Trouble Filling Suboxone And Clonazepam Together

RocksandHardPlaces asked

First, I have severe anxiety. It is not Generalized Anxiety Disorder (GAD), it is life-destroying anxiety. I live in Ohio and I was fired by my psychiatrist for missing two appointments in a row. Due to that, I no longer can get my necessary clonazepam. I am a Suboxone patient. There is a stigma attached to being on Suboxone, firstly it is automatically assumed one is/was a drug addict to end up taking this drug. While I do have a history of drug abuse from my disabling car accident, I have not abused anything since May 2009. It is June 2020 now. I am prescribed my Suboxone for a back injury disability. Having pain does not mean my anxiety, which is crippling to the point of agoraphobia, has gone away.

Since my psychiatrist fired me, I have seen entirely too many doctors in attempting to get my prescription back. No one will help me no matter how much truth and medical records/tests I give them. My current (2+years) Suboxone doctor cannot write a benzodiazepine, but he even agrees I do need to be on it. He has even written a letter to any doctor I was it saying he absolutely advocates then prescribing it to me. Since being dismissed from my psychiatrist, and not getting my medication on a regular basis, my life has completely fallen apart. 

I finally got a job after 13 years of not working, it was an excellent job and it was working out, but because I did not have my anxiety medicine, I started having severe panic attacks, I could no longer go to work. My life has gone from stable and well-adjusted to completely unraveled. I do not know where to turn, I do not know what to say to the next physician I see, I see no hope in sight whatsoever. I have had three doctors in two years open our very first meeting with the words “I am not prescribing you a benzo“. So I know my physician files and pharmacy profile are absolutely wrecked, I do not know what to do or how to sort this out.

There are legitimate people who are able to obtain two different controlled substance meds. I am in legitimate need and I am slipping through the cracks in this ‘opioid epidemic’. This is my life, I do not want to watch any more years pass by while I am too terrified to live it. I don’t know what to do.

Answer

Hello and thank you for your question. I certainly don’t know all of the specifics since I am uninvolved in your care. Due to that, I don’t know that I will be able to give you any precise answers, but I have had patients in similar situations in the past, so I hope my advice helps a bit.

First, I can certainly understand how this situation would be difficult for you. I know that anxiety can be debilitating. Usually, I am hesitant to fill clonazepam (or under the brand name Klonopin) or similar medications when I see that a patient is already taking Suboxone (or any similar medication). I imagine that your local pharmacist and physicians also share a similar concern. Using both medications can lead to unintentional overdose and death. It’s dangerous enough that in recent years, the FDA has warned all heath care professionals to avoid using these drugs together if possible. As a pharmacist, we are responsible (along with your physician) for all of the medications that we dispense. If you were unintentionally overdose, both the pharmacist and physician could potentially be held legally responsible or lose their licenses to practice.

That being said, that doesn’t mean that clonazepam should never be used in patients that are currently taking Suboxone, just that it should be used cautiously.

First, I would reach out to your physician that prescribes Suboxone and ask if they can refer you to a colleague about your anxiety. They might know someone specifically in your area that is willing to reevaluate your situation. It would certainly help if your Suboxone prescribing physician spoke with this new psychiatrist ahead of time about the possibility of prescribing clonazepam or another, similar medication.

Likewise, having your Suboxone prescribing physician reach out to your local pharmacy ahead of time will only help to make things go smoother. I typically don’t fill new prescriptions for benzodiazepines (the class of medications that clonazepam belongs to) without speaking with both the Suboxone prescribing physician and psychiatrists. Having everyone that provides you with medical care on the same page will only help. If you have a legitimate need, I imagine that all parties will be fine with you resuming your previous therapy as long as they think that it’s safe and everyone is informed.

Lastly, it might be a good idea to reevaluate how your anxiety is being managed. Again, I don’t know your medical history or any other medications that you are presently taking. Clonazepam works great to treat a panic attack, but it’s not very effective at preventing them. If you are not already taking something to help to prevent panic attacks, it is probably a good conversation to have with your physician.

Most psychiatrists don’t want to immediately prescribe clonazepam to a new patient. It’s reasonable to assume that they might want to try another medication or two before they start clonazepam or another similar medication.

I hope this advice helps and please write back with any follow-up questions!