Expert: Jacqui - 5/26/2009

Question
Hi, I will keep this short, and thank you for your help.
I am on day 5 of "cold turkey" off 30-50mg hydrocodone/day for a few years. I am beginning to feel human again :-)
My doctor prescribes 2mg Ativan for me but refuses to up the dosage. I am about to lose my health insurance, and live in a small town where any drug is a dirty word. My friend gave me some extra Ativan and Xanax, that I have been taking for about 2 months, this equals 4mg/day if Ativan (I keep a log daily). I have read that, if you do not do a very slow taper from a benzodiazapine it can be hell on earth for months after. All I want to do is get back to my 2mg Ativan a day from the 4mg. Problem is, I only have a few Xanax to do it with. I am sorry this is so confusing, I guess I am asking, is it dangerous, or will it be horrible, if I just go from 4mg/day (of which I have been taking 2mg before bed and the other 2 during the day) down to just the 2mg at bedtime? I am confused since I get not help from my doctor. Thank you, I just do not want to do anything dangerous since I know benzodiazapine withdrawal can really hurt you.

Answer
Hi Susan,

I am glad that you are doing okay coming off hydrocodone.  People often use benzodiazepines to withdraw off opiates, but unfortunately they can also have dependency issues, and sometimes the withdrawals are more serious.  

This is a timely topic for me as I attended a mini conference on benzodiazepines this morning (in particular Xanax) and the subject of withdrawal was raised.  It is generally recommended that people reduce very slowly off benzos, and ideally, would switch from a short acting one (xanax - alprazolam) to a long acting one (Valium - diazepam).  Obviously my first suggestion for you would be to do that, however I am not sure how feasible it would be.  I know the American health system is very "sick" but is there any kind of free clinic that could assist you with this?  

I am guessing that the answer to my last question is going to be no.  With that in mind, you need to be aware that withdrawal from benzos can be very serious.  Although there are not lots and lots of cases of people dying from benzo withdrawal (there are some cases, but it isn't common), some people do have serious withdrawals (seizures) as well as anxiety.  So, I would suggest the slower the better.  I know they are difficult to break into little pieces, but the best option would be to figure out how many pills you have access to, and come up with a plan where you are reducing by a small amount slowly.  

I have often come up with reduction plans for people coming off methadone or other opiates, but I am not as confident giving this kind of information about benzos because of the potential for problems to occur.  At the very least, it is important that you have someone with you while you are doing this, just in case things don't go so well and you need medical assistance urgently.  

Please let me know if there is any other information that would be helpful.  The main thing to remember is to ensure you are 'being kind to yourself' and making sure you get enough good food, try not to put yourself in stressful situations, and do some relaxation exercises.  Sleep may be difficult, but there are non-drug options to improve sleep (try doing an internet search on "sleep hygeine").

Best of luck!

Jacqui