Doctors unwilling to combine meds
Dear Dr. Roach: Recently, I’ve noted within the medical community a dramatic increase in resistance to prescribing opioids and benzodiazepines at the same time. I have been taking one 0.5 mg clonazepam at night for insomnia and one, or at the most two, 5 mg Percocet per day for pain as needed. Since the Percocet is “as needed,” I’ve probably taken no more than 50 in the past 15 years.. To understand the sudden resistance to this combination in the medical community, I tried to research the issue online. While there is a lot of information that says both drugs can have a compounding and dangerous effect on respiration, I can find nothing about dosage or conservative use. Is there any research which demonstrates that my usage is particularly dangerous?
S.P.
Answer: Opiates like oxycodone (Percocet combines oxycodone and acetaminophen) work on a completely different receptor from a benzodiazepine like clonazepam. However, the two of them together can cause greater sedation than either by itself, and that is probably why you see a reluctance to prescribe them together.
If you really mean 50 Percocet in the past 15 years, that’s only about one every four months. There is almost no danger of habituation at this level. Similarly, 0.5 mg of clonazepam a night has no risk of overdose. But there is a small risk of falls or motor vehicle accidents due to the medication.
Dear Dr. Roach: I just turned 65. I’m a female, in good health. I thought I had a pulled muscle in my groin area but today, I had sudden onset of all-excruciating pain. I had an X-ray. I was told it was arthritis. Is it possible to have a sudden onset of arthritis with severe immobility?
A.D.
Answer: It’s unlikely. Most types of arthritis take at least months to show up on X-ray. There are a couple of exceptions: crystal disease, gout and pseudogout.
Besides muscle pulls, I’d be concerned about bone lesions, nerve compression, trauma to the soft tissues in the joint, bursitis or blockages in the arteries to the hip. I wouldn’t be satisfied with the diagnosis of “arthritis” without more explanation.