Drug info - GP / Doctor's response to withdrawal of illegally obtained Alprazolam (Xanax)

[GreatWonder]

OK, SWIG wants to make it clear that this is a totally hypothetical situation and has been curious as to the possible results for a long time. It is not in relation to SWIGs situation, SWIMs or even SWIZs.

If SWIM were to stupidly get themselves a pretty nasty Xanax (Alprazolam) addiction through illegal / non-legit sources and then theses sources suddenly dried up what would SWIYs think a GP / Doc's reaction / action be?

This is on the basis that the Doc will have no record of their patient (SWIM) ever having been prescribed or approved for benzodiazepine / Alprazolam 'scripts but also knowing that at the same time a heavy benzo withdrawal (however obtained) can be fatal.

Would they give a SWIM a huge telling off and send him/her packing with a grin saying something along the lines of 'enjoy the ride' or would they be more likely to dish out some legit Alprazolam and start SWIM on a taper? Or maybe prescribe a course of Valium (Diazepam) or something else?

Like SWIG said this is a hypothetical situation*, I know only a SWIY will know if they've been in that situation, so just looking for opinions.

*SWIG does indulge in benzo use, but infrequently, less than 1mg of Alprazolam a week to aid sleep / social anxiety - SWIG obtains it illegally and has never attempted to ask his Doctor for it, couldn't be bothered / would get too worked up with all the shit that would come before getting that far.

[kareena]

UK doctors really really dislike prescribing benzos even if they are legitimately indicated for, so I'd expect they'd substitute the alprazolam for diazepam and taper SWIY off post haste. SWIY couldn't be prescribed legit alprazolam as it's not even used by the UK medical profession.

[GreatWonder]

Originally Posted by kareena

SWIY couldn't be prescribed legit alprazolam as it's not even used by the UK medical profession.

Really? SWIG had an incident in the New Year and a paramedic (in the UK) asked if SWIG had taken anything (naturally) so SWIG told him Xanax and the paramedic just looked blankly at SWIG and asked 'what's that?'

Is Alprazolam really a no-go in the UK Health profession?

[Zaprenz]

alprazolam/Xanax is available in the UK but just NOT on the NHS and even then only very rarely prescribed by private GPs. None the less it is possible - usually only for people who come from another country to the UK dependant on xanax for medical reasons and then go to a private doctor. I doubt many UK private GPs would initiate alprazolam from scratch [either because they are cautious or they are not familiar with alprazolam].

In terms of drug treatment programs although GPs can prescribe any benzo on a normal prescription the only one legally allowed on a daily pick up script (where you pick up each dose everyday at the pharmacy) is diazepam.

The guidance tends to be to convert any benzo addiction into diazepam equivalent dose and taper anyway so it makes sense. Legally or illegally aquired benzo addictions in most cases would be treated in this way (in the UK) SWIM would guess.

[GreatWonder]

SWIG thanks you for the above information SWIZ. He didn't realise it's totally not available on the NHS - SWIG wonders why, whether it's because of the cost or the reputation for misuse / dependancy.

SWIG *loves* Alprazolam, in it's intended for use, it pisses all over Diazepam for SWIG, quick onset, no side effects and thankfully no addictive qualities for SWIG (though that's probably just willpower and the price SWIG has to pay for it through an OP - SWIG only buys the Upjohn Xanax which costs a bomb so he has to eek it out)

[kareena]

Originally Posted by Zaprenz

alprazolam/Xanax is available in the UK but just NOT on the NHS and even then only very rarely prescribed by private GPs. None the less it is possible - usually only for people who come from another country to the UK dependant on xanax for medical reasons and then go to a private doctor. I doubt many UK private GPs would initiate alprazolam from scratch [either because they are cautious or they are not familiar with alprazolam]

That's interesting, I didn't realise that private doctors are able to prescribe alprazolam in the UK. As you note though it doesn't sound as though too many scripts are being written for it.

Originally Posted by GreatWonder

He didn't realise it's totally not available on the NHS - SWIG wonders why, whether it's because of the cost or the reputation for misuse / dependancy.

Most likely because it has a reputation for misuse. The UK has become extremely anti-benzo recently and it wouldn't make sense for the NHS to have another short acting benzo with a high potential for abuse on it's books so to speak. NB. Of course this anti-benzo stance is not unfounded as they can be extremely destructive drugs although this swim's opinion is that they seem to be a viable treatment option for some if used sparingly and sensibly.

[Jatelka]

Fascinating thread.

In SWIJ's experience the majority of medics would convert to diazepam and then proceed from there with tapering (with the appropriate referral to a specialist service, of course!) She herself has been in this position and the risk/benefit ratio strongly favours taking the person's word for it and reviewing the situation regularly. The risk of seizures and permanent injury/death is too significant to do anything else.

Zaprenz: I need a source/corroboration for this statement:

"the only one legally allowed on a daily pick up script (where you pick up each dose everyday at the pharmacy) is diazepam".

As far as I am aware, there is no such legislation. Is your mongoose getting mixed up with methadone maintainance?

[Zaprenz]

Well I correct myself for Wales but in England the following applies...

"In England, only Schedule 2 Controlled Drugs plus buprenorphine and diazepam can be prescribed in instalments on an FP10MDA prescription.

In Wales, it is possible to prescribe Schedule 2, 3, 4 and 5 Controlled Drugs in instalments on Form WP10MDA."

http://www.pjonline.com/mep/index.html

[From MEP - Medicines Ethics & Practice]

To clarify I wasn't suggesting a doctor could NOT prescribe other benzodiazepines on a normal FP10 (green prescription) in the UK, this would ultimately be at their discretion. [By this I mean all benzos permitted on the NHS, as mentioned this doesn't include alprazolam]

Taking the hypothetical case of a person getting addicted to ANY benzodiazepine ILLEGALLY the doctor who at that point would indeed have a duty of care to stop dangerous withdrawal would still be in doubts as to whether the person a) was really addicted and b) was honest about the dose. (in other words wasn't using addiction as a way of attempting to get benzo's]

Therefore a doctor treating an illegally aquired addiction would most likely put a patient on diazepam on an FP10MDA form. (Thus limiting the patients supply to only a day or so at a time rather than handing them a new script for a month or weeks worth were they could either sell or not take them according to the doctors withdrawal plan]

This is not to say getting benzos on an FP10 form wouldn't happen, its just the above scenario is much more likely as it covers all the concerns any doctor would have

#The patients withdrawal is not ignored [which would be breach of duty of care on their part]
#It minimizes the possibility of the doctor being held responsible for unsuitable prescribing on benzos
#The Choice of diazepam as I understand it is the recommended drug of choice for changing to a long acting benzo and tapering slowly.
#Daily pick-up allows for daily contact with pharmacy or DIP teams allowing some degree of monitoring and reporting back. For example if three doses are missed the doctor is usually contacted.

Of course if withdrawal was so bad it required hospital treatment prescriptions would all be internal hospital ones with far more nurse/doctor monitoring.

Reputation Comments on this post:

Marvellous: Thanks for clarifying

[GreatWonder]

SWIG told me to tell all the SWIYs that replied to this post that he has learnt a lot from this thread and is grateful for all the replies. But apparently SWIG still cannot come to terms with the fact that a benzo with such a great success rate at it's job - Alprazolam - is not available in the UK's general medical profession. SWIG is dumbfounded by this.

Yes, sure it's a high risk, high dependancy drug in the hands of abusers - but so are 101 other prescription only drugs. Alprazolam really has turned round SWIG's life (he told me). At least I can tell SWIG he has to continue to obtain this drug on the black market - and keep chucking his National Insurance contributions in to a big black hole.

[Nagognog2]

To further the explanation of the learned Jatelka - a doctor would be required to treat the patient. Even here in the Untied Snakes of Amerika.

Benzodiazepine addiction, untreated during withdrawl, can be more than uncomfortable - it can kill. Swapping diazepam (Valium) for another benzodiazepine would be an acceptable treatment course regardless of which one the silly mongoose got stuck on. It's a slow taper to get off them safely. A doctor that didn't know that - that's when you yell "Supervisor." Get another doctor involved who has read a medical journal in the last 30 years.

The mongoose might get a lecture - but that beats a pine box. So slap the mongoose and make sure it doesn't pull such a stunt again. A mongoose is better off wrestling a King Cobra than popping benzo's for shits & giggles.