Felt like fighting a losing battle

Being a regular reader of my blog would know who my special patient is. Its a challenge for both patient and doctor to manage his 8 year long dependency towards Benzodiazepine. , particularly midazolam, more popularly known as dormicum. It is a group under Benzodiazepines, used normally for sleeping aid, anxielytic, however prolonged use of this drug would result in physical as well psychological dependence on this drug. My patient before seeing me was taking an average of 30 -40 tablets a days! However, once he tried stopping it cold turkey style, he developed withdrawal effect in the form of generalized epilepsy/seizure. On top of the, the craving for the drug is so strong that withdrawal effect from an heroin addict doesn't manifest itself at such degree of side effects. He started drooling in speech. Now he is taking it just to feel good and to satisfy his craving. The first time i saw him, he was totally disorientated, slurring of speech, and doesn't answer properly to the questions i had asked. Initially he came for prescription only, and admitted that he is under psychiatric follow up in HUKM but since his drugs ran out of stock, I had to prescribed so as he doesn't get withdrawal due to sudden absence of drugs.
His history of drug abuse started more than 10 years ago, where he tries heroin, erimin, fortunately he developed severe migraine after taking these drugs, the found Dormicum as an alternative, since its easily available. What made things worst was that he works as a security guard on shifts, and that screwed up his biological clock. Hence just a pop of the blue pill, he goes into wonderland. In the span of 8-9 year, his body developed tolerance, and hence he increases the dosage till today, 30-40 per day.
15mg package.
7.5mg package.
As a result of prolonged abuse, he got into fights, loss his job, was jailed for 2 months, and currently still has to go for random urine drug test.
When he came to me, he was already under follow up from HUKM, where they prescribed him valium, and antidepression to ease off his cravings, but it doesn't work.
So, by the third time he came to me for prescription, i told him frankly, that i don't just prescribe medicine indescriminately, but i ask him to think about his family, his young wife, and three young children, youngest being 1 year old. How long or what are the children's impression on him seeing his father being a drug addict, and not able to function normally? Then i told him, the next time he walks to my clinic is not for prescription, but to seek help to overcalm his addiction. The first step in treating his addiction is to admit that he has an addiction problem, and he is mentally prepared to undergo dyscomfort during the course of treatment.
So, i treated him with replacement drugs, antidepressions, additional non habit forming sleeping pills, and some drugs to control the craving.
So, my regime was. Since he is already on Lexapro(an antidepression that has the effect to controlling the cravings at night, I told him to take it in the morning, since all Antidepressions would cause insomnia! And this was prescribed to him by a profesor in psychiatry.
I've changed the timing for Lexapro to take in the morning instead. In the morning, along the Lexapro, along with 2 Dormicum 15mg , then in the evening another 2 dormicum 15mg, and after dinner Rivotril 2mg, and an hour before bedtime 2x dormicum 15mg + seroquel 100mg.

Seroquel, a non addicting or habit forming sleeping aid.
Rivotril, a long acting benzodiazepine that circulates in the body for 24 hours to decrease the craving for dormicum.
Zolpidem 10mg two tablets, also a sleeping tablet, to ensure he doesn't get up in the middle of then night to ask for more dormicum, which he usually does.
Normally, the cocktail that i prescribed for him is enough to knock out an elephant. After about a week, he came for his weekly counseling, it appears that such drastic reduction in Dormicum made him feel incomplete! I told him he has a combination of 2 benzodiazepines, and 2 other group of sleeping pills. He insisted that he still couldn't sleep despite his wife telling me that he slept like a log. The problem is he has craving in the morning and evening, and unable to function while he's experiencing withdrawals. The following week, i added dormicum 7.5mg whenever he feels his craving starts to manifest. But instead, he took like 5-6 of 7.5mg and fall asleep instead!
I was feeling a little frustrated with his non compliance.
I tried my very best for the past 5 months. As i initially told the wife, for rehabilitation it may take about 6 months. So far, he is taking 3 dormicum 15mgs a day, but along with Stilnox and Seroquel. The other day, he came to my clinic, appear blurr, not focussed, tears were coming out from his eyes as he thinks he isn't improving and that i am beginning to feel frustrated at his progress. He had admitted that he will live and die with dormicum, and nothing is going to get rid of his craving.
That thought bothered me. I started going online searching for detox and rehabilitation programs. I have found one run by a pharmaceutical company is Taman Tun Dr. Ismail, which i wrote to them and requested to send a representative to see me and bring along brochures for me to get familiarized with the environment.
I remembered he was crying begging me not to give up on him, but i had no choice. By doing this, i don't think i am abanding him, but helped him instead.
Many doctors gave up on him, and started to talk harshly towards him, he claimed. But the comfort that he received from me needs to end if the therapy isn't fruitful.
I am sorry Mr X. I tried my best.