Valium is addictive…but not everyone gets addicted

I saw a new GP this morning to plead my case for valium.  I have been taking valium sporadically, on an as needed basis for literally decades now.  I have always had bad Premenstrual Syndrome (PMS), and mid cycle and just before my period I get very emotional, and suffer terrible insomnia.   Mostly I get very sad, and cry a lot.  Valium is calming, and helps me relax.  It also helps me sleep.  It works very well for me, where the usual treatments (contraceptive pill, anti-depressants and anti-anxiety medications) do not.   I take metformin daily for Polycystic Ovarian Syndrome, which is the underlying cause of my mood symptoms (hormone imbalance),  and that also helps with the emotional aspects of the disease.

The last two months, however, my symptoms have been much worse than usual.  I have had panic attacks, spent days crying, and just not dealing.  I don’t know why, but it likely has something to do with my pain levels increasing, my function levels decreasing, and life being largely confined the couch.

Not the life I would choose.  No one would.

But valium gives me symptomatic relief, and sleep!  Without sleep everything gets worse. Pain seems worse, and I am more short tempered.  Surprisingly enough it’s much harder to stay cheerful and positive on an average of four hours sleep a night.

My usual GP used to prescribe valium monthly for me, but lately with the whole opioid scare and addiction being such a major concern and the guidelines stating specifically that under no circumstances should you prescribe opioids and benzodiazepines together, he stopped my valium.  I wasn’t happy, but he was resolute.

I tried melatonin, it works for a few days.  And I tried Stillnox.  Stillnox had unbearable side effects, vivid nightmares, depression, anxiety, crying jags…Stillnox makes methotrexate look like a party drug.

I tried.  Now I want valium back.  I am heading into the PMS zone and I want some help managing that.  PMS acts as a huge amplifier for me. Whatever is on my mind is increased in intensity tenfold. So when I was happy, I was mega happy. But when I’m sad…it’s horrible.  The feelings are real, the issues are real, PMS can’t create things that aren’t there…but those feelings are usually under control.

I know it doesn’t sound so bad, it’s hard to describe.  I don’t experience rage symptoms, I’m not an angry person.  I don’t hurl abuse or yell or throw things.  I get intensely sad and self-destructive.  PMS is far more dangerous than valium, taken as prescribed, could ever be.

But explaining this isn’t easy.

I walked in and asked for valium to help me sleep and manage my PMS symptoms. She asked me what PMS was.  NOT a good start.

I explained, succinctly, my symptoms, and how valium helps.

She said she doesn’t prescribe valium.  She said that I would get addicted if I used that drug.  She said ‘everyone gets addicted’.

The great failing of medicine is that doctors see everything in majorities. If a study says that the majority of participants became addicted, the message becomes EVERYONE gets addicted.  But that isnt fact, it’s assumption.

I told her I’d been using it for over a decade with no signs of addiction yet.  I also told her that my life was constant pain, severe at least part of the day, every single day. That I spend 20 out of 24 hours a day lying down, and that’s a good day.  That without sleep I can’t function at all.   That I am not addicted, that I have been using it safely for decades, that my dosage hasn’t increased.

She read my file.  She asked me about my flares.  I told her I live in perma-flare.  I told her I am on my own, taking care of two highly anxious teenagers.  That I am on my fourth biological, with very little improvement.  That my life is constant pain, and valium helps me cope.

She was sympathetic as she ran through my history. She asked me where I experience pain.  I listed all the usual joints, the everyday ones – feet, knees, hips, lower spine, c-spine, shoulders, wrists, hands.  Elbows don’t hurt today.

She asked me when I last had x-rays, because there was nothing on file.

I said many years ago.  And then I asked her if I could have cortisone injections into my hips, because my hips are extra painful lately, and I have bursitis constantly.

She asked me how I knew it was bursitis.  I told her because I know what it feels like, and my recent SPECT-CT showed chronic bursitis and potential tendon damage.

Mistake. She told me no to the steroid shots.  She said you can only have 3 steroid shots into a joint in your lifetime. That is old information, and the guidelines have changed, but there was no point arguing.

And then we waded deeper into the arthritis history, which is always fun.  I know they have to do this. They want to go through everything, but listing all my failed treatments isn’t much fun for me.  And by the end of it they always come to the conclusion that there is nothing more they can do, which is also not a lot of fun for me.  Ultimately it always ends with a defensive doctor, faced with a patient they can’t fix.  No fun for anyone.  She actually said that she was meeting me for the first time and that I couldn’t expect her to fix what can’t be fixed in one consult.

I said I knew that.  I just thought I’d ask for the steroid shots, because I could really use some pain relief.  And then she started explaining again. I told her I understood.  I know it’s a dead end cycle. That I am waiting on a miracle.  So could we discuss the valium again please.   Because valium at least offers me symptomatic relief and a better quality of life.  It relaxes me, improves my mood and helps me to sleep.

She restated her concerns about addiction.

But I’m not addicted. I take it for several days of the month, as needed. My dose hasn’t changed in ten years.  It works well for me.

I even said ‘Please.’

She said she doesn’t prescribe valium, but she would prescribe Temazepam.   Another benzodiazepine, which is similar to valium (diazepam) but shorter acting.

Shorter acting.  Yes that makes sense, because I’m trying to achieve six straight hours of sleep.  A shorter acting drug is absolutely the logical solution.  Not.

The reason she is more comfortable with Temazepam is because shorter acting drugs have a lower risk of addiction.

In the U.S.  doctor guidelines are to prescribe shorter acting formulations of opioids for the same reason – a lower risk of addiction.  Which is the exact opposite of my doctors’ (GP and pain management specialists) policy on oxycodone.  With opioids, the theory in Australia is that slow release formulations have less potential for addiction.

So which is it?

I wish they could get their stories straight.

Regardless of what the studies say, I am not addicted to anything.  I don’t crave oxycodone, I crave pain relief. I don’t crave valium, I crave sleep and rest.  I can stop taking either with no ill effects, except that my pain levels rise to unbearable levels, and I can do nothing but lie flat on my back and stare at the ceiling.  Endlessly.

So life is better with these drugs.  I’m not looking for a cure, I’m looking for improved quality of life. Hard to do when the pain is endless and the prognosis is grim.

Ironic that I used to be the kind of person that never even took a Panadol/Tylenol.  Now I display ‘addict behaviors’, by walking in and asking for a specific drug by name. Unfortunately doctors can’t seem to understand that this is also the behavior of someone who has been taking a particular drug successfully for decades, and wants to keep taking that drug. Of course I’m going to ask for the drug by name.

Bottom line, I have temazepam. I hope it works. I need some sleep. I’m rambling now and I am not thinking straight. I cancelled my hearing aid follow up appointment because I am too tired and in too much pain to drive safely today.  Had I slept last night, I could have made that appointment.

But now all I can do today is rest.  Try to take a nap.  I have been awake since 1am, so maybe I can sleep.  That sounds good.