To think my Drs have deliberately refused to see me

[TheCatsPaws]

Background: long term clinical depressive with severe anxiety. Occasional diazepam user. I have never abused or overdosed on diazepam, or any other drug. Was stable until I recently had four miscarriages in a row, which has caused me to develop flashbacks, nightmares and for my depression to come back.

I went to my GP last week for some diazepam and was told flat out no, as I am a “risk” I’ve used it for nearly 10 years, about three times a year. I was instead given Zopiclone, which caused a horrible hallucination of blood running down my hands and sent me hysterical (my DP had to restrain me).

I threw the Zopiclone out and used my last few diazepam these last few days. I ran out yesterday and asked for a telephone appointment. The Dr never rings. I ring up and tell them. They say I’m still on the list. I ring at 5:30 and they say I’m still on the list.

6 I ring and it’s closed.

Now I have no way of getting my medicine and I’m going to have fucking nightmares and panic attacks when I sleep. AIBU to think this was deliberate? They just don’t want to prescribe it to me for some reason.

I don’t mind at all! Feel free to ask :)

I think needing them occasionally is almost a red herring. If you’re having symptoms that are that severe even a couple of times a year then there is an issue. And probably an issue severe enough to need whatever therapy is necessary.
OP has had a very traumatic experience. Benzos May help acutely but they’re not preventing the attacks nor are they giving her long term help to deal with it iyswim. Whether symptoms are weekly, monthly or once a year or triggered by specific items, the underlying problem is the same, and it’s not one that can be fixed by drugs.

OP I have huge sympathy for you because I know from experience that this is somewhere the NHS struggles. What I think could benefit you is the following.

1. Some kind of debrief from an ob/gyn, similar to what happens when someone has had a traumatic birth.
2. Medium term therapy to process the event first and THEN begin to rebuild and develop strategies to cope
3. Possibly a short to medium term course of a generally anti anxiety medication

Just giving benzos is like leaving a gaping hole in the pavement and putting tape barriers round it. Yes it’ll probably help today but some bugger is eventually going to fall in. It’s not fixing the issue.

And benzos are horrible meds - they cause untold misery. And yes, I absolutely get that you do not abuse them. At the same time a lot of people do and that’s why GPs are under massive pressure to not prescribe them.

And another thing I think from your posts you need is validation that what you experienced was traumatic and you’re ‘allowed’ to think that. Yes it was traumatic - it must have been horrific for you.

I don’t see how a debrief would help. I had one after my sons birth because that was also upsetting and it didn’t help much. I think I’ll feel better once I know (if I know) what might be causing my losses.

I’ve been told I need EDMR but I’m waiting for them to get in touch.

Anatidae "I think needing them occasionally is almost a red herring. If you’re having symptoms that are that severe even a couple of times a year then there is an issue. And probably an issue severe enough to need whatever therapy is necessary."

but life happens. My trauma happened several years ago. Also I still occasionally get anxious because - actually who knows?! My mum had it, her brother had it - in their day there was no issue in getting the odd course of diazepam.

I just don't get it. If I have a reccurrence of stress owing to PTSD, I'm not going to go back to therapy again. Sometimes bad things happen and we get to a point where we are okay but have occasional flashbacks - should this require daily medications and constant doctor visits?

It's interesting what you say about red herring, because the main partner at my surgery takes the view if you only need them occasionally, you don't really need them.

Also not everyone has the time for constant therapy and drs appointments. I have a two year old who is likely autistic, I’m studying myself, having investigations for these losses and also have unidentified chronic fatigue that they can’t work out what it is. I don’t drive either. I really don’t want loads more medical appointments.

the main partner at my surgery takes the view if you only need them occasionally, you don't really need them.

That’s almost the opposite of what I mean (sorry I probably didn’t express myself well.) I’m saying that severe attacks even 3-4x a year ARE an issue. A big one. No it should t require daily meds and doctor visits, but it shouldnt be ‘here take these when you need and go away.’ It should be ‘lets Get to the bottom of this with short term drug/mid term GOOD therapy ( not bloody useless CBT.)

The problem with giving out diazepam is that it’s massively abused - and that means that patients like the OP, who don’t abuse them, suffer. Benzos are the cause of quite shocking amounts of morbidity. Our parents generation who were given them more freelyvhave bourne the brunt of it.

I’m absolutely not saying that OP doesn’t need treatment- quite the opposite. What I’m saying is that sporadic benzo use is probably not the best. It may be the ‘easiest’ because it will allow her to justbpaper over the cracks but it’s not really helping long term. The trauma is still there.

And OP from what you’ve just said - there’s a very understandable issue that you do t know what’s caused the losses. Yes, I think that’s an important thing - with out knowing and addressing them there’s always the fear it will happen again and that’s very stressful.
I don’t have any personal experience of EMDR, but let’s hope it works for you.

I would be putting your case to the GP that you are looking at longer term solutions so that meds won’t be needed. And at the same time you expect that to take some time and that your previous medication has worked well for you taken infrequently with no signs of dependency, so you’d like some more until the longer term stuff takes effect.

OP in terms of time yes - one of the other things I experienced post trauma was the GP telling me I hadn't taken enough time off work, I was also at night school and they wanted me to suspend my course for a year.

I am very glad I didn't - adding insult to injury - imagine if I'd let it all delay career progression as well! Plus I didn't want my bosses to know much about my personal life so telling them I had to take time of for counselling appointments would have been a nightmare.

sadly I have also had a colleague who was told by his doctor that "If you aren't prepared to take time off work you don't really have anxiety". He managed to get proper treatment in the end but I don't know what planet these people live on where they can take all this time off work for counselling and regular medical appointments etc.

obviously I had time off work when I had a major injury but I didn't want my employer knowing my personal shit. Broken bones are a whole other category.

sorry, ranting.

also for me - counselling didn't help much. Time and medication when needed - now that helps. Also the counsellor made me feel a bit abnormal for having nightmares....who doesn't have nightmares with PTSD?!

And OP from what you’ve just said - there’s a very understandable issue that you do t know what’s caused the losses. Yes, I think that’s an important thing - with out knowing and addressing them there’s always the fear it will happen again and that’s very stressful.
I don’t have any personal experience of EMDR, but let’s hope it works for you.

Yes at the moment I’m nervous because without knowing why it’s happened. I find it hard to move on from it. I also don’t know what treatment (if any) I will need so the uncertainty is not nice.

I’m hoping it will help. I’ve had CBT in the past which I don’t think is THAT helpful but we will see.

Anatidae - I understood what you meant, I am just saying, I feel like I can't win because one GP will have your view and another will have the view like the senior partner at my surgery.

it's just like every possible excuse - including street value - is given out for refusing occasional prescriptions. As I said upthread, something else must be going on with these - and I bet it's to do with profits and longer term medications.

we have no evidence yet for morbidity on newer longer term use meds. One of the good things about older meds is access to more data.

also - what about quality of life? I'm curious about these morbidity studies you mention - I bet they are linked to far more than "I take appx 10 per year".

I'm curious about these morbidity studies you mention - I bet they are linked to far more than "I take appx 10 per year

Oh for sure. And doctors are well aware that some patients take them sporadically and are fine whereas some have terrible addiction problems. The dilemma facing the doc is they don’t know you and are a. Accountable for what they prescribe and b. Accountable for hitting targets (for reduction of prescription of certain medications.)

Here’s a sample prescribing guideline. www.ipswichandeastsuffolkccg.nhs.uk/Portals/1/Content/Members%20Area/Clinical%20Area/Medicine%20managment/Medical%20conditions/Mental%20Health/Final%20Guidelines%20for%20the%20prescribing%20of%20Benzodiazepine%20and%20Z-Drug%20Update%20Dec16.pdf

Key points:
 Benzodiazepines/Z drugs should only be prescribed as a last resort when alternatives have been explored.1,2
 They should only be prescribed at the lowest effective dose for the shortest time possible (2 to 4 weeks) as per licensing.1
 Only issue acute prescriptions for these drugs. These drugs should not be put onto a patient’s repeat.
 Inform patients that further prescriptions will not usually be issued.2
 Existing long-term patients should be gradually withdrawn from these drugs.
 Complex patients on long term benzodiazepines/Z drugs, especially those with a history of previous
dependencies, should be referred to Turning Point

So it’s against the current guideline for a doctor to continue to keep prescribing them. This is why OP is facing resistance. I do t think it’s a matter of trying to push people into more expensive stuff (the NHS generally prefers to try cheaper older stuff before Shelling out for new.)

"@WiseUpJanetWeiss"
Diazepam is used to relax muscle spasms that cause pain.Although it it is in the benzos category it can potentiate the action of anesthetics and opioid analgesics (Flecknell, 1996).It is also addictive and other things like mental health referral/ talking therapies etc should be considered. When all of these drugs are being given by various care providers - out of hours, mental health, hospitals, GPs there is a huge risk.

This is not excusing the GPs.

I am appalled that you are not being called back, OP. You should definitely write to the practice manager. There is no excuse for this. Even if the GP is not happy that you sought a second opinion, it is your right to do so and the GP should be considering their own development as a result.

As an aside, if more money was invested in mental health service there would be improved outcomes for everyone. Sadly, funding is reducing - even if TM says it isn't. There are more doc retiring than joining. It will only get worse.

All the best

Riverside Could the problem be that people who take 10 a year, without dealing with the underlying problem, tend to deteriorate and gradually need more? I don't know but wonder if that concern is part of the escalating use problem

No excuses for patients being left untreated but there was a flurry of articles a year or two back when all the benzo studies came out, suggesting GPs could be held liable for patients becoming habituated if they prescribed inappropriately which I suspect led to the policies of not allowing it other than advice of a specialist.
I wonder if part of the problem for GPs is finding, in a very short appointment, who are the patients who genuinely working through difficult issues and needing that bit of occasional support and who are the ones on the slippery slope to habituation.

Anatidae

this is the last post I'll put on this subject as I don't want to derail OP

OP usage fits in perfectly with all those guidelines.

you say yourself you mentioned morbidity and it's got nothing to do with people taking as few as OP

as for "doctor doesn't know you" - I am guessing the OP has, like me, a perfectly accessible medical record which will show occasional use of benzos over a period of (in my case - 17 years...) xxx which is ample proof that she doesn't turn up demanding them.

I think the longest gap in my requests has been about 5 years. The shortest has been about a year.

If I have understood OP correctly, her requests don't count as "asking for a doctor to continue prescribing them".

I'm on the Patient Participation Group at my surgery and the number of people who are treated like this is amazing and all for occasional requests. The irony is, as one man said (quite bravely because no one wants to piss their doctor off) "I'm not an addict, but the minute you make a song and dance about the odd request, you make me feel like one".

and then, particularly with anxiety, you take your 10 pills home and think "is it okay to use these because I'll never get them again...shall I save it till I'm about to throw up on my commute to work". It's insane.

are you a GP? Your data you've put in has listed all the long term use stuff, which is nothing to do with OP.

I haven't had a request in since June last year. The impression I got then was that they were very unhappy so I imagine if I ever need them again I will be refused, or told to take amitryptaline which makes me feel like shit for hours afterwards.

Cross post with Anatidae who has said it far better!

News " it’s still better than the alternative"

does that mean the alternatives of long term sedating drugs?

The thing is. Benzodiazepines are absolutely brilliant drugs and work really well when sometimes nothing else will. They don’t have shitty side effects either.

Exactly. They don’t make me feel like shit or unable to look after my son. They just stop the horrific nightmares and panic attacks.

Not a GP. I’m a scientist - quite a lot of pharmacology type experience. Currently working in drug development.

The shitty side effect IS addiction.

And the fact that you build a tolerance to them fast. I’m very surprised someone would be given 28 a month. That’s a fair amount long term. A fair proportion of people would develop tolerance and addiction well before that level of usage (please note, I’m not saying this directed at you - obviously your psych has decided you have a low addiction potential)

There need to be much better options for both long term pain and for conditions like this. Right now there are no good painkillers for example at all. Paracetamol is highly toxic and doesn’t even work for a lot of people. Ibuprofen has unpleasant side effects. NDAIDs as well. All the opioids are very addictive - look at the opioid crisis in the USA just now. There’s just nothing safe and effective for people with chronic pain.
Drugs for acute sedation are similar - there just isn’t anything that isnt abusable or addictive that actually works.

The long term stuff doesn’t mean taking one a day long term only - it also includes long term sporadic usage. The OP doesn’t fit the criteria because she would need long term repeat prescription. That’s contraindicated in the list I posted.

GPs are under a lot of pressure to stop prescribing benzos on repeat. This all leaves patients in a bit of a pickle. Those with a dependency will suffer, those without a dependency will suffer.

I’m glad you got help from out of hours. What you went through was awful. I don’t think people should be saying what drugs you do or don’t need, that isn’t the issue, the issue is the surgery not phoning you.

*I'm on the Patient Participation Group at my surgery and the number of people who are treated like this is amazing and all for occasional requests. The irony is, as one man said (quite bravely because no one wants to piss their doctor off) "I'm not an addict, but the minute you make a song and dance about the odd request, you make me feel like one".

and then, particularly with anxiety, you take your 10 pills home and think "is it okay to use these because I'll never get them again...shall I save it till I'm about to throw up on my commute to work". It's insane.*

All of this! My last prescription of 28 tablets (2mg) was at the beginning of October. I still have 12 tablets left. I don't abuse them and I am not addicted, but I worry each time that I need them that I will be treated as an abuser/addict. Thankfully, my GP is happy to prescribe them for now. I know other GPs in the practice wouldn't be. He prescribes them for the issues I have with my back and frankly when I go through a flare up and my back is in full spasm mode for up to a week, I need them because nothing else will touch it, because Valium is a relaxant. It's bloody magical.

I also use them for anxiety, which is - and again I am very grateful for this - infrequent. I take high dosage anti-depressants, but when anxiety hits, they are not very helpful.

My take on my experience is that while I don't absolutely, positively have to have them, they help make certain circumstances in my life that won't go away far easier to deal with. They make me able to live my life at times when I would otherwise find life pretty unbearable for however long that circumstance lasts for.

I don't think any of us who have used/do use Valium are ignorant of the fact that it can be addictive, but personally I find it hugely unhelpful when all we hear about is the addictive nature of benzos, but equally we all know that they help us and that at the rate we take them we are absolutely NOT addicted and so should not be treated as though we are ignorant or told that we should not be "relying" on them whenever we do need them for a day or two or maybe a week.

Re therapy. If you can't afford to go privately, then there is a long wait on the NHS, and then you are most likely to be sent for CBT. I had a session of CBT last year and while it was helpful, it certainly wasn't the answer to ongoing mental health issues. It helped me find some coping methods, but the underlying issues haven't suddenly disappeared and there are times when all the coping methods in the world just don't cut it.

As my usage is for two separate things, even if I suddenly became free of depression and anxiety I'd still need them for periods of intense back spasms. They, alas, are never going away and will only get worse.

Now, if there were something that worked in the same way without addictive side effects, but also working in exactly the way that Valium does, then I would be delighted to switch over, but it seems to me that currently there isn't, so what are people in need to do in the interim? I think medical marijuana could be the answer, but that doesn't seem to be on the cards in the short term. Ergo (sorry, all tl;dr) people who use them as most of those who've posted here do, at irregular intervals, should be able to do so without being continuously lectured about who addictive they are. We know and we are not addicts!

Right now there are no good painkillers for example at all. Paracetamol is highly toxic and doesn’t even work for a lot of people. Ibuprofen has unpleasant side effects. NDAIDs as well. All the opioids are very addictive - look at the opioid crisis in the USA just now. There’s just nothing safe and effective for people with chronic pain.
Drugs for acute sedation are similar - there just isn’t anything that isnt abusable or addictive that actually works.

I get prescribed tramadol regularly for pain. They’ve never given me any difficulty obtaining that, oddly.

I am very sorry to hear of your losses op, but very surprised you have been given Zopiclone, my son was taking them short term, but when he asked or more he was only given a weeks supply, then refused altogether
I have been on Diazapam 2mg for more years than i can remember and still get them monthly
Different Drs look at things different ways i guess
My Dr told me i have been on them for so long taking them for ever wont matter now

I think that Valium was originally developed to treat muscle spasms of the back. - missing the point of the thread -

OP, if you can, get an appointment with a private psychiatrist. You will hopefully be listened to and get treatment for you, rather than have guidelines thrown in your face.

If she’s also being given tramadol that may account for why the GP is reluctant to prescribe diazepam.

I did not post the guidelines in order to throw them in anyone’s face or lecture. You will see that all of my posts are sympathetic to the OP and the undoubtedly traumatic experience she has had.

I posted them to try to explain the general climate around prescribing such drugs and the pressures GPS are under. There is no value judgement here.