To think the GP could just cough up the good stuff?

[Pantone363]

Longstanding and boring OCD diagnosis, successfully treated with private CBT and a maintenance SSRI dose. At its worse upwards of 5 panic attacks a day. Currently about 4 a year (go me).

So I have the SSRI meds and when I have a panic attack I have a 2.5mg diazepam that I can take if I feel I can't handle the panic. I haven't taken one for over 9 mths. Mostly just knowing I have them is comforting and I work through the panic. For those of you know don't know 2.5mg is a minuscule amount.

Last week I lost my handbag which had my last 4 tablets. Repeat prescription refused and doctor asked to see me first (my old GP has retired).

Basically GP refused to prescribe and looked aghast that I expected her to. Asked if I had tried breathing exercises and basically said she wouldn't give me any as they are addictive and uneccesary.

I understand that but I was basically asking for 5 tablets at a tiny dose which would last over a year! Hardly a drug habit. DPS threw his neck out last year and the GP handed him a script for 5mg diaz about 12 tablets! My friend got some for a fear of flying!

So AIBU a to think the doc should just cough up the good stuff and not fob me off with breathing exercises (which I'm well versed with and do not work by the point I would take the Diaz)

[Fromparistoberlin73]

Expat

[mamadoc]

Forever- well one reason I choose not to be a GP is that this rarely comes up for me as I am not responsible for long term prescribing GPs are. I realise that is a cop out but it is true.

I would not seek to stop someone's long term treatment that they are happy with and/ or dependent on unless they wanted to but I would not start someone newly on long term benzos and I would not escalate the dose of any that are being prescribed. If I prescribe them short term in a crisis I make every effort to ensure they are the lowest dose for the shortest time and that they don't get put on an automatic repeat. I see that as responsible prescribing. You may see it as paternalistic but the system is that OTC meds are at your own discretion but prescription only meds require a Dr (or non medical prescriber) to be involved and that means that they have a duty to exercise their own judgement.

[expatinscotland]

Due to child bereavement, I have a lot of trouble sleeping, particularly getting to sleep. Meditation, pranayama breathing, yoga, sleep hygiene, exercise, stable weight, do all that, but having been an insomniac before, it's worse now. So I take Nytol One a Night every night and use melatonin or I don't fall off until about 4am. I have to go into a city and hop around chemists to get it. 'It's not for long-term use.' Yep. But unless someone comes up with a spell to magic up my dead child, sadly, I'm always going to be left with some residual issues, and this, after three years, looks like it's the one. I'm pretty much back to appearing to function normally in society, except when it's time to go to bed. And some times of year, it is worse than others, understandably.

Of course, I know quite a few parents like me, and plenty use booze and/or hash to cope because there's just no 'fix' for people like us. Not even time has improved things for some (it changes things, it makes them different, it is not, however, a healer). Some cannot sleep well unless they pass out from drink.

So I have every sympathy for you, OP. Sounds like you are managing very well. As 'crutches' go, a few tabs of 2.5mg blue is small potatoes. It sucks, but you gotta do what you gotta do, so shop around.

[CrystalSkull]

'It isn't for GPs to overrule medication programmes being given out by specialists' - quite right. I wish it worked that way in practice!

[OpalQuartz]

Yanbu. If you kept on going along and saying you had lost them that would be different, but everyone can lose something once and you only need them occasionally.

[CrystalSkull]

I sympathise - getting prescriptions refilled for the class B drug I need to take (legitimately) every day is an absolute nightmare. I also recommend changing GPs. I had one in the past who flat-out refused to prescribe the drug to me despite my being under the care of a hospital consultant! They do seem to vary a great deal in their attitudes.

[expatinscotland]

True, butterfly, or hash.

[Foreverdepressed]

mamadoc
So just out of interest what would you do if a patient such as myself came along who has been taking one of these "most addictive substance known to man" for a long time, was not out of control, was happy with their treatment and wanted to continue?

AAPs make you fat, diabetic and tired. Not to mention rare risks of tics and whatever. No thanks.

[butterfly133]

YANBU

This is one of my pet hates, I know someone who was offered 2 on her second time! Imagine paying for 2! I totally know what you mean, it's not like you're in there every month asking. I had the same problem when averaging ten per year of the 2mg dose. As a highly anxious colleague said, the real stupidity is that a desperate person may resort to booze etc. try asking another GP?

[expatinscotland]

If you can ever get to Mexico or C. America, just visit a pharmacy there.

[FlumptyDumpty]

YANBU. GPs tend to be wildly underinformed and frightened about prescribing benzos. You have shown you can use them judiciously, without creating tolerance. Yet she seems more concerned about covering her own backside or protecting you from an addiction you just can't create on such a small quantity of such a low dose. Can you see a psychiatrist instead? They tend to take a more sensible view and not react like you've requested a prescription for crack.

[expatinscotland]

I doubt you're going to get addicted on 2.5mg tablets you use 5x/year. But you'll always run into one who acts like you're asking for enough blues to supply a scheme.

[expatinscotland]

Just go to another GP .

[mamadoc]

The problem is that you can't really tell who will get addicted until they are addicted and it can be hellish to climb down from and create huge problems of its own. It is horrible to see people who have basically been made into addicts by Drs, who are not getting any anxiolytic effect any more but are dependant on drugs to avoid withdrawal seizures.

Maybe there are certain people for whom it is the only solution but it should be done by a specialist never by a GP and only after all else has failed ie antidepressants at adequate dose for adequate duration, CBT from a skilled therapist, other drug options like mood stabilisers, atypical antipsychotics and pregabalin. All of those are preferable to long term benzos in my estimation.

Also I would never choose lorazepam as it is short acting and so has greater addictive potential than diazepam or clonazepam. Lorazepam is only for rapid tranq in my book and alprazolam is just the most addictive substance known to man.

It's not an exact science and on this one opinions will vary hugely. I am happy to negotiate treatment plans with patients and take their preferences into account but ultimately the prescriber is responsible for the drugs they prescribe and I can't give out something that I don't believe to be in a persons long term best interests.

[Foreverdepressed]

mamadoc
I appreciate what you are saying as they are not a 'long term solution' but sometimes there is no better option surely?

As someone who has done CBT multiple times, mindfulness and almost every antidepressant on the market (including MAOIs) I feel lucky to have a doctor that put me on a hefty dose of lorazepam as a last resort. It is absolutely brilliant to be able to shut off the anxiety when required and over the 2 years on them my life has improved and I've actually reduced the dose by about half on my own.

Sounds like if you had been my psychiatrist I'd be stuck in the same old loop. IMO the people that get psychologically addicted and abuse Valium are the same ones that get abuse codeine, or alcohol, or gambling, etc. People prone to it.

Of course OP situation is different as she is using them as a safety net and getting from a GP but still, is it really a big deal to be given 14 valium sleeping pills a couple of times a year?

[mamadoc]

Drs really vary in their attitude to benzo scripts.
I also agree that saying you lost the previous ones triggered a 'red flag' in the GPs mind as it is absolutely what addicts always say.
I expect if you ask a different GP it will be fine.

I'm afraid that as a psychiatrist I am fairly anti-benzo. They do work a treat in the short term for anxiety but they provide no long term solution. They are physiologically and psychologically addictive and they often prevent people from addressing the underlying issues. I would personally never give a long term benzo script. Only ever 2/52 whilst getting definitive treatment in. Same goes for sleeping tablets.

In OPs case you can argue it is fairly harmless but the keeping of some tablets in the bag isn't the best coping strategy. If your strategy is always to take tablets you will never have any different strategy and it will become a self fulfilling prophecy that you can't cope without them. It is a form of avoidance which a CBT approach would say maintains anxiety cycles. For a lot of people this escalates into taking tablets before going out 'just in case' and then further generalises to lots of other situations and this is how addiction happens. Not for everyone but I do see it a lot and would prefer not to take the risk. I have seen people very angry with Drs that started them off on 60-80mg a day diazepam habits they can never kick.

[expatinscotland]

'I'm a bit confused, panics attacks are acute, how does the Diaz kick in in time to have any impact?'

And they can be cyclical. You get a bad jag and you get attack after attack.

I would go back and see another GP.

[crispiecrunchie]

I agree I had the same issue with zopliclone sleeping tablets a few years ago. Having a few in the house was reassuring and I rarely used then. I think they should differentiate as these drugs can be used appropriately.

[DoctorShoe]

As a doc, YANBU.

[eyebags63]

YANBU I think there was a period a couple of decades ago when valium was handed out like smarties and a lot of people got addicted. However the balance has gone too far the other way now and doctors essentially have 'benzo phobia', and many wont use them even when appropriate.

Oh and it IS possible to have a long term prescription / use of Valium or similar drugs and not become hopelessly addicted and dependent.

[spillyobeans]

Yes please just go to a gp! Why would you risk it???

[ilovesooty]

How can you buy them legally online if possession of benzos without a prescription made out to you is punishable by a fine and /or imprisonment? And her mother would be stupid to pass them on - penalties for supply are much stiffer.

[Fromparistoberlin73]

Unless someone comes up with a website I would go via the GP or nick your mums OP !

Not proud but a while ago I found a forum where people shared their websites - but there was some
Mysterious code of silence and you had to be aeber for ages before people shared details - was not that desperate and gave up . Anyway this is not helpful for the OP who I hope has some ideas and possibilities now .

And big love to all of those with chronic pain conditions and hope they get the support - my dear friend and father have always been given what they need eventually and it saddens me others have to battle for setting that was specifically designed to help them

[AliceScarlett]

You can buy benzos legally online, pretty much the same as diaz, but there's a small chance they could be rat-poisony.

[spillyobeans]

Surely it cant be legal to buy something like that online? If you cant buy it over the counter? Not judging just worried for the saftey of it!