Question: My daughter who was put on Xanax for depression and anxiety became pregnant about 3 months after starting this medicine. .Could she have been weaned off the Xanax? Another doctor put her on Subutex to get her off the Xanax.They want her to detox after the birth of the baby. What can we expect for her and the baby going through withdrawels from this?

Dr. David Sack Says...:

Thank you for your question. Obviously you are very concerned about your daughter and for good reason - it is always a serious matter when a pregnant woman is taking prescription drugs. She is lucky to have a parent looking out for her.

The
prescription of medications during pregnancy is best managed by an obstetrician
with experience in managing patients with substance abuse.  It sounds like
your daughter is seeing someone familiar with these issues and without more
information it is hard to evaluate the specifics of her care.  In general,
if someone is addicted to opiates it is better to continue subutex until the
end of the pregnancy as this is much safer for the baby.

Question: I take 2m Xanax everyday to help me with panic attacks (have them often) and have been on them for at least 4 years. Now, however, I am about to start taking Suboxone to help with my withdrawl symptoms from getting off of pain killers. My body is so dependent on the Xanax because I cannot sleep with out them. Is it safe to take the Suboxone and Xanax in one day? Your advice is greatly appreciated.

Dr. David Sack Says...:

Your doctor must be made aware of the fact that you are taking Xanax on a daily basis.   Taking multiple drugs that suppress the central nervous system increases the risk of overdose. 

Xanax is not a good long-term solution for anxiety and panic attacks and can actually increase the number of panic attacks over time.  As you become more dependent on the Xanax, panic attacks may become more frequent (every time the dosage goes down).  Eventually you simply can’t take enough Xanax to be able to function safely and live a productive life. Serotonin reuptake inhibitors and mixed Serotonin-Norepinephrine Reuptake Inhibitors may be very effective in treating your anxiety symptoms along with cognitive behavioral therapy.  If your attacks are due to an underlying mood disorder, proper assessment and diagnosis could help you find a better medication that is not addictive or mood altering.

Question: My son is a morphine addict. He has contracted hepC from this. I have been paying for the methadone clinic for him now for about 16 months. He was recently laid off his job and will be homeless in a couple of weeks. I cannot afford to pay for the clinic much longer. Is there a chance of finding a rehab for him to get him off the methadone? Is this an advisable move? He has no insurance & I certainly can't pay for an expensive clinic. Help!

Dr. David Sack Says...:

The particulars of which emergency health services and mental health services are available vary by county and state.  You should consult with the local health care agencies to see if you son would qualify for indigent services. If it looks like that will not be an option, you could try to negotiate a temporary reduction in rate at his current clinic.  It this is not feasible you can speak with them about a taper schedule so that he does not come off cold turkey.  Relapse rates following discontinuation can be high, particularly if the individual has not been involved in recovery-based programs or other therapy.   

Question: I am opiate addicted but ready to quit the lifestyle. I am an American but I work in Canada for periods of up to 2 to 3 months at a time in the logging industry. In the past, I have had no problem scoring dope while up north, but this time I actually want to stay clean. I am thinking about Suboxone but I have to go up north again in about 6 weeks. Will a doctor be able to prescribe me enough Suboxone to last me for my work abroad periods? Will I have a problem getting it across the border? It would be ironic if I managed to avoid arrest after years of scoring dope only to get arrested for trying to get clean…

Dr. David Sack Says...:

You should be able to bring legitimately prescribed drugs into Canada. Be sure to keep them in their original packaging and bring a copy of your original prescription from your doctor.  Suboxone is prescribed in Canada as well, so you might consider finding a doctor there just in case you are delayed in your travels or somehow lose them.

Question: I take Xanax for anxiety problems and I am also addicted to Vicodins. Can I use Suboxone to get off the opiates and still continue to take the Xanax?

Dr. David Sack Says...:

At Promises, one out of four of our clients addicted to opiates (heroin, Vicodin, Percodan,oxycodone) had an anxiety disorder before they became addicted.  In many of these clients, the opiates were used in part to control their anxiety.  On the other hand most of the other clients who did NOT have anxiety problem before getting hooked on opiates also abuse anti-anxiety medicines (Xanax, Klonopin, Valium, Serax, Librium) and sleep medicines.  There are three reasons for this.  First, anxiety is a nearly universal symptom of opiate withdrawal and many addicts use anti-anxiety to blunt their withdrawal symptoms.  Second, opiates disrupt sleep and decrease the restorative quality of sleep and because anti-anxiety medications are sedating they are used to control insomnia and restless sleep. Finally, sedatives and alcohol are used with opiates to amplify the ‘high’ or to soften the crash.  Regardless of the reason, over half of all the opiate abusers we treat also need to be detoxed from anti-anxiety medications.
 
Xanax is rarely the best long term treatment for anxiety disorders, and this is especially true for those who have opiate dependency.  There are number of other medications that can be very helpful such as Selective Serotonin Reuptake Inhibitors and Serotonin-Norepinephrine Reuptake Inhibitors, atypical antipsychotic medications such as quetiapine (Seroquel), and mood stabilizers.  All of these are non-addicting and may be helpful once someone has been detoxed.

 

Question: I was prescribed Oxycontin 11 months ago after hurting my back badly working construction. I will not deny that I liked these medicines and took them more than I should have and for a while everything was OK. Now, my doctor won’t give me as much as I need anymore and it is a big problem for me because if I don’t get what I need my pain is out of control. I taught my kids to stay away from drugs my whole life and it is humiliating for me to be walking around street corners buying drugs like a criminal but I do not know what else to do. I feel like my doctor gave me these drugs in the first place and got me in this situation and now he won’t do anything to help. Now he only gives me tiny prescriptions that are not even close to what I need. I know that I am addicted but I cannot tell him because if I do he won’t prescribe to me anymore and then I will be in even bigger trouble. I am spending everything I have just to get enough to make it through the day. How can I stop using the only thing that gives me any pain relief and without the pills I can’t make it out of bed in the morning? Can I get some sort of rehab treatment so that the dose I need goes down but where I can still take the pills I need for pain?

Dr. David Sack Says...:

The problem you are having is not uncommon when trying to manage pain with narcotic analgesics (pain killers). A significant proportion of people will develop tolerance to the pain medications over time and will require higher doses to achieve the same result. In some, tolerance is so great that increasing the dose provides little benefit. Another thing that can make matters even worse is that in some people pain severity actually gets worse as a result of chronic use of medicines like OxyContin. This is called opiate-induced hyperalgesia and is a real problem.

You may need to see a physician who specializes in pain management and can evaluate what approaches may be most helpful. In some cases switching pain medications will do the trick. In others gradual tapering is needed. Some people will benefit from antidepressant medications like Cymbalta that provide relief from chronic pain, or antiepileptic drugs that also suppress pain such as Neurontin. Nerve blocks and epidurals can also be helpful.

You are physically dependent on OxyContin but you may not be addicted. Addiction implies that you are using the medication to elevate your mood, decrease anxiety, or to experience pleasure. A physician specializing in pain management or addiction medicine can help sort this out. Drug rehab can be very helpful especially since you are getting very little benefit from the pain medications now.

Question: How bad is a Suboxone Detox? I went through a few weeks of Hell long ago jumping off methadone and, like an idiot; here I am in the same position again. I’m sick to death of this life once again. I won’t do methadone again and I can’t afford to stay on Suboxone for too long. How long should I budget for and what kind of detox can I expect when I jump off at the end?

Dr. David Sack Says...:

Most people are able to detox off Suboxone with minimal
difficulty. The amount of time varies from individual to individual and can be
as short as several days and as long as several weeks. Sometimes additional
medications can be helpful when people are detoxing from suboxone; these
medications may decrease anxiety or assist with insomnia that can accompany the
detox process. 

It’s also important for treatment providers to recognize
that sometimes people are taking other medicines in addition to Suboxone that
may require their own detox. It has been my experience that a lot of the difficulties
are not caused by the Suboxone detox, but by the detox from those other drugs,
such as the benzodiazepines, which include Xanax, Klonopin, and Ativan, among
others.

It is critical to work with a professional when detoxing
from Suboxone. You will want to work with someone whose philosophy is that
Suboxone should be used as a short-term therapy, not as a long-term maintenance
drug. At Promises, we have created a specialized program for people who have
been on Suboxone for extended periods of time because we recognized this as a
growing problem. The goal is to make the client as comfortable as possible so
they can fully withdraw from Suboxone and be completely drug-free. We have
found it to be helpful to include alternative therapies such as neurofeedback,
acupuncture, and massage during detox to ease symptoms.