Aswad
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Joined: 4/4/2007
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quote:
ORIGINAL: kalikshama
Al-Aswad is correct - Restoril is meant for short term insomnia management and as benzos are highly addictive, no responsible doctor should prescribe them for long term use without first considering sleep hygiene.
Actually, I wasn't thinking about addiction. It just isn't the best treatment, that's all.
Concerns about addiction are a real obstacle to good treatment in some cases, as I've painful and costly experiences with. I'm sympathetic to the issues, having almost lost two close friends, and having been solicited by a relative out to finance her next hit and too far out to recognize me until she was right in front of me. But I am skeptical of the idea of treatment being withheld on statistical grounds. On individual grounds, sure. As a consequence of others' abuses, no.
For that matter, in my experience, some doctors have a poor understanding of the mechanics of addiction, or the difference between addiction, dependence and the various other related concepts. Many fail to give the patient an understanding of same. Just something as simple as reminding the recipient of an ad lib dosed scrip that it is important to keep track of the use, and to review it periodically, can make a substantial difference. I've run into many patients who haven't realized that threshold shift is a major factor, even well after they've crossed the line into the land of downward spiralling interactions between tolerance buildup and threshold shifting. Explaining that it's important not to derive a comfortable state from drugs when one is ill would have gone a long way with those.
I was aware of that, so when I started having panic attacks, I set the first rule for myself right away: I would not reach for the pillbox if it mattered to me whether that was the last one I'd ever get. If I could weigh the future against the present, it wasn't bad enough. The second rule was to not reach for it if I could function under duress. If I could be there for my loved ones, it wasn't bad enough. My tolerance was to go up, not down, and the pills were there to limit the collateral damage of building that tolerance, much as good physical therapy will put just as much strain on your body as will rehabilitate it, no more and no less. The rest were the same rules as for the insomnia, which is from the Parnate. As a result, I had a brief increase when the attacks started, and my use has declined steadily since then; it never reached the per-patient average. Despite flunitrazepam being one of the most strictly regulated drugs in Norway (every scrip is audited, there are random controls of the docs, and docs exceeding the national average get an inquiry), even the substitute doc doesn't have a problem refilling the scrip, and I'm the one asking them to make it the smallest package, because I want my journal to document my use for the doctor's benefit in case there should be any hassle with the supervisory authority.
I tend to think that's a good use of an admittedly double edged sword.
And it's sad to think how the tolerance and rebound issues could have spiralled out of control in a situation where neither the doctor, nor the patient, is sufficiently aware of the need to retain patient tolerance (while also realizing there's a point where one must treat to confine the scope of a problem or provide worthwhile quality of life). Doesn't need to be any addiction in there for it to go horribly wrong. And with most of the docs I've been to, it would have, if I didn't know these things already. I've seen plenty back pain cases end up that way, and when one explains it, they're usually quite able to understand, and eager to regain the sense of stability that comes with striking a balance that has long term sustainability. They just didn't grasp things until they were pointed out. Being ill isn't comfortable, and no non-curative drug makes it comfortable to be ill in the long term, just less uncomfortable, that's fairly simple and common sense (it's also a gross simplification, but it's as accurate as it needs to be).
My long-winded point being that a responsible doc shouldn't treat addiction any differently from other concerns they deal with on a day to day basis (e.g. don't give renally excreted drugs to renally impaired patients without explaining what to look out for as an early warning it isn't going well), and that taking a quick peek beyond the surface symptom presentation (they're getting better at this, I'm noticing) will often provide other treatment options that have more long-term viability (e.g. sleep hygiene for the OP, which will usually fix the problem).
quote:
I have travel anxiety and take a Xanax the night before I fly. My doctor prescribes them to me 5 at a time. Neither of us are opposed to benzos, we are just very conservative as to their use.
I'm praɡmatic about it. I think patients need to be patient and have (or get) perspective, and that doctors need to be disciplined about considering the options without prejudice and an eye to being healers instead of bioproblemsolvers (i.e. don't hold back on killing a significant insomnia, but make sure sleep hygiene is in order, and don't treat normal occasional sleepless nights unless it's a one time thing to patch someone up the night before a once in a lifetime event), as well as having the integrity to only practice in a way that is in line with the ideals and demands of the job, even if that means losing business.
It's clear most doctors do the right thing, but there are hotspots (e.g. one hospital has like twice the WHO reference rate of C-sections) and bad apples (e.g. docs that prescribe valium when they should be saying "you're not cut out for that job, and I'm not going to be part of letting drugs pad the difference"). It's also clear there are a lot of patients, perhaps even most (I'm not a doc, so I couldn't say, but my medical professional acquaintances lend credence to "a lot" being more accurate than "most"), that are willing to comply with treatment, and who understand the role of a doctor as a caretaker of anomalies pertaining to their health, not a go-to person for comfortable living and increased performance.
Note that I'm not, in principle, opposed to using drugs for performance enhancement and comfortable living. I actually support transhumanism. But as to the current role of a doctor, the established ideals of what it is to be a doctor, and the tradition they come from, and the available capacity, and the epidemological concerns, all point to the simple conclusion that it is a character flaw which lies at the root of a doctor stepping outside that role in most cases. And those that do, rarely seem to be equipped to practice from a perspective of transhumanism, or be biofunction engineers, nor do they seem to bill themselves as such. There are exceptions, and those I can of course support, except if they have taken oaths to the contrary (the medical profession being, after all, widely infected with the memetic virus known as the Hippocratic Oath, which essentially means that medical knowledge obtained without being infected by it has come from an oathbreaker at some point, and usually not one that has taken up arms against the infection, so hardly a point of pride).
And, in case it's not clear, since there's a bit of criticism baked in this post, I have great respect and appreciation for the medical profession and its practicioners.
My apologies for the somewhat off-topic verbosity.
Health,
al-Aswad.
P.S.: This post should not be interpreted as implying anything about specific individuals in the medical profession, beyond anything stated explicitly.
_____________________________
"If God saw what any of us did that night, he didn't seem to mind.
From then on I knew: God doesn't make the world this way.
We do." -- Rorschack, Watchmen.
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RE: Restoril reviews/hints/tips - 
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