Policy for Benzodiazepine Prescription (3/2019)
Evolving research and heightened scrutiny of quality of care—along with law enforcement concerns of misuse and diversion—have intensified the concern and monitoring long term (and even short term) benzodiazepine use. Because tranquilizers in the benzodiazepine class such as Xanax (alprazolam), Ativan (lorazepam) Klonopin (clonazepam) and others are controlled substances subject to definite standards of clinical and ethical care — as well as laws— we are providing this notice to make our office policy clear.
The risks of Benzodiazepine use are well known, including—but not limited to — dependency, addiction, impaired alertness, and illegal misuse and diversion. They can be especially problematic when combined with legitimate medications, and/or ill-advised medicines/drugs. Furthermore, because they are widespread and easy to find in the community, they can be abused with the potential for overdose. For public health and law enforcement agencies, this approaches a public health hazard.
These tranquilizing medications, when used only as prescribed, are effective agents for the quick relief of acute anxiety. They are indicated (short term) in appropriate clinical situations, as long as there are no contraindications. Those would include—but not be limited to—past or current misuse of benzodiazepines and other dependency-producing substances such as alcohol, cannabis, narcotic pain meds, stimulants, barbiturates, and various street drugs. Also, any history of illegal activity (convicted or not) connected with use of such.
Therefore, benzodiazepines are only prescribed for acute use (assuming no contraindications) for up to 3 months. Chronic maintenance is rarely supported, even for those whose lives seem continually fraught with life’s stress. For those who have been taking benzodiazepines long term, abruptly stopping could quickly lead to uncomfortable withdrawal symptoms. Therefore, a gradual taper schedule is called for in order to achieve physiological freedom from the tranquilizer. The time required can be individualized.
If more time, or closer monitoring, be required at any time, a formal detox program would be in order. The availability of our prescribers is limited by a tight, part time appointment schedule. As a result, any emergencies are directed to your nearest ER. If this proves too limiting and/or challenging, inpatient detox might be necessary.
For those who have been incorporating benzodiazepines into their very coping, the “loss” of such medication can seem daunting.
We are always pleased to meet and discuss with you alternative therapies, be they pharmacology, counseling, CBT, biofeedback, meditation, prayer, exercise. and the like. For most patients in this practice, benzodiazepine use (problematic or not) is only a relatively minor aspect of their medication protocol. Their more important medications pertain to mood, anxiety, content, adjustment and attention disorders. Getting off the “benzo” (and any other uncalled-for substance) will only enhance the treatment of all conditions and improve quality of life. It is our belief, that the benzo replaces the learning healthy coping strategies.
If you are interested in learning more, please consult with you medical provider.