benzo ?

[50960]

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Clinical practice opinions wanted!!

Is is better to continue giving benzos to a person who is showing signs of abuse bx until you can research the situation and get to know the patient, or to stop prescribing them and tell them to get some help with their addiction problem?
I know all about the pharmacology, binding kinetics, addiction research etc, I am just looking for opinions on general practice philosophy in this area?

 

[Poety]

Clinical practice opinions wanted!!

Is is better to continue giving benzos to a person who is showing signs of abuse bx until you can research the situation and get to know the patient, or to stop prescribing them and tell them to get some help with their addiction problem?
I know all about the pharmacology, binding kinetics, addiction research etc, I am just looking for opinions on general practice philosophy in this area?

Hi Psici, I'm sure you already know this but you can't just stop the benzos cold 🙂

Is this your patient? I did do a year of addictions research - what I saw was a lot of the psychs transferring them onto other meds (anti-d's and buspar) while simultaneously weaning them from the benzos.

Not much help but I thought I'd try 🙂

 

[Anasazi23]

Clinical practice opinions wanted!!

Is is better to continue giving benzos to a person who is showing signs of abuse bx until you can research the situation and get to know the patient, or to stop prescribing them and tell them to get some help with their addiction problem?

Depends...depends on what benzo they're taking, daily dose, from where they're getting other benzos, their age, comorbid medical conditions, reliability, and so on.

I assume you're referring to an outpatient.

The physician's choices include continuing to prescribe the benzo, cutting it off, convincing the pt. to go to detox, rx a tapering dose, substitute a longer-acting, and a few other less-used tricks (cross-taper with a low-dose atypical or other med, and a few others).

I know all about the pharmacology, binding kinetics, addiction research etc,

Hmm...okie dokie.

signs of abuse bx

P.S. I don't know what an 'abuse biopsy' is.
P.P.S. Had a patient seize this week (first seizure at 67 yo) from abrupt discontinuation of klonopin.

 

[50960]

By Bx I mean Behavior. This is not about a patient per se, but about policy. The clinic I work at has no psychiatrist, and the MDs and mids handle alot of psych meds...with help. They get alot of benzo seekers, so are looking at how to write a policy to help providers manage this. The two opinions I have heard are the ones I listed. My view it that is makes no sense to just cut people off for many reasons, primarily medical as well as behavioral, but I get the liability aspect as well.

 

[Anasazi23]

I know some general medicine clinics have a policy that certain psych meds won't generally be prescribed by non-psychiatrists. These may include antipsychotics, mood stabilizers, benzos, and other particular meds. Instead, they provide a psychiatric referral. They will prescribe SSRI's and other relatively benign meds.

However, if someone comes to the clinic already on benzos, and they have documentation as such, one refill can be given, with a psychiatric referral...and that's all they get. It's up to them to be evaluated by a psychiatrist and they will make the determination how to handle further benzo prescriptions.

 

[50960]

I agree, and that is what sorta what we will be doing. However we have no psychiatrist here or elsewhere to refer to so the docs and mids handle it. I will ignore your put down about pharmacology. Regardless of what I know, my point was that I was looking for practice guidelines in psychiatry, and not a diatribe on you must rule out this and that, do this exam, lab etc..
We have some providers who do not understand the difference between dependence (ie. upreg of receptors etc.) and addiction, and this has caused some serious probs when folks cold turkey...there have been 3 admissions this year for just this.
I would tell you who manages all this here, but I am afraid I would piss you off...... 😉

 

[Anasazi23]

I will ignore your put down about pharmacology. Regardless of what I know, my point was that I was looking for practice guidelines in psychiatry, and not a diatribe on you must rule out this and that, do this exam, lab etc..

? What put down? "okie dokie?" That's not a diatribe, and believe me...I didn't come close to giving a diatribe on benzos. It was just the truth, and you didn't specify that this was a policy-driven question, and not clinical. The first line of your post was "clinical practice opinions wanted," not..."medical clinic policy applications opinions wanted." I'm not going to go against what I said in that those factors must be weighed when managing a patient clinically.

We have some providers who do not understand the difference between dependence (ie. upreg of receptors etc.) and addiction, and this has caused some serious probs when folks cold turkey...there have been 3 admissions this year for just this.
I would tell you who manages all this here, but I am afraid I would piss you off...... 😉

I, too, will ignore the passive-aggressive smiley, and the innuendo that psychologists somehow manage withdrawal states in the hospital. Not only does this make the hospital ripe for lawsuits and is not the standard of care, I simply don't see how it's possible. Oops...I guess I didn't ignore it.

 

[50960]

okie dokie....

You are easier to piss off than my wife man!!! Insults aside, I appreciate your answer, and apologize for not being more clear. I did not mean you were on a diatribe at all, but only that I was not looking for one. I really doubt psychologists handle this in hospitals. I was referring to who handles psychopharm in my clinic.

Take a xanax and reply...... 😀

 

[Anasazi23]

okie dokie....

You are easier to piss off than my wife man!!! Insults aside, I appreciate your answer, and apologize for not being more clear. I did not mean you were on a diatribe at all, but only that I was not looking for one. I really doubt psychologists handle this in hospitals. I was referring to who handles psychopharm in my clinic.

Take a xanax and reply...... 😀

I couldn't get a hold of any xanax...I seem to be the only person in New York that doesn't have ready access to the stuff. I can't wait for the soluble Xanax tabs...just what the world needs - a faster acting Xanax.


You'll all be glad to hear that I had no diatribe prepared for today. I won't touch the 'psychopharm in the clinic.' 🙂

 

[Poety]

I couldn't get a hold of any xanax...I seem to be the only person in New York that doesn't have ready access to the stuff. I can't wait for the soluble Xanax tabs...just what the world needs - a faster acting Xanax.


You'll all be glad to hear that I had no diatribe prepared for today. I won't touch the 'psychopharm in the clinic.' 🙂

Wow, two moderators, head to head, the PD's would be loving this! Watching us in our experimental realm hehe jk (refer to are there any PD's here.. its a joke, sorry!)

Psicici, I spoke with my attending about this, and he said that he would recommend like Sazi said: script them with 7 days worth, and refer to psych to handle the rest - he said psych would be the best to deal with the dependence/abuse issue - he also said to recommend them to an addictions psych although a general should be just as good if thats all that is available.

I hope this helps 🙂

<ducking back out, has no diatribes, is afraid of moderators>

 

[50960]

Oh come on.... 🙂

 

[Milo]

Given: convincing signs of abuse w/o clear signs of therapeutic benefit (ie bzd for MDD)


I would prescribe a tapering dose of the benzo, less than that of detox but a steep enough taper that the patient would be off the bzd in 2-4 weeks.