HealingWell
Search Close Search
☰

New family doc and Ativan

Support Forums
>
Chronic Pain
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 3/5/2019 7:52 PM (GMT 0)
Hello all. I hope you are all doing well. I need some advice. I have been on .5 mg Ativan twice a day for several years. It has always helped with my anxiety and especially helps me sleep without waking many times a night. My doctor and I tried several medicines before we finally found that Ativan works great for me. I am also in pain management for a chronic back injury. I recently got a new family doctor because my old doc left. This new doctor said she is not able to give me ativan with pain medicine (that my pain dr prescribes). She said a new law will not allow her to prescribe them together. I have been taking these meds for 10 years with no issues. My pain dr knows I take the Ativan and my old family doc knew I took pain meds and they had no issues with it.. Ativan has been a great medicine for me and I have not been on it now for a few months. My anxiety symptoms and insomnia are back. The new doc told me to get my pain doc to write for the Ativan or go to a psychiatrist and get it. If it is illegal for drs to give ativan and pain meds together why would this new doc be telling me to get other docs to prescribe it?? I would love some advice on what I should do. I have been taking these two meds together responsibly for the last 10 years. Thank you in advance.
Posted 3/5/2019 8:25 PM (GMT 0)
Shaw:
Your new PCP is being prudent and cautious in her discussions with you on not being comfortable providing you with concurrent prescriptions for a benzodiazepine and an opiate/narcotic.

We hear a lot about the opioid crisis. The other crisis that receives less news coverage is a concerning and growing use of prescription benzodiazepines. Prescriptions for benzos increased some 37% between 1996 and 2014 (My reported figure may be slightly off the official statistic. You can check the specific data on the National Institute of Health website).

The 2016 CDC guidelines urge physicians to avoid prescribing a benzodiazepine concurrently with an opoid/narcotic wherever possible. Both benzos and opioids now carry “Black Box” warnings highlighting the dangers of using these drugs together. A “Black Box” warning is the highest level of precaution issued by the FDA or CDC.

While it is not technically “illegal” for a physician to prescribe both, the degree of heightened concern for serious or life-threatening possible side effects disseminated in the CDC recommendations is enough for most physicians to take a serious pause. I can see where a new physician to your care would be less than comfortable extending prescriptions that you have had for both a benzo (Ativan) and an opioid, as he/she would be placing their medical license and state board certification at risk if you were to have an adverse event.

Opioids and benzos are both powerful medications.

The National Institute of Health (NIH) has an informative website and information on this discussion of concurrent use of benzos and opioids as well as on the concerning incidence of benzo prescriptions.

Talk with your psychiatrist to get his/her assessment of your particular situation of your pain and anxiety issues and risk/benefit of the combined medications. You will want to discuss this with a medical provider who knows you and with whom you have an established relationship.
Karen
Posted 3/5/2019 8:29 PM (GMT 0)
Shaw, what Karen has posted above has been going on for a few years now. A lot of pm patients found their selves in your situation. I suggest trying to get in with a psychiatrist to be evaluated for the Ativan.

Take care.
Posted 3/5/2019 10:44 PM (GMT 0)
I love you guys! You are all always so helpful.
Posted 3/10/2019 11:55 PM (GMT 0)
Usually if a psychiatrist prescribes it. There is not a problem. As someone said earlier. It is not illegal for a patient to be prescribed opiates and a benzodiazepine. But the benefits must outweigh the risks. Primary care doctors do not have the training and education in mental health issues psychiatrists do.
Posted 3/29/2019 6:51 PM (GMT 0)
So I have an update. I went to a psychiatrist and explained my situation. The psychiatrist said he had no problem giving me the ativan but he could not do it if I was on Belbuca (buprenorphine). He was looking at my prescription history on his computer and saw everything controlled I have filled. I don’t mind because I was honest with him. They are really really cracking down on this. I think it is sad for legitimate patients. I have been on this combo for years. Do you all think I should leave it be and just choose between sleep/anxiety and pain or should I get a second opinion from another psychiatrist? Thank you all.
Posted 3/29/2019 10:02 PM (GMT 0)
I am a lite sleeper and awaken freuqently during the night.

Lack of adequate deep REM sleep can be deeply affecting. It’s more than feeling sleepy. Lack of restorative sleep affects my ability to think clearly and has a multiplier effect on how I am able to handle simple stressors. So I can appreciate how you feel unmoored by your psychiatrist’s decision to not prescribe the Ativan that you have become accustomed to.

But your psychiatrist may be doing you a large favor. Benzos become harder and harder to taper off of with continued use. Benzos also have effects on the brain chemistry that have latent effects.

It would be to your long-term advantage to be able to be benzo free, if you can.

To help me with sleep, I have had success with each of the suggestions below:
A. Children’s Benadryl (12.5 mg) 1-2 tablets a half hour before I turn out the light. I am more child-sized than adult-sized, so children’s formulations are a good fit for me. For average adults, children’s formulations can also be a preferred dosing option as the lower dose tablets give you more control in desired effect
(Ex. Take only one 12.5 mg tablet if you do not want to feel overly sedated).

B. “Simply Sleep” by the makers of Tylenol. Simply Sleep contains the sleep aide found in Tylenol PM and TheraFlu but without accompanied Tylenol (acetomenophen). There is less risk of liver compromise Tylenol-free. A teaspoon of Simply Sleep helps me have fewer night awakenings. You will find Simply Sleep in the store aisle with over-the-counter aspirin and cold-allergy products.

Here’s wishing you a good night’s sleep and restful zzz’s.
Karen
✚ New Topic ✚ Reply