16 doctors weighed in:
Is it legal for a doctor to perscribe 60mgs of aderral, 16mgs of suboxone, and 8mgs of klonapin a day?
16 doctors weighed in

Dr. Kevin Passer
Pediatrics - Psychiatry
5 doctors agree
In brief: For the same person?
Whether something is legal or whether it is good medical practice are two different things.
It is legal, but not at all good for a doctor to prescribe all three of the drugs to the same patient. I wonder if it is a so called "pill mill?" the combination of opiates like Suboxone and Klonopin (clonazepam) can be deadly. The Klonopin (clonazepam) dose you mentioned (8 mgs/day) is very high. I would not trust such a doctor.

In brief: For the same person?
Whether something is legal or whether it is good medical practice are two different things.
It is legal, but not at all good for a doctor to prescribe all three of the drugs to the same patient. I wonder if it is a so called "pill mill?" the combination of opiates like Suboxone and Klonopin (clonazepam) can be deadly. The Klonopin (clonazepam) dose you mentioned (8 mgs/day) is very high. I would not trust such a doctor.
Dr. Kevin Passer
Dr. Kevin Passer
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Dr. Dheeraj Raina
Psychiatry
4 doctors agree
In brief: Legal, but
Legal? Yes. But probably unwise and potentially dangerous (for patient).

In brief: Legal, but
Legal? Yes. But probably unwise and potentially dangerous (for patient).
Dr. Dheeraj Raina
Dr. Dheeraj Raina
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Dr. Donald Jacobson
Psychiatry
3 doctors agree
In brief: Yes, but
When confronted with this scenario ( and I have been) the diagnosis of adhd should be confirmed by outside sources and necessary history, using strict dsmv guidelines.
Klonopin (clonazepam) levels should be checked. Cytochromep4502d6 status should be documented. Urine drug screens to confirm the presence of all drugs should be obtained regularly, and a sleep study should done on all meds to see if there are central or obstructive episodes throughout the night. CPAP must be supplied as necessary and documentation of compliance should also be made. This is of course a lot of work. I am fortunate enough to be boarded in both psychiatry and sleep medicine so this is easier for me then for most clinicians. A safe and slow tapering schedule of the Klonopin (clonazepam) should be in place and the patient must be in psychotherapy and support groups. They also must have years of clonopin use. No one should be put on Suboxone and high-dose Klonopin (clonazepam) unless they have shown that have developed a tolerance to the Klonopin (clonazepam) at that dose over many years, in which case it makes respiratory suppression much less likely. Informed consent should be obtained in all such cases and family members should be involved if it all possible in the informed consent process.

In brief: Yes, but
When confronted with this scenario ( and I have been) the diagnosis of adhd should be confirmed by outside sources and necessary history, using strict dsmv guidelines.
Klonopin (clonazepam) levels should be checked. Cytochromep4502d6 status should be documented. Urine drug screens to confirm the presence of all drugs should be obtained regularly, and a sleep study should done on all meds to see if there are central or obstructive episodes throughout the night. CPAP must be supplied as necessary and documentation of compliance should also be made. This is of course a lot of work. I am fortunate enough to be boarded in both psychiatry and sleep medicine so this is easier for me then for most clinicians. A safe and slow tapering schedule of the Klonopin (clonazepam) should be in place and the patient must be in psychotherapy and support groups. They also must have years of clonopin use. No one should be put on Suboxone and high-dose Klonopin (clonazepam) unless they have shown that have developed a tolerance to the Klonopin (clonazepam) at that dose over many years, in which case it makes respiratory suppression much less likely. Informed consent should be obtained in all such cases and family members should be involved if it all possible in the informed consent process.
Dr. Donald Jacobson
Dr. Donald Jacobson
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Dr. Byron Law-Yone
Psychiatry
3 doctors agree
In brief: Yes, but...
This may or may not be clinically sound.
It depends on the patient and the clinical situation. As all are addicting drugs the risks of creating more dependence and addiction is real. The subject in question may be someone with adhd, an opioid addiction and incapacitating anxiety. However use of benzodiazepines like Klonopin (clonazepam) should be avoided when using suboxone. The dose of Klonopin (clonazepam) is really high.

In brief: Yes, but...
This may or may not be clinically sound.
It depends on the patient and the clinical situation. As all are addicting drugs the risks of creating more dependence and addiction is real. The subject in question may be someone with adhd, an opioid addiction and incapacitating anxiety. However use of benzodiazepines like Klonopin (clonazepam) should be avoided when using suboxone. The dose of Klonopin (clonazepam) is really high.
Dr. Byron Law-Yone
Dr. Byron Law-Yone
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Dr. Marcus Romanello
Emergency Medicine
2 doctors agree
In brief: Legal , but ...
Unless there is a clear plan for tapering , significant dependence risk.
The combination of a stimulant , a depressant and a narcotic dependence substitute outside of a drug dependence treatment program smells strongly of pill mill. Drug diversion also likely at those doses.

In brief: Legal , but ...
Unless there is a clear plan for tapering , significant dependence risk.
The combination of a stimulant , a depressant and a narcotic dependence substitute outside of a drug dependence treatment program smells strongly of pill mill. Drug diversion also likely at those doses.
Dr. Marcus Romanello
Dr. Marcus Romanello
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