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Good question. There is another discussion string regarding benzo/opioid detox. I'll post on both. At first, I thought that all opioid had additive sedative effect with benzos. I've come to wonder if it might be worse with buprenorphine. Here is an anectodal example: I saw a young woman recently who told me when she was opiate naive, she took a single 8 mg suboxone with 5mg of valium to get high. She had no recall of the next 18 hours. This just seems more than one would have with 5 mg of valium. In regard to detox from benzos. I first tell people that I expect both in the same way I suggest to patients that if they continue to use cocaine, marijuana, or alcohol they are likely to relapse. If they continue on benzos they are likely to relapse. I don't believe you can get the brain high on one substance and recover from another. Further, if you are taking a drug for a panic disorder, and the withdrawal symptom from the drug is a panic symptom, how do you know the difference. I have had the best success putting patient on an anticonvulsant first (like 750mg of depakote a day) then doing a rapid taper with a longer acting bzd or phenobarb. I keep them on the depakote at at least 500mg a day for a month after they come off the benzos. If I'm going to detox them as outpatients I do the benzos first then the opioids. If I'm doing it as an inpatient I do both at the same time. Granted it's pretty imperfect, especially since the urine drug screen is not interpretable for weeks following long acting benzo ingestion.
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