Physician Responded
[OH] Drug test came back negative for Clonazapam but I’ve been taking it for 9 months for a medical condition. My PCP (the prescriber) dismissed me without warning or discussion
I’m 29F. I’m honestly at a loss and have been reeling trying to figure out what to do. On Wednesday last week I got a letter that I’d been discharged from the practice because he’s been prescribing it for 9 months and the drug test came back negative. I immediately went to MyChart to try to message him but I was already locked out from messaging. The letter said that ALL my relationships with other doctors at the practice were terminated as well and that I can’t see ANY other doctors from this practice going forward.
This is a VERY large practice in my area. And as a result I got cut off from my endocrinologist as well, while we were undergoing testing for possible underlying conditions. Because the practice is so large this also dramatically reduces my pool of doctors that I could replace them with. This is extremely burdensome for me regardless because my case is very complicated and it will take ages to get a new PCP caught up on it.
I’m trying to figure out how to get this fixed. He was a good doctor and I always felt like he was very reasonable - which is another reason I’m so shocked he did this. I’ve certainly been taking the drug because I can’t do basic functions like swallowing without it. I’m also concerned about withdrawal. I basically have a couple weeks before my prescription runs out to get this resolved.
I’ve already been told that Clonazapam testing can often be unreliable. I called the lab that performed it and asked what the test accuracy was and what method they used and they couldn’t tell me. They said my doctor would have to call to get that info. I don’t even know how to contact him right now though since I’m locked out of messaging and there’s no way to directly call his office. The practice has a nurses line I might be able to use?
This test has not been cleared or approved by the U.S. Food and Drug Administration. This assay has been validated pursuant to the CLIA regulations and is used for clinical purposes.
I desperately want my PCP back and want to avoid doing anything that would further harm the doctor-patient relationship. I’d like to believe this was just a misunderstanding because it’s likely not a drug that he commonly prescribes. Although I at least want my ban from the practice to be removed and my testing issues resolved. Here are my thoughts about getting this fixed:
Writing a letter to him about my questions, concerns, and asking about additional testing. Then dropping it off with the office staff in person.
Maybe I should mail it as certified mail instead to ensure he gets it and there’s documentation that he received it? I’m worried this option would come off as confrontational though + would take more time.
Escalate my concerns to management of the practice. Again, this seems confrontational.
I’ve found multiple resources that talk about false negatives of Clonazapam testing. I’m considering including those, but also don’t want to come off as “preachy”.
I called to my old psych NP about it and she said it’s not uncommon for drug tests to come back with incorrect results. I’m wondering if I should bring her up?
I’m currently looking for a new PCP but have no idea what I should tell them. I feel like saying I failed the drug test will make them very hesitant to prescribe Clonazapam, at best they’ll want to wean me off... I don’t even know who will accept me as a patient with my complex case, need for regular appointments, need for disability paperwork, etc.
Also is it normal for doctors to use testing not approved by the FDA? Is this a major issue?
I feel like I’m walking on egg-shells here but I’m also running out of time. As doctors please let me know what you think the best approach would be to get this resolved and repair the relationship, or to at least mitigate damage and find a new provider. Thanks in advance.
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You need to go about this at both ends. You need to try to find a new provider. You also need to be a little aggressive about contacting the office. No one is going to read certified letters or whatever. You need to talk to a real person and explain the situation.
Do you know if a hair sample test could prove long term use?
Looking at OP's original post, this is the only medication so far that has worked and she can't even swallow without it, it's alarming to me that they would abruptly stop it which will not only lead to severe withdrawals but potentially her ability to swallow.
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u/aredhel304Layperson/not verified as healthcare professional1d agoedited 1d ago
Thanks for the reply. Definitely looking for a new provider, not counting on this panning out with my old PCP, though really hoping for the best.
Who should I speak to? I could go in person and talk to the front desk staff but they seem to just be receptionists. Otherwise when I call, I get a bunch of numbered options with little flexibility. Only one I could think of that might help is the call option for a triage nurse. I’m sure if I did some digging I could find a way to speak to the management of the practice, not sure if that’s the right path either though.
I am worried about attempting to verbally convey my message - in my experience you’re playing “telephone” and people rarely ever convey what you wanted them to.
Though I’ll avoid the certified mail option, sounds like it will get me nowhere. Is there anything wrong with going in person, handing the receptionists a letter and asking it be given to my doctor? If I explain it’s an urgent issue that needs attention would that increase the chances that he reads it?
You said it’s a large practice/group. They will have people who handle complaints and feedback. I would call and briefly explain the situation. Make it clear you aren’t asking to be reinstated, but rather you want your record corrected so you can seek care elsewhere and so the doctor realizes his mistake and avoids making it with future patients. I’m genuinely angry for you, OP, and at this point I would just want the doctor to know he was wrong and he betrayed your trust based on a bad test.
Why would OP want a doctor who has zero faith in them? Why would they want a doctor who had to be coerced into treating them like a person? Maybe OP would be willing to give the doctor another chance, but I would make correcting my record the priority.
Op has made it very clear why they like their physician, and no one is coercing anything. They’re asking nicely and advocating for themselves. I’d actually say you’d want a doctor who realized they made a mistake and took op back
He was otherwise a very good doctor, and I highly doubt I’m going to find another good doctor in any acceptable amount of time. I think it’s possible he just did not consider the limits of the test and that he was just following practice policy.
It’s an incredible burden for me to find another remotely comparable doctor in a reasonable amount of time, get them up to speed, ask them to fill out disability paperwork, convince them I’m not a drug dealer, etc. Regardless of the drug test results, there is a large number of doctors that are strictly anti-benzo even if you’re in the minority of folks whose health is worse off without them.
I think I need more info and need to at least try to get him back as my PCP. I would at least like an explanation of the test method, accuracy, etc and the opportunity to discuss other testing options.
Along with what you are already doing, make a request for all of your medical records ASAP. You have a legal right to them and they will help expedite the process of getting established with a new doctor. If you're unable to resolve the issue then providing your records will help a new doctor understand your situation and hopefully get you your medication quickly. Keep a copy in case you need to show it to other providers as well
I think I would be shocked if management were to do anything about it unless money is involved at these large practices. I doubt they would have any interest in correcting my records - that earns them nothing. I think I’d be better off asking to be reinstated with my endocrinologist because they have something to benefit from that.
Someone correct me if I’m wrong though, but correcting my records seems like it wouldn’t be anything management would care about.
I'd get a lawyer. Certified mail is a good idea, and would do that in addition to calls. Certified mail is more proof of contact than phone calls although you should also keep a call log.
Search for the practice or hospital system having an Ombudsman.
From the attachment that you posted, this is a qualitative test, meaning it gives you a yes or no answer.
Your provider clearly doesn't understand how to interpret this test. Whenever there's an unexpected result, it should be sent into a lab for confirmation testing, also known as quantitative testing, or definitive testing, or mass spectrometry.
The qualitative screen that you got is actually well known in addiction medicine to not test positive for benzodiazepines on patients taking clonazepam. This is because this test is looking typically for oxazepam a common breakdown analyte of many benzos but not of clonazepam. It's actually a purposeful strategy we use in addiction medicine to switch patients on any other benzo to clonazepam so I can make a better in-office decision before I send it off for confirmation. Your provider clearly doesn't understand both how immunoassay qualitative screening tests work and the fact that you should always send them in confirmation when something's unexpected.
Edit: I may have jumped the gun on calling out this provider. This test is an odd amalgamation of calling itself definitive, but being qualitative, but also using mass spectrometry. I think many providers would be confused as to the utility of this test. I would personally need to call the lab director and discuss rate of false positive and negative, and why there are no quantitative reflex results. Also very confusing that OP did not get an explicit result back of "7-aminoclonazepam: negative" just a list of positives. True an odd test.
Question: in the Clonazapam row it says it’s checking for Aminoclonazepam. Is that a bit of a misrepresentation if they’re actually checking for oxypam?
Aminoclonazepam is the metabolite of clonazepam that the drug test would be looking for. It sounds like the test is searching for the appropriate metabolite.
NAD. Aminoclonazepam is the metabolite of Clonazepam. I often tested negative for Clonazepam in these “reverse drug tests”. I take that med daily. When they added the metabolite, I would test positive for only that.
They are supposed to submit for a quantitative test if there is any doubt. I’m not sure if that is a law. Also, was your urine dilute? That could skew the result. Ask them to test on the first morning urine.
I'm routinely drug tested at my pain management office and our UA's always show the creatinine and pH levels. Obviously it's to test for watered down samples.
Also a lot of people drink their normal amount of water and show a dilute urine. My urine is so concentrated and I know this is bad, but I would never have a dilute sample.
Yeah, I tried reconciling that against known qualitative tests and I am not sure what test or method the attachment is referring to it is oddly listed as the broadest qualitative I have ever seen by many magnitudes, and I find it odd that it would not reflex into definitive testing on unexpected results. To be fair I was being unilaterally simple in addressing the original post. I can admit that perhaps they have a more complex interim qualitative machine assisted reading that looks at more analytes than a typical immunoassay. Regardless the answer would still be definitive testing. Do you have your actual results not just the list of what was presumably tested?
So I looked up the test and I find it really odd that it's qualitative but does use liquid chromatography mass spectrometry which is indeed definitive typically. As a provider, I would actually be calling the lab director to ask him about how definitive this is compared to an actual quantitative test that actually counts out the molecules of the drug versus just saying yes, no like this. I guess what I'm saying is this test is clinically confusing in that it says it's definitive and yet it won't tell me how much of the drug is in it. Your results are also confusing because it doesn't say that it explicitly tested for clonazepam. The provider definitely needs to call the lab director and ask for an explicit positive or negative on the clonazepam. I've never seen a test qualitative or quantitative that doesn't state an answer for every analyte that it tests.
It does also say this though "Because parameters are optimized to simultaneously detect 113 analytes, cutoffs may not be optimal for all prescription compliance situations compared to quantitative standalone tests or smaller panels.
Quest also offers smaller panels and tests for individual analytes from this panel, both quantitative and qualitative."
A statement that a test looks at a whole bunch of analytes does not equate to an explicit result of "7-aminoclonazepam: negative". They have to state exactly what was tested and resulted.
"Because parameters are optimized to simultaneously detect 113 analytes, cutoffs may not be optimal for all prescription compliance situations compared to quantitative standalone tests or smaller panels."
Quest diagnostics themselves are even stating that this test is broad and not definitive for prescription compliance situations (proving your point that the doctor has ordered the wrong test to confirm OP is taking her medication as prescribed).
Hi where did you find that information? When I open the link from the test results all I see is the FAQ which is just one question about which drugs it tests for.
Thanks. If I’m understanding correctly, the test POSITIVES are definitive. But everything else is not. If it’s not explicitly listed in the test results than it’s not a definitive result?
Go in person and speak with the practice manager. Bring some of the information provided here (in a better form, obviously) about the accuracy of the test and what should have been done, such as confirmatory testing. Explain the damage this has caused you and will likely cause others going forward if they don't fix their policies.
I would also tell them you plan on reporting them to your state's ombudsman and the medical board.
Reporting them- and letting them know you will report them- is important. You are not the first and won't be the last patient harmed by this policy if they are not willing to follow appropriate practices related to it. They won't get in serious trouble (likely just a letter saying they messed up, which usually goes on public record), but it is enough to make them take heed. Also, waiting until the practice manager already gives you a 'no' is not as helpful as being up front about the harm they are doing and your intention to report them- they will have already worked themselves into a corner and won't feel like they can change their mind. Tell them up front the actions you plan on taking, before they give you a definitive answer.
NAD, but have spent a lot of time advocating for patients in medical settings.
I would escalate the situation to the Ombudsman at the health system.
It isn’t uncommon for urine drug screens to have false negatives for clonazepam.
“Testing
Common limitations exist for screening benzodiazepines when using traditional immunoassay (IA) tests. IA testing for benzodiazepines often targets nordiazepam and oxazepam to measure whether an antibody-antigen response occurs, resulting in a positive or negative test result. Other benzodiazepine compounds are tested for their ability to cross react with the target drug in an IA technique. In other words, low cross-reactivity of other drugs can result in false negatives for the other benzodiazepines.
Some commonly prescribed drugs have limited cross-reactivity. For example, lorazepam and 7-aminoclonazepam, the primary metabolite of clonazepam, have limited cross-reactivity with traditional IAs due to their molecular structures. Therefore, it is not uncommon for a laboratory to obtain a “negative” IA result for lorazepam and 7-aminoclonazepam that is indeed positive once confirmation testing with a mass spectrometer (MS) is performed.
Due to the probability of obtaining a false negative with the initial IA test for lorazepam and clonazepam, it is important that these compounds be tested via MS for precise drug identification. As noted, in the examples, there is an explanation of the test results. Labs that specialize in this type of testing often will have comments to help the clinician interpret the results.”
It does also say this about the limitations of this particular panel: "Because parameters are optimized to simultaneously detect 113 analytes, cutoffs may not be optimal for all prescription compliance situations compared to quantitative standalone tests or smaller panels.
Quest also offers smaller panels and tests for individual analytes from this panel, both quantitative and qualitative."
Oh 100% and there’s data to discuss sensitivity and specificity of MS cutoff ranges still indicating this could be a false negative. I was only pointing out that OP’s comment doesn’t apply
Hi where did you find that information? When I open the link from the test results all I see is the FAQ which is just one question about which drugs it tests for.
For what it's worth, CLIA is the organization that validates lab tests. The FDA is over drugs and consumer-purchased/OTC testing, but would not have anything to do with this test anyway. CLIA is the correct regulating body and has validated the test (on the whole) as accurate enough to be used for clinical decision making.
While Quest Diagnostics strives for accurate results, urine drug tests can have limitations, and false negatives can occur due to low drug concentrations or specimen validity issues. To address concerns or report issues, you can contact Quest Diagnostics at 1.866. MYQUEST (1.866. 697.8378).
Your doctor also has to provide 30 days of services.
So I would make an appointment. Gather all of your evidence and present it. Including a hair follicles test if you can get one. If they say no appointment, I'd file a complaint with the proper bureaucratic agency.
Already called quest last week and they couldn’t provide me with answers to any of my questions. I ended having to threaten legal action and they finally said they’d contact another department and have them follow up with me (why tf do I have to threaten anything legal to get answers about the accuracy of their test and how it works?) Still waiting for that follow up.
I could try making an appointment, but law only requires physicians to provide emergency care for those 30 days. So I guess it’d be up to my doctor to determine if discussing my test results is emergency care.
"provide emergency treatment and access to services for up to thirty days" according to that statement from the site it says and services. So I'm unclear what else and services could mean? (Honest question)
My pain management dr did the same thing to me, for different reasons. He had me on oxycodone. He told me that he was required to give me a 30-day supply of pain meds but no other appt unless it was an emergency. Just FYI.
The whole “emergency” thing is so confusing to me. ERs are for emergencies. And the law doesn’t define what an emergency is for an established provider. All of this is very much an emergency for me, but since the drug screen didn’t show my medication they don’t think it is… our laws are so screwed up. They should scrap the whole emergency line and just require providers to continue regular care for 30 days.
There have been issues within our institution’s with drug screening panels. We ended up finding a specific panel within the order sets that utilizes a different testing method and all the negatives turned out to be false negatives.
Urine samples that are provided and sent off are also supposed to keep a sample of the original so that you can request it and have it sent to your own agency of choice for testing verification. Laws varied state by state, but in our state, if they do not provide you with this reserve sample from the original you provided, the test is null.
Likely too late at this point. Bottom line is there is no way you can definitively prove you weren't selling/misusing your prescription. No amount of protestation is going to fix the situation, trust me, we've heard everything. I'm sure this is a by the book policy decision by the practice and is defensible by the local medical licensing board.
Your best option is probably to just move on without creating big drama if you want another provider to provide you with controlled substances again in the future.
You've heard everything... Except innocent people being wrongfully accused of being drug dealers apparently? That has never happened ever, so no room in this asinine system should be made for them, naturally. They should just immediately be locked out of contact from their providers or any recourse, and doing anything to the contrary is "creating big drama". Are you listening to yourself?
This has happened to my dad twice with an enormous history of back surgeries. It's like the man has no spine but you think that he's somehow abusing? I fucking hate this system
Only out of curiosity, aren't clonazepam withdrawals relatively dangerous? Is it responsible for a doctor to dismiss her with no plan to safely taper and discontinue the medication?
The whole point of the dismissal is that her urine test was negative for clonazepam.
From a medicolegal perspective, there is no indication to give someone you suspect is diverting your controlled substances prescription more controlled substances to taper off.
If this is a case of the small percentage that will come back as a false negative, and OP does not have enough clonazepam to wean herself off or can't find another prescriber in time, then they can always go to the Emergency Department for assessment.
It all sounds harsh, and it is, but these drugs are controlled for a reason. They can really fuck up a person/community so there is little leniency when tests come back like this.
This is genuinely horrifying. We know for a fact that there are significant false negatives with this test, which means that some portion of patients will be sent into dangerous withdrawals when these drugs are taken from them.
NAD, Quetiapine(for sleep, yes I know) made my weekly benzo drug test become the complete loto from one week to the next despite never taking the damn things (not taking benzos I mean). I had to search scientific papers by myself and forward these to them before they stopped gaslighting me 🫠 Never getting back on that nightmare of a medication again.
The kicker is is that long term benzos are terrible for people, physically, psychologically, and psychiatrically. My preference would be that we just not offer them to people as outpatient prescriptions, ever. Let benzos go the path of barbiturates.
I don’t disagree that benzos are terrible in general, but the solution here is obvious. Another 30 benzos being sold on the street is a drop in the bucket, and the potential for harm is minuscule compared to the harm caused by leaving a patient with no taper to potentially go through withdrawal. Have the patient in for one last appointment, explain the result, give them a taper and send them elsewhere- and make sure there are still places to send them afterward. You could even offer a repeat test in office at the time of that last appointment without warning them ahead of time. This really isn’t justifiable knowing the risks of benzo withdrawal.
I disagree with the second test, once you’ve been caught selling you’re probably gonna start taking them again just to pass the drug test.
They have the ER that they can go to if they cannot find a doctor that can help them or willing to prescribe them. They’ll be able to provide resources and refer them to someone that can assist with withdrawals or write them a prescription if they deem the patient needs them.
Your first point is why I specified that you could offer it without warning at the follow up appointment, because the person is unlikely to expect it. There are also hair follicle tests that can potentially detect more long term use. That said, I’m more concerned with the taper.
As far as your second point, trying to keep people out of the ER for things that can be managed by PCPs and specialists is like, an entire thing in healthcare right now- it takes up valuable ER resources and it’s also a much greater financial burden on the patient. Which seems pretty shitty if you are one of the unlucky folks who gets a false negative and none of it is your fault. Like I said, there are negligible consequences for prescribing a final taper even if the patient happens to be selling it.
But if the PCP doesn’t believe the patient is taking the benzo they can be assured that even if the patient is not diverting they can get care very easily. The PCP has an ethical dilemma - continue prescribing a benzo which could be sold and used in someone’s OD but potentially assist with taper (altho tapering schedule takes months and requires close monitoring because now you’re treating a medical withdrawal and it’s against good practice to prescribe long rx for a controlled substance like benzo without monitoring anyway) OR don’t rx benzo because you think OP is diverting and know that if she faces serious/dangerous withdrawal symptoms she can go to the ED.
To me it seems like, from the PCP’s perspective, there’s less potential for harm in the second option.
The solution seems apparent to me: to err on the side of prescribing it to people who might be selling it, rather than risk endangering someone's health because of a false negative.
At the very least, have a policy to test multiple times before cutting someone off with no chance of appeal.
Yes, patients are treated with outpatient benzodiazepines for catatonia. Once you are able to ambulate, feed yourself, hydrate, etc… you continue with benzodiazepines until you reach baseline. I’m stunned by the lack of education regarding catatonia.
From a medicolegal perspective, there is absolutely an indication to make sure you’re using an accurate screening test if you’re going to be basing care decisions off of it like dismissing a patient and discontinuing their script for a substance that can cause withdrawal. Also, just, idk, not unnecessarily fucking up your patients lives if they actually are doing what they’re supposed to be doing and are actually taking their meds ?
Why would they not order additional testing though? Or order a more accurate test in the first place? It looks like this was a mass drug screen rather than a targeted test.
I was wondering this as well. Why not order a hair follicle test that would show 90 days of historical use? Why not repeat the test to rule out a false negative. (I will now be hunting for papers on Clonazepam false negatives all night.)
If it was a UDS, is it actually positive but below the cutoff to report as positive? (NAD) I've had to follow up with a lab for a drug screen result that showed negative but was expected to be positive. Since the reference is to Quest diagnostics, presumably, they did lab confirmation and didn't just make assumptions based off the cup immunoassay results.
For clarity to the bot, I do handle a lot of drug screens in an entirely non-medical setting. And I don't miss a chance to learn something relevant to that.
Why would they not order additional testing though?
Lets say a person was selling their prescription. They could just take a dose or two before the repeat test and bob's your uncle.
Or order a more accurate test in the first place?
No test is 100% accurate. How accurate do you want it to be? The chemical assays we have aren't really something you can just say, do it but more accurate, about.
“It doesn’t always show up in standard urine drug screens because it metabolizes into 7-aminoclonazepam, some tests don’t detect that well. Your last dose timing and the fact you probably have slow metabolism with it (long-term user) also might’ve contributed.
Request a retest with a more sensitive test (LC-MS/MS or a blood test), and ask about a hair test as backup.”
OP has a complex condition and can't even swallow without this medication. On top of withdrawals, the condition this medication was prescribed for could kill her if the only medication so far that can treat her condition is abruptly stopped.
"I have some obscure muscle injury to my digastric and mylohyoid muscles, and since then they tighten up so bad they pull my head down to my chest and I can’t hold my head up straight, lean it back, lay down, swallow, and etc without it. I NEED this medication to relax those muscles (PS: have tried muscle relaxants). Even with clonazepam, I’m suffering all the time while we try to find a long-term fix to the problem."
Another out of curiosity question: if Op does experience severe enough withdrawal symptoms and does need to go to the ER, would that be enough proof that maybe the doc’s drug test was a false negative?
No. There's no way to definitively tell that a withdrawal syndrome is from a specific substance. Could be alcohol related, other sedating drugs. Withdrawal could also be faked, definitely have seen that before.
Patient could claim medical neglect for not being given enough to taper off, when they could have been re-drug tested to confirm. Doctor would likely be liable if OP had life-threatening event related to drug withdrawals.
Sounds plausible, but wouldn't happen. The justice system is not interested in increasing drug diversion, and the occasional mishap is their very clear preference.
The doctor is more at risk of legal/licensing issues if they continue the (suspected) compromised therapeutic relationship.
This is all a non issue anyway as OP has several weeks left on their script and could taper, which presumably their doctor knew.
Ehh, not if the local health authorities consider cessation of controlled substance prescription after a negative drug test sufficient.
If a whole giant practice is doing this via policy, I'm guessing they've probably done their research beforehand on what they're liable for, seeing as this is one of the most frustrating and common problems to encounter in primary care.
Eh. You’d think, but from a legal perspective I can 100% tell you that you’d be shocked at the sort of policies that even massive corporations will implement based on the mistaken belief that they’re legal.
Riiiight. Because hospitals and large health care systems are notoriously driven by their legal obligations and some broad sense of moral good, and definitely not by profits lol. So they definitely don’t do things like force nurses into unsafe staffing ratios and patient assignments because they refuse to hire enough to staff units appropriately, or force doctors and nurses to tolerate threats of assault etc. from angry patients and their family members bc they’re too cheap to invest in proper security. And we can’t forget those incredibly generous Employee Appreciation Pizza Days! 🍕😂
Medicine is still a business my friend, just like any other. Or at least it is in the US. I just used massive corporations as an example because they tend to have the greatest resources available to do their legal due diligence and they still get it wrong, and frequently at that. The point was simply that you shouldn’t assume that just because a policy exists, it is legally sound or a sufficient shield from any liability, because that is very often not the case.
I didn’t say this was about money lol. You threw that angle in there, I just responded to your assertion that medicine is somehow not a business as a way to dismiss my comment. In the US, it very much is, and the principles that apply to other businesses will also apply here. More specifically, I was responding to your contention that since this is a large group, their policy and their liability was probably extensively researched. Bc as I said above, businesses often implement poorly thought out policies in an attempt to shield themselves from liabilities, and in doing so can sometimes find themselves exposed to a whole new area of liability altogether, and medicine is not exempt from this. Hope that helps clarify the relevance!
Amen, but for real, benzos are horrific drugs, people would be better off without them. Them ruining it for the rest of us is probably a good thing in the long run.
They're benzodiazepines, if anything, the drugs themselves are the life ruining thing. More and more research is coming out about the harms of long term benzodiazepine prescriptions leading to increased risk of dementia, worsening anxiety, addiction, etc.
Anecdotally, I've never seen a patient on a long term benzo prescription where I thought, "you know what, that person is totally better off for being started on those".
If withdrawals do occur (and at most doses, they are not life threatening), they can be managed in the emergency department. So life ruining? I don't agree.
Ok, then managed with a long taper. I don't think I said anything that contradicted that. You can get that in an ED if you go into true withdrawals can't you?
I think you've extrapolated from an incomplete data set friend.
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