Posted by Anthony Quest on May 3, 2004, at 21:43:51
In reply to Re: Klonopin for Social Anxiety -- Dosage ? » Anthony Quest, posted by Kon on May 3, 2004, at 21:11:50
I agree that addiction potential is much higher with Xanax, but whenever we speak of addiction potentials or abuse potential - this is by definition meaningful only in the context of a large population.
I think practitioners use Klonopin for precisely the reason that in the aggregate they will have less patients who will develop problems. Even if the majority of patiens would never develop a problem.
Klonopin just doesn't give the high that Xanax nor does it have a "street value" so diversion is not an issue. Of that, there is no dispute. Neither does Klonopin have the stigma with some doctors.
But how important is this for an individual clinical decision. Assuming for the sake of argument, patient X doesn't get a high from Xanax or simply doesn't have any propensity to abuse or sell drugs, why does abuse in the general population matter? I would argue it shouldn't.
The benefit of Klonopin in the situation I describe does not go to the patient- it's to society or the physician or some nebulous interest. I think one could argue the patient, absent a history suggesting abuse or addiction potential, should be able to make this choice for himself.(Of course, ask for Xanax and see where that gets you).
I think most people would agree that Klonopin is the best way to go, but I am not convinced for the following reasons:
1. After a few months, one gets a tolerance to any high fron any benzodiazepine. At that point, abuse will depend on something other than the "euphoric" factor and rather the common trait of all benzos. So this is a short term worry. Diversion would always be a concern. Also, for sleep purposes, if you just have trouble falling asleep but not staying asleep, Klonopin is going to leave a hangover effect that Xanax wll not.
2. Withdrawal is probably worse with Klonopin. I think someone who knows more about pharmacology could comment but I know that if you are comparing opioids, it's easier to withdrawlfrom say Oxycodone than it is from methodone. The longer half life means the drug stays in one's body longer and the withdrawal is prolonged. The shorter half-life means the withdrawal happens quicker but it's over more quickly too. I have no idea whether this is a fair comparison between opioids and benzos.
I know some people consider Klonopin a still short acting benzodiazepine. When you look at the half-life of Valium, or Librium, Klonopin is not that long acting. The gung-ho benzo haters say Klonopin is just as evil as all the rest and its just America's way of denying reality. (Ashton et al)
But you know what, I am just arguing for the sake of arguing. Unless there is reason Klonopin is not satisfactory, I would agree that Xanax is not the first choice. Except for maybe truly PRN use- like fear of flying when some flies a few times a year.
poster:Anthony Quest
thread:342908
URL: http://www.dr-bob.org/babble/20040429/msgs/343039.html