Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

It’s important to keep tight controls on benzodiazepines

Samuel Ridout, MD, PhD
Meds
April 15, 2019
Share
Tweet
Share

When I completed my residency training in 2017 I never imagined so much of my clinical efforts would be directed towards educating patients about controlled substances. As I stepped into clinical practice and took over patients who had long-term relationships with providers that had retired or moved to other positions I began to notice a preponderance of patients, some elderly, taking benzodiazepines daily, frequently at high doses. Often conditions other than anxiety were being palliated with benzodiazepines to numb symptoms. Gradually escalating doses throughout years of daily use were evident as I examined their charts. All of this is in spite of clear direction that these medications are only for use in “severe, disabling anxiety or insomnia.”

As I spoke to these patients, took new histories and provided full informed consent on the risks, benefits, alternatives to their current medications another worrisome trend became evident. My patients had the perception that they had not received informed consent around their medications.

Informed consent in medicine is the process by which a patient is apprised of the risks, benefits, and alternatives to a procedure, treatment or medication they are considering. While it may be the case that in limited instances a previous provider practiced paternalistic medicine and abdicated this responsibility it is more likely that informed consent was provided to patients previously.  However, their perception that they are not receiving this information is especially worrisome when considering addictive medications that require careful management, such as benzodiazepines.

It is no secret that there is a critical shortage of psychiatrists in the United States and that this shortfall in practitioners is likely to worsen in the coming years. Predictions suggest that by 2024 we may have a deficit of more than 31,000 psychiatrists. The downstream effect of this need for more providers is that those of us currently in the workforce have large patient panels and an ever-growing need to see more patients. It can often feel like patient education, and difficult conversations are not allowed for in one’s daily clinic schedule. Time pressures can lead to avoidance of transitioning patients to safer alternatives to manage anxiety, setting firm limits around addictive medications, connecting them with therapists and groups (where available) and addressing the core issue the benzodiazepine is palliating. Just authorizing the refill of the ever-escalating dose of benzodiazepine can often seem to be the path of least resistance. In a climate where reducing burnout is a ubiquitous topic of conversation it can surely seem this time investment is overly burdensome.

I suggest revisiting patient education often and keeping tight controls on benzodiazepine use to unburden our system overall.  Our goal should be to carry educated panels of patients who are well managed, not dependent on inappropriate controlled substances and subject to the risk for falls, overdose, dementia and cognitive slowing posed by benzodiazepines. This will facilitate the next generation of psychiatrists stepping up to continue care and prevent needless iatrogenic harm that increases care burdens and cost to psychiatry and across specialties.

All of this is not to say that benzodiazepines should be avoided altogether.  To be sure, they are effective medications but almost universally the temporary or episodic basis on which they should be used is ignored. Safe prescribing practices, investing in the patient so they are an educated participant in their own care, treatment agreements explicitly reviewed with patients and documented, and encouraging adjunctive treatment (therapy, groups, exercise, diet) can only benefit patients and is in line with treatment recommendations. Considering the risks of these medications and that up to 20 percent of nationwide benzodiazepine consumption is “misuse” we are faced with a critical issue to take head-on as a profession if we are to claim we are doing our fiduciary duty to our patients and supporting each other as providers.

Samuel Ridout is a psychiatrist.

Image credit: Shutterstock.com

Prev

Change the approach to triage to alleviate ER overcrowding

April 15, 2019 Kevin 8
…
Next

Telemedicine and access: Leave no patient behind

April 15, 2019 Kevin 0
…

Tagged as: Psychiatry

Post navigation

< Previous Post
Change the approach to triage to alleviate ER overcrowding
Next Post >
Telemedicine and access: Leave no patient behind

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

Related Posts

  • Think beyond benzodiazepines for anxiety

    Wallace B. Mendelson, MD
  • Why your doctor may be concerned about prescribing benzodiazepines

    Arash Javanbakht, MD
  • Are benzodiazepines “the worst thing that’s ever happened to people”?

    Nicole Lamberson, PA
  • Stop cutting patients off their prescribed benzodiazepines

    Christy Huff, MD
  • Don’t miss this adverse drug reaction when tapering benzodiazepines

    Christy Huff, MD
  • Beware of online retailers selling designer benzodiazepines

    Abraham M. Nussbaum, MD

More in Meds

  • Why retail pharmacies are the future of diverse clinical trials

    Shelli Pavone
  • Why does rifaximin cost 95 percent more in the U.S. than in Asia?

    Jai Kumar, MD, Brian Nohomovich, DO, PhD and Leonid Shamban, DO
  • A world without antidepressants: What could possibly go wrong?

    Tomi Mitchell, MD
  • The truth about GLP-1 medications for weight loss: What every patient should know

    Nisha Kuruvadi, DO
  • The hidden bias in how we treat chronic pain

    Richard A. Lawhern, PhD
  • Biologics are not small molecules: the case for pre-allergy testing in an era of immune-based therapies

    Robert Trent
  • Most Popular

  • Past Week

    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • Why male fertility needs to be part of every health conversation

      Hoag Memorial Hospital Presbyterian | Conditions
    • How home-based AI can reduce health inequities in underserved communities [PODCAST]

      The Podcast by KevinMD | Podcast
    • Inside human trafficking: a guide to recognizing and preventing it [PODCAST]

      The Podcast by KevinMD | Podcast
    • Graduating from medical school without family: a story of strength and survival

      Anonymous | Education
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • My journey from misdiagnosis to living fully with APBD

      Jeff Cooper | Conditions
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
    • Why does rifaximin cost 95 percent more in the U.S. than in Asia?

      Jai Kumar, MD, Brian Nohomovich, DO, PhD and Leonid Shamban, DO | Meds
  • Recent Posts

    • How home-based AI can reduce health inequities in underserved communities [PODCAST]

      The Podcast by KevinMD | Podcast
    • Adriana Smith’s story: a medical tragedy under heartbeat laws

      Nicole M. King, MD | Physician
    • What if medicine had an exit interview?

      Lynn McComas, DNP, ANP-C | Conditions
    • Why U.S. health care pricing is so confusing—and how to fix it

      Ashish Mandavia, MD | Physician
    • From survival to sovereignty: What 35 years in the ER taught me about identity, mortality, and redemption

      Kenneth Ro, MD | Physician
    • When doctors forget how to examine: the danger of lost clinical skills

      Mike Stillman, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 1 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • Why male fertility needs to be part of every health conversation

      Hoag Memorial Hospital Presbyterian | Conditions
    • How home-based AI can reduce health inequities in underserved communities [PODCAST]

      The Podcast by KevinMD | Podcast
    • Inside human trafficking: a guide to recognizing and preventing it [PODCAST]

      The Podcast by KevinMD | Podcast
    • Graduating from medical school without family: a story of strength and survival

      Anonymous | Education
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • My journey from misdiagnosis to living fully with APBD

      Jeff Cooper | Conditions
    • Addressing the physician shortage: How AI can help, not replace

      Amelia Mercado | Tech
    • Why does rifaximin cost 95 percent more in the U.S. than in Asia?

      Jai Kumar, MD, Brian Nohomovich, DO, PhD and Leonid Shamban, DO | Meds
  • Recent Posts

    • How home-based AI can reduce health inequities in underserved communities [PODCAST]

      The Podcast by KevinMD | Podcast
    • Adriana Smith’s story: a medical tragedy under heartbeat laws

      Nicole M. King, MD | Physician
    • What if medicine had an exit interview?

      Lynn McComas, DNP, ANP-C | Conditions
    • Why U.S. health care pricing is so confusing—and how to fix it

      Ashish Mandavia, MD | Physician
    • From survival to sovereignty: What 35 years in the ER taught me about identity, mortality, and redemption

      Kenneth Ro, MD | Physician
    • When doctors forget how to examine: the danger of lost clinical skills

      Mike Stillman, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

It’s important to keep tight controls on benzodiazepines
1 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...