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The way I was trained, prescribing benzos or adderall to patients who have an active substance use disorder or high-risk use should be a "never" event.
But I'm increasingly realizing the real world is much more nuanced.
What about substance use disorder that's in remission? How long is long enough?
It's also quite possible to have a substance use disorder concurrently with a condition where stimulants or benzos are indicated, such as panic attacks or ADHD, and treating the ADHD can actually make the substance abuse less severe.
If I catch someone with a positive UDS for illicit or unprescribed drugs, we have a candid conversation about it and they are required to get a series of negative tests in order to get back their prescription. But a positive UDS also doesn't say anything about frequency, amount or reason, and everybody lies, particularly about substance use. And I've never worked in a facility that tests for EtG on UDS's, where that's even an *option*, whereas alcohol use is what I'd *really* want to know about when I'm prescribing, let's say, benzos.
I'm curious, do others here have mental algorithms as to how to think about this?
But I'm increasingly realizing the real world is much more nuanced.
What about substance use disorder that's in remission? How long is long enough?
It's also quite possible to have a substance use disorder concurrently with a condition where stimulants or benzos are indicated, such as panic attacks or ADHD, and treating the ADHD can actually make the substance abuse less severe.
If I catch someone with a positive UDS for illicit or unprescribed drugs, we have a candid conversation about it and they are required to get a series of negative tests in order to get back their prescription. But a positive UDS also doesn't say anything about frequency, amount or reason, and everybody lies, particularly about substance use. And I've never worked in a facility that tests for EtG on UDS's, where that's even an *option*, whereas alcohol use is what I'd *really* want to know about when I'm prescribing, let's say, benzos.
I'm curious, do others here have mental algorithms as to how to think about this?