Therapist urges inclusion of suicide hotline number

The People’s Pharmacy

Q: I’d like to make a suggestion in relation to a recent letter you answered. The person was suffering from horrific muscle spasms due to Parkinson’s disease.

She had been using Dilaudid (hydromorphone) for five years to deal with the pain when it became unbearable. However, Centers for Disease Control and Prevention guidelines had pushed her doctor to try to get her off Dilaudid, even though she had never abused the medication. She said that she now spends most of her day in bed and that she is ready to take her own life.

You responded to her heartbreaking letter with good information about recent changes in the CDC guidelines, which acknowledged that their 2016 rules had caused patient harm and perhaps even suicide. You addressed the changes in the CDC guidelines, but I was aghast to see you end your reply with that, given the seriousness of her suicidality.

I have been a therapist for more than 30 years. In the past, I too have gone through years of suffering from chronic pain that left me bedridden and suicidal. Therefore, I would have liked you to take her suicidal ideation more seriously — not only for her sake, but also for the sake of countless thousands of people who may not know where to turn for help.

I wish you had provided a simple statement like this: “If you or someone you know is suicidal because of chronic pain or any other reason, we urge you to talk with your doctor immediately or seek support from the Suicide & Crisis Lifeline (call 988).”

A: Thank you for pointing out that people experiencing suicidal thoughts for any reason should be encouraged to get support from the Suicide & Crisis Lifeline. 988 is the new nationwide phone number.

We hope that health professionals will change their opioid prescribing and dispensing practices in line with the new CDC Clinical Practice Guideline. It urges health care providers to offer “compassionate, safe, and effective pain care.” No one should be driven to suicide because of inadequate pain relief.

Q: I take alprazolam (generic for Xanax) each night. It is prescribed for anxiety, but it helps me sleep. I have been taking it for years.

I know that I should start to wean myself off it, but I hate a sleepless night. Melatonin does not help me sleep through the night. Do you have any other suggestions on how I could taper down?

A: Getting off benzodiazepine medications such as alprazolam, clonazepam, diazepam or lorazepam can be quite challenging. Several decades ago, a physician and psychopharmacologist named Heather Ashton developed detailed protocols to help patients withdraw from benzodiazepines after long-term use. Her Ashton Manual is available online and provides information for a very slow taper.

You may also wish to consult our eGuide to Getting a Good Night’s Sleep. In this online resource, we discuss both sleep medications and nondrug approaches to overcoming insomnia. You will find it under the Health eGuides tab at PeoplesPharmacy.com.

Q: You wrote recently that coffee can interfere with levothyroxine absorption. I drink two cups of coffee with milk every morning right after taking my levothyroxine pill. My doctor says that is fine because I do it every morning. As a result, my thyroid levels stay very consistent. Taking it at nighttime makes it more difficult for me to stay on a regular schedule.

A: Thank you for sharing your experience. So long as you are consistent, your doctor can adjust your dose appropriately.