Discussion Psychiatrists and Controlled Substances

[the witch’s lament]

I have been receiving psychiatric help for four years now. at the beginning of my treatment I saw a psychiatrist who was not very invested in his patients and would just write prescriptions left and right. after seeing him for 4 months, I was on a daily regimen of 60mg cymbalta, 3mg clonazepam, and 15mg temazepam and 10mg ambien for sleep. I was managing my anxiety much better back then, but I attempted a CTB using a then non-scheduled research benzodiazepine. I failed and once my doctor caught wind of this I was taken off of everything. I was unmedicated for almost two years until starting again last year.

my new psych is very nice and I have a great therapist as well. it seems like my new psychiatrist is not aware of my previous history, but acts like he doesn't generally prescribe controlled substances. I am now on 30mg cymbalta, 40mg adderall xr (20mg*2) 45mg buspar (15mg*3) and 25mg vistaril for sleep. I have been trying to get another benzo for my anxiety since we started talking but he won't budge on it, saying it would counteract my adderall (which makes sense). I just had a facetime appointment with him and told him about my recent increase of insomnia and brought up having taken ambien in the past. he said they generally don't prescribe more than one controlled substance at a time. I said that I had been in the past and he became very curious about who prescribed them and when. I'm worried he's going to look back and see my history and I will have lost my trustworthiness to a second doctor.

he said in plain terms that we are at a standstill regarding medication for sleep as he refuses to prescribe multiple controlled substances, inferring that he is this way with all his patients. he has been receptive of my symptoms and we have tried a few meds for my depression. do you think he is just trying to dance around mentioning my history? would a doctor come out and say "well you had an overdose in the past on similar meds so I won't prescribe them"? anybody have any experience with this?

 

[Life_and_Death]

you should have an in between option. i was on medication but im too sensitive to this kind of medication (antiphychotic) so im going to see about doing a DNA test to find a medication suited for me until then im on nothing.

 

[ferfer]

Hi, I take amitriptyline for sleep and as my anti depressant. It's definitely not for everyone, kinda bummer side effects but nothing major major, but it's given me reliable sleep for a year now and I wouldn't trade that for the world

 

[GoneGoneGone]

Which country are you from? If you could disclose?

First, what is a non-scheduled research benzo?

The first prescription is shady in the sense that psychs will not prescribe two similar substances (clonazepam + temazepam).

If you have anxiety I can understand the clonazepam, but then I cannot understand the adderall in the second prescription. Which one would be the second controlled substance? Aren't both cymbalta and adderall controlled?

I don't know your diagnosis but from what you've been prescribed it seems depression and anxiety. For this, most psychs will give you two substances for which you need prescription: an SSRI/SNRI and potentially a benzo for a while until you get used to the antidepressant.

Source: own experience with psychiatrists and meds

 

[Life_and_Death]

potentially a benzo for a while until you get used to the antidepressant.

what do you mean by this and does this include antipsychotics?

 

[GoneGoneGone]

you should have an in between option. i was on medication but im too sensitive to this kind of medication (antiphychotic) so im going to see about doing a DNA test to find a medication suited for me until then im on nothing.

Are you doing one of those pharmacogenetic tests?

 

[Life_and_Death]

Are you doing one of those pharmacogenetic tests?

hopefully going to be. i have to set up an appointment with my family doctor first

 

[GoneGoneGone]

what do you mean by this and does this include antipsychotics?

Most antidepressants have side effects in the beginning until they reach "therapeutic levels" in your blood, side effects such as anxiety, insomnia. This is why they are prescribed with something like a benzo.
In my own experience, I have not been prescribed an antidepressant with an antipsychotic yet, but I have heard of others who have been.

 

[the witch’s lament]

Which country are you from? If you could disclose?

First, what is a non-scheduled research benzo?

The first prescription is shady in the sense that psychs will not prescribe two similar substances (clonazepam + temazepam).

If you have anxiety I can understand the clonazepam, but then I cannot understand the adderall in the second prescription. Which one would be the second controlled substance? Aren't both cymbalta and adderall controlled?

I don't know your diagnosis but from what you've been prescribed it seems depression and anxiety. For this, most psychs will give you two substances for which you need prescription: an SSRI/SNRI and potentially a benzo for a while until you get used to the antidepressant.

Source: own experience with psychiatrists and meds

yes thank you for your response and consideration on this. allow me to clarify some of the things I mentioned.

I live in the U.S. the controlled substances I reference abide by the Controlled Substance Act.

in 2017, there were a number of benzodiazepines that were being synthesized among clandestine online vendors. examples include: clonazolam, etizolam, and flubromazolam. the last one mentioned is a very potent hypnotic benzodiazepine, that had a handful of cases of overdose resulting in death around that time. I attempted CTB using that chemical at that time. since then, many of these "research" chemicals have been scheduled and made illegal (especially in my state).

I agree with your sentiment that this is unusual. as I mentioned, it seemed my first psych would throw meds at me and his other patients with little consequence. my clonazepam treated my anxiety and over a 4 month period was increased from 1mg(.5mg*2) daily to 3mg(1mg*3) daily.
my insomnia was (and still is) a considerable issue for my mental health. so at some point, he determined a small dose of temazepam alongside my clonazepam regimen was found acceptable. I cannot speak to that one way or the other.

following my re-enrollment in college, I had a psych-eval to reassess my diagnoses and find meds that worked. a diagnoses that resulted from this assessment was ADHD. I have been on adderall since this evaluation, and has caused a huge improvement in my focus in all daily activities. adderall (amphetamine salts) is controlled for the purpose of the likelihood of abuse. cymbalta (duloxetine) is scheduled differently and only requires a prescription without much control outside that. after my CTB attempt my treatment shifted away from benzos as treatment for my anxiety, resulting in my large daily doses of buspar (buspirone). hope that clarifies and thanks again for your response.

 

[valentine]

That's interesting that your psychiatrist doesn't want to prescribe a benzo with the adderall. I'm on 20mg a day with a valium prescription and I've never had any issues or have a doctor say anything about it.

 

[GoneGoneGone]

my clonazepam treated my anxiety and over a 4 month period was increased from 1mg(.5mg*2) daily to 3mg(1mg*3) daily.

In Europe they are more lenient with benzos but they wouldn't give high doses like this to someone in their 20s. Max 1 mg clonazepam as it's one of the strongest benzos. I can understand the temazepam reasoning but it's kind of a big no-no to give two benzos.

I always read on wiki about schedule II, III, IV etc meds but in most of Europe we don't really make the distinction, afaik, between controlled, scheduled, and prescribed, because either way they have to come from a psychiatrist in theory.

I also took buspar 3 times a day, but I need to check, I think I was taking 3x5mg... It was great for anxiety but if I didn't take it at the same time every day I would have massive panic attacks.

I don't think your psych knows about your attempt, he would have told you. He is trying to keep you off addictive medication, such as ambien.

 

[the witch’s lament]

That's interesting that your psychiatrist doesn't want to prescribe a benzo with the adderall. I'm on 20mg a day with a valium prescription and I've never had any issues or have a doctor say anything about it.

yes I was unaware of such restrictions until being under his care. I am unsure whether this is a genuine concern of his having treated others in the past, or if he is knowledgeable of my history with benzos and does not want that to 'make or break' my being his patient.

In Europe they are more lenient with benzos but they wouldn't give high doses like this to someone in their 20s. Max 1 mg clonazepam as it's one of the strongest benzos. I can understand the temazepam reasoning but it's kind of a big no-no to give two benzos.

I always read on wiki about schedule II, III, IV etc meds but in most of Europe we don't really make the distinction, afaik, between controlled, scheduled, and prescribed, because either way they have to come from a psychiatrist in theory.

I also took buspar 3 times a day, but I need to check, I think I was taking 3x5mg... It was great for anxiety but if I didn't take it at the same time every day I would have massive panic attacks.

I don't think your psych knows about your attempt, he would have told you. He is trying to keep you off addictive medication, such as ambien.

3mg of clonazepam is a lot. I was definitely benefitting from it, and if I hadn't attempted CTB I would likely still be with that same psychiatrist on a similar mix of meds. I hope you are right about him being unaware of my attempt/history. I have gotten strange looks from GPs and dentists after this incident and I believe they were aware.

 

[Sinkinshyp]

last year I was taking xanax and temazepam. The FDA made some rule changes. My primary care said I cannot have both the xanax and temazepam. I've been on xanax for 13 yrs so I choose that. For my psych my primary care doc has had to deal with it due to no psych will take my insurance. For depression, anxiety, grief disorder and ptsd I take seroquel, xanax, rozerem, trazadone and duloxetine. My August phone call with pri care he said he doesn't know what to do for me anymore and wishes I could find a psych to take me. With the hippa law I am not sure if your psych can see your past CTB attempt. Honestly if they do find it they wont come right out and say I wont prescribe x because you y. He may ask have you tried to hurt yourself in the past and how. If they ask be honest with them.

 

[GoneGoneGone]

I have gotten strange looks from GPs and dentists after this incident and I believe they were aware.

Do you live in a small town where they might find your info? Was your attempt known to many other people? There is no reason why dentists would have access to that sort of information. This is just a bias that we have, it's called the 'spotlight effect,' we think people think about us more than they actually do. I wouldn't worry too much about it.

 

[DyingAlf]

I'd be very surprised if your psych doesn't know about your o/d attempt. Apparently a warning flags up on the system when a GP enters any medications for me so they can check if it's "safe", consider an alternative or prescribe with restrictions, so I imagine it would do the same if a psych was looking at putting me on medication again too.

edit: I'm in the UK & I know you are not but I feel like there could be a similar system.

 

[GoneGoneGone]

I'd be very surprised if your psych doesn't know about your o/d attempt. Apparently a warning flags up on the system when a GP enters any medications for me so they can check if it's "safe", consider an alternative or prescribe with restrictions, so I imagine it would do the same if a psych was looking at putting me on medication again too.

edit: I'm in the UK & I know you are not but I feel like there could be a similar system.

What about dentists though? That makes no sense. What, he would ctb on the anesthesia? I don't even think his current psych knows, he would not have prescribed cymbalta again if that were the case.

 

[Meditation guide]

last year I was taking xanax and temazepam. The FDA made some rule changes. My primary care said I cannot have both the xanax and temazepam. I've been on xanax for 13 yrs so I choose that. For my psych my primary care doc has had to deal with it due to no psych will take my insurance. For depression, anxiety, grief disorder and ptsd I take seroquel, xanax, rozerem, trazadone and duloxetine. My August phone call with pri care he said he doesn't know what to do for me anymore and wishes I could find a psych to take me. With the hippa law I am not sure if your psych can see your past CTB attempt. Honestly if they do find it they wont come right out and say I wont prescribe x because you y. He may ask have you tried to hurt yourself in the past and how. If they ask be honest with them.

They can look up what prescriptions you have had and when you got them in a huge data base.

 

[Sinkinshyp]

They can look up what prescriptions you have had and when you got them in a huge data base.

yeah I see pain management for oxy and they have access to my pharmacy in the database. I knew they could see your meds because of the opioid issues. Just not sure what else they can dig up since the HIPPA laws. I took 50 pills a yr and a half ago. It did NOT show up to my pain management nor my primary care doctor. I spent I think it was almost 1 1/2 - 2 days in the emergency room recovering than 30 hours in the psychiatric hospital. I know pain management has already pulled my pharmacy records before I'm in for my visit. But- I don't know if psychiatric and pull other psychiatric history/hospitalizations. @the witch's lament like I said. If your doc you are with now suddenly asks questions about any attempts or hospitalizations for an attempt it would mean they've found it. At that point I would be fully honest and tell them yes you had a total breakdown and did this and that but you would never do that again. That you were at the lowest point you had ever been due to xyz reason.

 

[Spitfire]

I'd be very surprised if your psych doesn't know about your o/d attempt. Apparently a warning flags up on the system when a GP enters any medications for me so they can check if it's "safe"

They can look up what prescriptions you have had and when you got them in a huge data base.

The doctor should know. I do not see why not? In the US this information is a click away about your prescription history. Nearly every doctor or prescriber I ever met had access to this information about their patients, and used it.

Any psych history could be a completely different story. It should not be readily available in the same way. This is a psych doctor though.