time from quitting after two months, and you mentioned feeling like you shouldn't complain because other people have it "worse" or took it longer. I don't think you should ever feel like your experience is less than someone else's because you took it for a "short time." Two months is plenty of time to become dependent on these drugs, and quitting make your symptoms more challenging at first if you did so cold turkey. I'm on year nine and I don't think about people who took for less time than me that way. We're all in this together. Some (rare) people can take them for decades and just quit. All of benzoworld is mysterious.

 

Secondly, that is awesome that you are looking to help other people with the knowledge and experience you've acquired. That's what we need. People in the field, spreading the word. Giving real patients good advice, warning their peers about the dangers of bad prescribing, and just spreading the word. So good on you for taking this fight forward! For now you obviously need to concentrate on your own healing, but learn as much as you can during the process, and ask all the questions you want to ask. It looks like you already know your mission, which is a powerful force to sustain you during withdrawal.

 

One piece of forum advice: You've posted to the "Chewing the Fat" section. Which is where people tend to theorize and be more speculative. You might get more responses if you posted under one of the "Planning your Taper" sections: http://www.benzobuddies.org/forum/index.php?board=163.0. (Substitution seems to be the most obvious one for this particular question). Or when you are looking for support for your own taper, under "Withdrawal Support:" http://www.benzobuddies.org/forum/index.php?board=145.0. There is also a section for those folks who quit suddenly "Cold Turkey, Detox & Rapid Withdrawal:" http://www.benzobuddies.org/forum/index.php?board=133.0. So you've got options for asking questions for future patients, as well as two different sections for your own withdrawal (plus a lot of other more specific areas for things like anxiety, etc). You'll find where you feel most comfortable at, or you might just roam freely.

 

To your questions: And this is ALL just my opinion as a layperson, so get as much advice as you can from as many people as you can.

 

Yeah, generally people switch to longer acting benzos to avoid interdose withdrawal. Then with the longer half-life, you kind of have a natural taper. So there are less shocks to the system. The most common long-acting benzo used is Valium. Valium is also helpful because there is a prescription liquid form of it. So you can taper by any amount you like, you can micro taper, you don't have to make liquid forms of it it in your kitchen, and you aren't cutting up little bits of pills (where the medicine is a tiny part of each pill anyways so it makes it challenging). Valium helps you avoid many of the at-home-methods that people often need to resort to. People can be very successful at these methods, I'm not disparaging that work, I did it myself during my first taper. But you'd be hard pressed to find someone who wouldn't rather avoid it if they could. But we all do what we have to do.

 

Valium also has some further benefits. It comes in small doses if you stick with pills. So you can get down to the "recommended" jump-off point by using regular pills, not grinding anything up or cutting pills with razors. And you can achieve your "jump off" dose by snapping a 1mg Valium in half (though many people do need to go lower than that). Where if you did that with, say Klonpin, you would need to be smashing up your pill and using a jeweler's scale, or a razor blade. People do that too, it's a kind of whatever works world.

 

But those are the usual stated benefits of Valium. Other's can put it more elegantly and scientifically than I can.

 

The other long-acting benzo people use is Librium, but it's so much less common that it's hard to find helpful information from your fellow taperers. Though I know people on here who understand things about the mechanisms of these medicines, that I will never have the background to understand, that swear by it. So it's another option. Just one that less people can speak about from personal experience. 

 

Also, for some people, another reason to switch is that their current benzo starts to have paradoxical effects, and so switching can help. So you might be on Ativan or Klonopin, and it stops working, or it starts to do the "opposite" of what it is designed to do, and so switching might be beneficial and provide: but there are no guarantees.

 

Some people can't take Valium though; for whatever reason the crossover just doesn't work for them. It has a reputation as being the benzo that can cause the most depression in people, maybe because it is more sedating for some of us. I found crossing over to it lessened my depression, but that could also be because the crossover period also halved my total dose. And I moved from two benzos to one. It's always hard to say. Regardless, a crossover should to be done slowly, and carefully (for most people), unless they are on an extremely low dose (and then still carefully .) 

 

Some doctors are hesitant to prescribe Valium in the US. It has an ill-defined "bad" reputation, which is, I think, nonsensical, since it is, in many ways, the least harmful one if you're going to start off on one, and the easiest to come off of (for many people) as it has such small available doses. But it's something you have to contend with occasionally. I think doctors might be slowly turning around on that, but who knows, it's a big field. I believe this perception is more of a historical issue, since it's been around so long, and acquired a stigma, than one based on an actual comparison between it and other benzos.

 

Also, Valium isn't like some perfect remedy, and no one is going to be ruined if they can't switch to it. People taper off other benzos every day. And they do it the same way people on valium do. There are also liquid forms of some of the other benzos as well (the one I know doesn't exist in liquid form is Klonopin). So you can make those small daily adjustments with them as well, they just lack that longer half-life. But many people would rather stick with what they have been using, because crossing over has its own issues. Often, the less amount of variables you change at any given time, the better. Ideally, you want your body to not even know it is missing something it has grown to need. That's why people stress tapering slowly. I would guess if you were on a smaller initial dose of something, you'd be more likely to want to stick with it. Just a guess.

 

If you'd like to get a really good detailed explanation of how all of this works, as well as a set of tapering schedules, the place to start is the Ashton Manual. Dr. Ashton explains many of the issues surrounding benzos, their uses, problems, and methods of withdrawal, with precision, but in a language that both doctors and patients can find engaging and accessible. It's not long at all, and it includes crossover schedules to get from other benzos to Valium. Some people find her tapering schedules to be too fast. My guess (purely a guess) is that they are ok for most people, but not for the kind of person who ends up on a board like this. We tend to be more sensitive to the medications, or to have already been cold tukeyed too many times or whatever. In any case, the tapering schedules are designed as a guide, not as a rule, so people should always go by their symptoms and how their body feels, not some arbitrary taper schedule. Here is a link. It's saved more lives than any of us will ever know. If you find recalcitrant prescribers, it can sometimes help to give them a copy. Sometimes, as I'm sure you know, they will listen to another doctor before they will listen to anyone else.

 

https://www.benzo.org.uk/manual/bzsched.htm

 

p.s. One thing you will read that Ashton once believed, but that she later corrected, and that is backed up by many people's experience, concerns alcohol. It is the extremely rare person who can drink while coming off of benzos, during withdrawal, or even for years afterward. Though some people will talk about having a glass of wine after being past their withdrawal period. For most people it's a horrible idea and not worth the risk. Just a brief disclaimer, since it's in the manual that she once thought you could drink occasionally during the process. She learned otherwise, as have many people here.

 

Best of luck! People cold turkey like you did and heal all the time. In that sense, I do believe that being on for "only" two months and recognizing you were at risk stands in your favor. So just keep going. Welcome aboard.

 

quiet