Benzo's as appetite stimulant's

[Rafterman]

The incident with my suicidal friend was a few years ago, and she is doing much better now. Sorry I should have made that clear, but thank you both for the concern anyway.

It raises an interesting question... would you introduce someone to the world of IOPs? A couple of years back I had another friend who was very depressed and suffered panic attacks, naturally he ended up with an SSRI. I suspect that had he either been given a short course of diazepam, or perhaps even just a small number of benzos to carry on himself for emergencies, he'd have been much better off. But after a lot of thought I didn't put him in contact with the IOP world because I think he'd have replaced one problem with another and he'd now be horribly addicted. He knows I have some kind of "source" online, so if he ever went in the direction of buying then I have no doubt he'd speak to me and at that point I would save him from the bad IOPs and scammers.

For context the incident I described was in the UK. If you get hit by a car then the NHS is great at fixing you up, but it is poor on mental health. In many cases someone has to get worse in order to qualify for significant treatment (i.e. more than a doctor throwing some SSRIs at the problem). The doctor who prescribed these SSRIs was a psychiatrist - I don't recall his specialities beyond that. The whole interaction was awkward because he knew I was a psychologist (the PhD type) but I was there in the capacity of a friend. Also, I'm conversant with medical terminology, but I'm not the variety of psychologist who treats people. (Which is also very relevant to the paragraph above about introducing people to IOPs.) As mentioned there is the problem of second guessing a doctor, whilst also dealing with a friend/patient who was in a dangerous situation and on the edge of being hospitalised.

There seems to be a new generation of medical doctors who have been taught to be profoundly anti-benzos. Whereas I accept there are people with both short and long-term need. But the system right now opens up a doctor to criticism if they prescribe for more than two weeks - it isn't impossible, but they need an exceptional reason. The one positive thing I can say about the anti-benzo generation of docs is they understand benzo tapering reasonably well, and are less dismissive of the failings of SSRIs. (In the past it was a bit "You've begun having thoughts of self harm since you started taking these pills? Well, it sounds like we should double the dose then!").

I greatly respect those who have worked in the field of counselling because I'd find that hard on an emotional level. I'm the type who takes problems home with me. But I find your point about learning from others very interesting, and that's certainly true in other areas of my life. When I encounter students who want to go into clinical psychology, they quite often have their own issues which make them inclined to want to help others.

Wow, Fire, what a post. I did not know that you held a Ph.D. is psychology! I mean, you write like you do, but I never knew that you actually did. I am aware, more than most, the amount of education that requires, which makes it even more impressive to someone like me. In the US, over the last three decades or so, there have been problems recruiting psychiatric counselors. So, the powers that be began changed licensing requirements to let those with master's degree's become fully licensed psychotherapist's (my official title when I was working). So many of us just stopped when we reached that level. Some in the US still go on to get their doctorate, but many of those are interested in using it to author books, etc.

I agree with everything you said when you write about a generation of doc's who have been taught to be anti-benzo. It seems that the doctor's are learning to look out for themselves more and more. Here in the US, the price of malpractice insurance is prohibitive. It not only greatly raises the price of healthcare, but it keeps many talented people from going into the field. It also makes those already practicing fear making one false move. They will choose non-scheduled meds over scheduled one's at every turn. But I think that they have really stretched it too far with AD's. Giving them to suicidal and pre-suicidal types, failing to give a companion script for benzo's, to allow the client to get used to the excitatory effect of the AD, and/or not having sufficient training to even correctly dispense AD's, as indicated, in the first place. This is all bad medicine.
 
I also hear you when you mention the dilemma about possibly turning someone on to IOP. It's truly something that has to be decided on a strict case by case basis (IMO) and with that said, it still comes down to a judgment call. You never know what someone is going to do when exposed to the world of IOP, particularly if they are truly hurting, or if they are self-destructive and prone to have that "too much is never enough" mindset. To say that it's a tricky call would be an understatement. You can imagine that I have run into this dilemma a few zillion times over the years, and you would be correct.

Have a great night/day. Fire. Regards, RM

---

Ooops. My apologies to all concerned! I am not very used to the formatting of post's on these boards yet. I have never seen post's layered quite like this. Don't get me wrong. I think it's a beautiful forum that wonderfully managed. Just that when 5 or 10 post's are cluttered together, I am just getting used to making sure that I write back to the correct poster. I do read posts carefully before writing back, as I did with the recent one that I attributed to Fire. I failed to trace the thread up the left-hand column, or I would have seen that it was Barq-who I was responding to. I really haven't met the main players on here yet, so it's tough for me to recognize them by their stories or talk their about their credential's. Sorry, all. Lesson learned. RM

Don't worry about the mix up of names! It gets confusing when there are lots of quotations in the reply, so I've edited a few out.

That's interesting to hear about the masters level. In the UK there is a split, so someone calling themselves a therapist could be completely unqualified, whereas a "Chartered Psychologist" is doctoral level entry. Typically the latter would be a 3 or 4 year BSc, then a 1 year MSc, followed by the doctorate. PhDs vary in duration, mine was 7 years because I did it part-time (full-time would be 3 or 4 years, typically 4). After that psychologists often have a post-doc period where they work for a senior colleague for a few years. It was about 11 years study before I became autonomous (for lack of a better word).

I spent a summer at the University of Michigan so had exposure to a very different system. Even PhDs felt quite different in their scope (even down to the word count). The points where people choose to specialise in a subject are very different. The emphasis on GPAs was totally alien to me. In the UK a BSc or BA is graded as 1st class, upper 2nd, lower 2nd, 3rd, pass, fail. So given the historic relations between the USA and UK it was surprising just how different it felt.

As for malpractice, I get the impression there is far more litigation for this type of thing in the USA. In the UK a lot of people would be reluctant to take legal action against the NHS (it is seen as wasting NHS money, which could otherwise be spent on patient care). That said, there is a system of complaints and so many doctors will fear being complained about. Patients do need some power against bad doctors, but it also puts pressure on them to do things like prescribe antibiotics to people with a virus, etc. I think legal cases against doctors are increasing, but the cost often rests with the NHS more than the individual doctor.

I imagine you've had the IOP dilemma far more often than me, partly because of your role and secondly because of the costs of medicine. (In the NHS system there is a flat rate charge of about £8 whatever the medication is.) I totally agree that it has to be case by case. One friend who kept telling me that all meds online were fake was worrying excessively about me, so I ended up showing them one of our better known IOPs so they could see it was a professional organisation, with hundreds of good reviews. I also showed them my own quality tests... so I test for fentanyl, I test for the presence of the drug it is supposed to be, then I do an allergy test, and after that I know I'm pretty safe. But another friend would see that IOP like a candy shop! I just know he'd want to try everything and end up with massive addiction problems.


All the best,
barq

Thanks, Barq-
Very cool the hear how things are done in the UK regarding credentialing. So it was 11 years of study until you were out from under everyone and anyone. I can definitely relate to what you are saying. I know that the laws vary by state in the US and, in my particular state, the MA was enough to get my the autonomy that you speak of. I was able to prescribe non-schedule meds, didn't have anyone reviewing my cases, and would only call on one of our prescribing doctor's if I needed him to prescribe something controlled. I think that many in the US go all the way to the Ph.D. in order to increase their options. In many states, you need one to hang up your shingle. I would imagine that many who go "all the way" are interested in publishing, as well. All I wanted was a gig where I could see my own client's and be (reasonably) free to tend to them as I saw fit. I wanted limited legal liability and that is why I joined a group. I needed to get under their umbrella. Interesting, the observations that you made about the propensity for those in the US to file suit, versus the reluctance to sue in the UK. I wish that folks in the US considered of the system as a whole before jumping into legal action. Also very interesting to hear how your grading system works and I couldn't agree more wholeheartedly with your observations about the obsession with GPA's within the US system.

Thanks for your post. I enjoyed it very much and look forward to interacting with you again, as I have more time to be on here, now that I am retired.  Regards, RM