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October 30, 2013 4:47 AM   Subscribe

How do I ask my new doctor for tranquilizers without seeming like a crazy drug addict?

Tomorrow I go for my first appointment with my new GP. If the world were simple and fair, and if I could ever stop overthinking and worrying, here's how it would go: I would ask for a prescription for my blood pressure med, and a benzodiazepine for occasional panic. But that second one is a problem.

I used to work for pain and sickle cell clinics, and I got an earful about patients with 'drug-seeking behavior.' The term has burned itself into my consciousness, because doctors treat you differently if they think you're just going to them for recreation. I am seeking a particular class of drug, but I don't know how to ask for it without sounding like an addict, since even knowing the names and classes of the drugs (let alone their half-lives and how that affects which ones might work best) seems to cause docs to become suspicious of you.

I do have a bottle from my last prescription of Ativan, so I can prove that it was actually prescribed to me by my former doc, but I see myself stumbling through the request for it and somehow being talked into going on a pill I don't want or need.

From about 1992 to 2002, I suffered debilitating panic disorder. I went through over a dozen meds in widely varying dosages and combinations, before slowly getting better. I was unable to keep down a job, couldn't maintain relationships or friendships, and was basically house-bound for much of that time.

I really don't want to go back there. These days I have a very fulfilling career, a family, and some carefully constrained, safe socializing. It's not ideal, but I have managed to accommodate my residual anxieties without letting them totally ruin my life.

I'm only interested in meds that I can take as needed for anxiety. I do not want an antidepressant, since I've never found one that effectively treats anxiety without (a) life-altering side effects and (b) suddenly ceasing to work. I have been on a variety of mood stabilizers and antipsychotics as well; the whole gamut served to make me sleepy, dull, and fat, but without really dealing with the anxiety other than throwing a heavy blanket over it.

Either because of the anxiety, or possibly as a cause of some of it, I am extraordinarily bad at communicating with people. I consistently misjudge their intentions, thoughts and emotions. I mean, I'm not the world's worst person-reader, but seriously, it's like trying to pick up a second language. Worse, I tend to check out during conversations, especially when people are saying something I already know, and so I end up being a really distracted-seeming conversationalist.

So the questions--because I guess I'm really asking a couple--are:

* If I know the name of the benzodiazepine I want, and the dosage that is effective, would there be any reason for the doctor to assume I'm just there for Happy Drug Time? Or am I worried over nothing?

* What is the best way to ask for something specific, while politely refusing SSRIs or other drugs, in a way that isn't totally offputting?

* Will my case be worsened by the fact that I can't talk to people the way normal people do? I can't really do a lot of sustained eye-contact, my posture is atrocious with strangers, and I keep finding myself making weird faces or hand-flappy gestures that I don't think other people understand.

These kind of concerns have kept me from finding consistent medical help for a while, so if I can just nail this visit tomorrow, I am hoping this will be a doctor I can keep.
posted by mittens to Health & Fitness (25 answers total) 4 users marked this as a favorite
I think I'm having X problem again, does it make sense to refill this prescription for Y?

::hands over the empty bottle::

A doctor that can't handle this basic level of appropriate discourse needs to be replaced. Cross that bridge when you get to it.
posted by oceanjesse at 4:54 AM on October 30, 2013 [9 favorites]

You can have your records sent from your prior doc that will show you were prescribed something that worked for you and you didn't abuse it. You've since functioned without it for quite a while but may need it again.

I wouldn't necessarily refuse SSRIs or other suggestions from this New doc. Definitely say they have not worked for you in the past, and ask why she thinks they may have different results now, but be open to the idea that your school, your body/brain, meds, etc., may have changed over time and that this doc may have ideas or an approach that you haven't tried yet.

To communicate effectively and not forget details, bring notes with you. It's more common than you think.
posted by headnsouth at 4:59 AM on October 30, 2013 [3 favorites]

I would think, for starters, that the intake form is going to include questions about current medical conditions and any prescriptions you are taking--names and dosages. I would frame this as asking for a refill on a current prescription, even if you've run out since your last refill. That's a perfectly normal and even expected thing to ask for -- refills on maintenance medications. If the doctor happens to suggest weaning you off it or steering you toward an SSRI, then and only then do you need to get into your back history about trying several other medications and combinations and how they did not work for you.

Hugs. You can nail this.
posted by drlith at 5:08 AM on October 30, 2013 [2 favorites]

School=dx, sorry saw it too late to edit but makes no sense as-is.
posted by headnsouth at 5:13 AM on October 30, 2013

I think a lot of it depends on your history with the doctor. The longer you have been with the doctor, the more likely they are to trust that you aren't drug seeking. Especially if they already know your history of panic disorder.

* If I know the name of the benzodiazepine I want, and the dosage that is effective, would there be any reason for the doctor to assume I'm just there for Happy Drug Time? Or am I worried over nothing?

I think this depends on what you are asking for. Are you asking for 60 Xanex bars a month? Or 10 Valium?
posted by gjc at 5:13 AM on October 30, 2013

From about 1992 to 2002, I suffered debilitating panic disorder. I went through over a dozen meds in widely varying dosages and combinations, before slowly getting better. I was unable to keep down a job, couldn't maintain relationships or friendships, and was basically house-bound for much of that time.

I really don't want to go back there. These days I have a very fulfilling career, a family, and some carefully constrained, safe socializing. It's not ideal, but I have managed to accommodate my residual anxieties without letting them totally ruin my life.

Tell him this.
posted by CrazyLemonade at 5:27 AM on October 30, 2013 [3 favorites]

I'm not saying to necessarily not do this, but brand new GP + asking for a prescription for a psychiatric issue that also happens to be widely abused is kind of the bad combination, not just the latter bit. Some GPs will prescribe those sorts of things easily; some really aren't terribly comfortable handling psychiatric issues to start with. I would seriously consider going straight to a psychiatrist for that one, or else waiting a couple visits with the new GP.

Also, it probably makes a difference whether your last prescription was last year, or back in 2002. Even if it weren't something widely abused, a lot of GPs might similarly have an issue with, say, you showing up asking for asthma medication but having not had anything for a decade and yet only being willing to consider one particular medication--but not have the same issue if what you wanted was more of what you'd been on until you lost your job last year or something.

This is exactly why I see a psychiatrist for this, because they're way less nervous about this class of drugs, usually, and way more understanding of the fact that you're not going to necessarily seem like a normal functional adult because if you were a normal functional adult you wouldn't need it.
posted by Sequence at 5:31 AM on October 30, 2013 [3 favorites]

I've had no issues with my PCP prescribing xanax to me. I just explain I take them as needed for panic. But I don't need 60 bars or anything. I usually ask for 30 0.5. I fill out current medications and medical conditions and always disclose this.

Toward the end of my physicals I just say, "Thanks - could you write me prescriptions for my birth control and xanax?"
Just be straight forward like it's no big deal. Because it isn't.

IF the doctor says no for some reason, just see a psychiatrist and go that route.

I hope you get better. I am also going through horrible panic attacks for the first time in almost 10 years. My SSRI kept my panic at bay for quite a while.
posted by KogeLiz at 5:42 AM on October 30, 2013 [1 favorite]

Lot of good advice, especially the stuff about bringing notes and being open to other alternatives. I've asked for a no refill prescription for klonopin or similar for 5-10 pills at a low dose and never had a problem. (The low dosage, low number of pills and specification of no refills should all signal to the doctor that you are not drug-seeking.) I think that would address your current issue - need for something right now - and you can also talk about it in the larger context of "this has been an ongoing problem for me for X years, basically I manage it well but the medication can be very helpful to have on hand when I do need it. Here is my most recent prescription bottle; I am happy to faciliate getting my medical records released to you so you can see my history with this drug - I do suspect that at some point in future, I may need the option for a refill although I'm not asking for that today, at our first meeting."

And switch doctors if that doesn't fly, because such a small prescription with a rational explanation shouldn't raise a red flag.
posted by data hound at 6:26 AM on October 30, 2013 [1 favorite]

I really don't think you need to worry about this. Doctors are smart and you are coming across as sincere even in writing. Just be honest about your condition and what works for you and he or she will likely give you what you want.
posted by something something at 6:38 AM on October 30, 2013

I agree with other people that describing your symptoms and concerns as listed above, and mentioning your old prescription, should be enough if your doctor is capable and attuned to your needs.

That said, Human Nature 101 (and Medicine 102) suggests that if you want to avoid a knee-jerk response from your doctor, you may also want to begin by phrasing it as a question and try to remain open to other suggestions. So, rather than "I have XYZ symptoms and so I need Ativan" and interpreting any other suggestions as browbeating, you could say something like, "I have XYZ symptoms. I used to have a prescription for Ativan. Things have been getting tough again lately and I was wondering what you would suggest." If the doctor suggests SSRI's, you have an obvious rejoined (and notes are a good suggestion here!) but there's also the possibility that he would have other, good suggestions you haven't yet considered, and you should in theory be open to those as well - even though the odds are you are right, and you shouldn't walk away with anything but Ativan unless he makes a very good case for something else.

Maybe one way of thinking about it is that a doctor who is on the lookout for 'drug seeking' behavior isn't out to categorize you as a delinquint criminal; he's trying to keep you from substituting something you don't need (drugs) for something you do need (the best help and treatment available). So you don't have to convince your doctor that your intentions are pure as the driven just have to convince him that you are committed to getting help for your problems. You have a theory about what will help (Ativan) but as long as your desire for that is secondary to your desire to get better (which it very clearly is), you are good to go.
posted by pretentious illiterate at 6:38 AM on October 30, 2013 [1 favorite]

I don't think you should be nearly as worried about this as you are, as others have said.

I have a Xanax prescription that I use extremely infrequently, but which is very, very helpful when needed. When I need a refill, I ask for 10 pills with 0 or 1 refills, at the lowest dose. That never sets off any alarm bells. Pretty hard to abuse benzodiazepines that way.
posted by Cygnet at 6:53 AM on October 30, 2013

I take Xanax occasionally and got it from my new GP when I started with him a few years ago. I said, I get panic attacks and have taken Xanax before. I would like some Xanax. He asked me what the panic attacks felt like and I briefly told him, very factually what it felt like and what the circumstances were. He wrote me a prescription and that was that.

He now writes for a greater quantity (60 instead of 30, I think more refills too) since it's been years and he sees me regularly and I actually go through prescriptions very, very slowly since I only take it in specific circumstances.

I'd tell the truth plainly and simply and if he gives you a real hassle or tries to sell you on other meds or seems like he's going to be a pain in the ass, seriously, find a different doctor. It isn't worth it. Find someone who is willing to work respectfully with you within the parameters you want.

As far as what to say, I'd recommend not going on and on about it. Simple, clear, straightforward. Expect some questions. Answer them simply and truthfully. See how it goes.
posted by A Terrible Llama at 6:55 AM on October 30, 2013

If anecdotes help at all, this past August I went to a new doctor for the first time, and one of the first things I asked about was whether there was something I could get for flight anxiety on an upcoming flight. This was the first time I'd asked for something like this and I was pretty stumbly and awkward due to weird guilt issues and fear of being labelled a drug seeker - but he had no problem at all prescribing me a small number of a low-dose benzo, right there at our first meeting. And right now I literally JUST got off the phone with him to request a refill (I still have some from the initial prescription but I've got multiple long flights coming up); he again had no trouble providing the prescription.

Now, the irrational part of me is still a little fretful that my medical file is now written on an actual giant red DRUG SEEKER flag, but looking at the situation realistically, the way my doctor responded is how I would expect a doctor to react in a situation like this. I think deep down a lot of us are kind of afraid of doctors and our charts, but I promise it won't be like Elaine from Seinfeld.

Just explain the situation briefly - you have occasional panic attacks that you have managed with Ativan under your last doctor, and would like a new prescription - and go from there. You are truly not doing anything wrong.
posted by DingoMutt at 7:06 AM on October 30, 2013

In addition to all the good advice above, it might be helpful if you put together a written list of the various medications you've tried in the past for your anxiety (along with dosage and dates taken, if you remember). There's a huge difference between "I only want to try this one medication" and "I've been open to trying a lot of different medications, but this is the only one that's ever worked for me."
posted by jaguar at 7:14 AM on October 30, 2013

And I also doubt you'll have much of a problem, but you might also want to focus on the symptom rather than the desired treatment, since determining treatment is what the doctor's trained in. That is, you're not going to the doctor to get benzos; you're going to the doctor to get help treating your anxiety. So something like, "I have a history of disabling panic attacks, and I've noticed my anxiety coming back a bit lately. I've tried all these medications in the past (hand over your list), but Ativan as-needed is really the only one that's helped. I'm thinking I may need to go back on it -- what do you think?"
posted by jaguar at 7:20 AM on October 30, 2013 [3 favorites]

Last comment and I'll stop serial posting -- you might actually want to stay at least a bit open to the idea of trying something else. A couple newer antidepressants (Cymbalta, Lexapro) have been shown effective at treating anxiety and tend to cause many fewer side effects than earlier SSRIs or SNRIs.
posted by jaguar at 7:26 AM on October 30, 2013

Yeah I've had no problem with this in the past. You present your history calmly and rationally, tell the doc you'd like to continue to take the drug that works for you, and they prescribe it.
posted by radioamy at 7:35 AM on October 30, 2013

Stick to the facts and describe your symptoms. Focus on your medical history: I am experience X, Y and Z symptoms. When I experienced them before, I took A and it helped. I have also tried B and C and they did not help. The best doctors I've had have been problem solvers so I've been able to say, here is my problem and they've said, there are a few ways we can solve this, let's talk about the pros and cons with each one.

Can you identify a specific trigger for why you're feeling more anxious these days? Doctors feel more comfortable if you can say something like, I just lost my job and I'm really anxious. After my mom died, no one had a problem writing me a prescription for anti-depressants.

Also explain whether you plan to take the drugs daily or as needed. I've had a prescription for Klonopin and my GP trusts me with it because I manage to make 30 pills last for three months. Call your doctor a month later if your symptoms persist. And keep an open mind regarding SSRIs.

I've been seeing my GP for seven years. He has always written my prescriptions for Wellbutrin and Klonopin. At one point, I thought, maybe I should see an actual psychiatrist about my problems and see what they recommend. They just did not feel comfortable writing me a prescription for Klonopin, even though I had been taking it problem-free for years. I stopped going there and went back to my GP. If a doctor doesn't write you a prescription for a drug you want, that doesn't mean that you are a drug seeker or a bad person or wanting the thing you want is wrong.
posted by kat518 at 7:39 AM on October 30, 2013

Good advice above.

Talk frankly about your symptoms, their impact on your life, what you have tried, what worked and what didn't work. Then ask what they recommend.

I've found that when I talk to my doctor saying "C is happening, this is how it impacts my work, x and y don't help, I'm looking for a talk therapist but I know it can take time to see results." They usually are willing to help. It's clear I want to solve the problem, whatever the best solution is. A drug seeker just wants drugs and (I've heard) may get angry if other solutions are suggested.
posted by bunderful at 8:39 AM on October 30, 2013

"My anxiety is starting to act up again. Would it be a good idea to go back to my old perscription?"
posted by windykites at 9:28 AM on October 30, 2013

Great advice above and want to add that one of the defining characteristics of anxiety is exactly what you wrote: becoming anxious about asking for pharmaceuticals because the doctors will think the worst about you. Think about it. The very fact that this makes you anxious kind of proves that you need it, right? So chalk this up to, "This is the anxiety talking, and I will get the medication," and you'll be fine!
posted by kinetic at 9:33 AM on October 30, 2013 [1 favorite]

When first encountering my GP I said something like "I have taken [sleeping pill] for most of my adult life, and I have seen specialists and tried many other medications, and I am not interested in messing with the status quo right now because my sleep problem has a big impact on my life and [sleeping pill] is what keeps it in check. I take [larger than usual dose] but it has been that dose for a decade. Do you see any problems with me continuing on as I've been doing?" For what that's worth as a script. I think with your documented history, and articulate rationale, you're not likely to be suspected to be a recreational user.

Make clear that what you are after is an ongoing relationship, not to get a prescription and disappear -- "Historically I have ended up refilling a prescription for # in [time frame] -- how often do you feel I should see you, given that? I am open to seeing a (psychiatrist, or...) if you think that's appropriate," etc. You want a partner in helping you manage your medical problem; focus on that, not the issue of the Rx, to lessen anxiety over the Rx itself. These anxiety-over-anxiety things can certainly be dreadfully circular. Lay as many cards out on the table as you can, including "the anxiety can make it difficult for me to address the anxiety," so your situation is clear, and the appointment ends with a plan for maintaining your care.
posted by kmennie at 9:48 AM on October 30, 2013

Another anecdote, if it makes you feel any better: I actually went to a walk-in clinic last January, right after the holidays, because my depression/anxiety spiral had gotten so bad I couldn't take it anymore and didn't know what else to do. I'd never tried benzos before but went there with that in mind, and left with a short-term script for Ativan to last until I could see a psychiatrist. (I said, truthfully, that my grandmother had used it successfully.) I put off going to a doctor for as long as I did because I was worried about being seen as a drug seeker, but that meant that by the time I got there, I was shaking, crying, and in an obvious emotional crisis. It seems like you're worried that your anxiety-related issues with communicating will be seen as shady, like you're trying to get away with something, but I think it could actually work in your favor - theoretically a doctor should be able to recognize anxiety in a patient. My advice:

1. Print out a copy of your initial question here to take along and give to the doctor. They will likely only glance at it, but it's very well written and can be an aid since you're having verbal communication issues. Having that in your file may be of help to you in the future.
2. Expressing that "this is what I've used in the past and it worked, I'd like to try it again" has been effective in my experience when it comes to sleep aids.
3. Keep an open mind, or at least pretend to, when it comes to SSRIs or other longer term treatment strategies. An attitude that's perceived as "I only want this one thing and am unwilling to consider anything else" is less likely to get you what you need. One possibility is that you leave with a script for your benzo AND another drug or two, doesn't mean you have to take them.

In my situation, I took Ativan daily for several months, then was able to wean myself off, and keep it just for emergencies. A combo of Zoloft and Buspar seems to be working well for maintenance, and anxieties that I've had for so long I didn't realize they weren't just parts of my personality are now fading. Best of luck to you.
posted by storminator7 at 9:34 PM on October 30, 2013

Response by poster: Ah, AskMe, you're like a tranquilizer all by yourself! This was all such great advice. I took my list of ailments in, I didn't get all foot-put-downy about SSRIs, and I explained (briefly) my history and what worked, and had the best doc visit I've had in years.

When I confessed my worry about asking for Ativan on the first meeting, they exploded in laughter, saying I should hear some of the requests for pills they get. Which made me feel a little saner too!

It was so relaxed once that fear was out of the way! I am so glad I asked you guys about this.
posted by mittens at 8:37 AM on October 31, 2013 [6 favorites]

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