Across the country, healthcare organizations are working to decrease the amount of benzodiazepines they are prescribing to patients — and are considering whether they should go ahead and adopt a “no benzo” policy altogether.
In this piece, we’ll discuss the pros and cons of using benzodiazepines, best practices for prescribing policies, and benzo alternatives your organization can utilize.
What are benzodiazepines, and how are they used?
Benzodiazepines are a class of sedatives or hypnotics, and they are most commonly used for insomnia, panic disorders, situational anxiety (like fear of flying), or other sleep disorders.
The three most commonly prescribed benzos are:
- Diazepam (Valium)
- Clonazepam (Klonopin)
- Alprazolam (Xanax)
However, you can generally identify less common benzos from their generic name — which will often end in “pam.”
What are the pros and cons of using benzodiazepines?
The pros to using benzos are that they’re effective and fast-acting, making them a common medication for panic disorders and situational anxiety. A benzodiazepine will work a lot faster than an SSRI, which would take several weeks to start working. If someone is going on an airplane and they have a fear of flying, they might take a medication just for that one time during that day, or if they have panic disorder, but only have panic attacks once or twice a year, they might have the medication available as needed.
There are also specific cases where someone may experience involuntary movements as a side effect of an antipsychotic medication, and benzos can help treat those side effects. In these cases, providers and patients might find that the benefits of using benzos outweigh the risks.
However, there are certainly some significant risks to using benzos — with the most common being that people become physically dependent on them with regular use. Then, if they were to rapidly stop the medicine, a patient could have seizures as part of that withdrawal. People can also become psychologically dependent on the medication. These two dependencies mean that benzos are fairly common drugs of abuse.
If someone takes a benzodiazepine in combination with alcohol, an opiate, or another sedating medication, they can have a fatal overdose. So, that’s a risk your organization and your providers have to consider whenever you’re prescribing benzos.
Additionally, chronic long-term use of benzos can increase a patient’s risk of early-onset dementia.
More and more organizations are finding that, despite their efficacy, the potential downsides to prescribing a high volume of benzos are too serious to ignore.
How to identify whether your organization needs to change your benzo policy
Generally speaking, it’s a good idea when possible to reduce your organization’s use of benzodiazepines.
One of the first steps to doing that is to take an inventory of your current prescription volume. It’s not uncommon that we’ll start working with a health center whose previous provider had as many as 30% of their patients on a benzodiazepine. Often, providers can be surprised themselves when they see just how many of their patients are using them.
If you find that your organization is prescribing a high volume of benzos, it’s important to take that seriously because that’s a lot of medication getting out into the public. You hope that all of it’s being used appropriately, but there could be dangerous outcomes if it’s not.
Across the board, clinics with low benzodiazepine, or no benzodiazepine, policies notice fewer issues with patients needing immediate refills or demanding their medication be filled.
Best practices for reducing benzo usage with your patients
For organizations that previously had a high volume of their patients using benzos, it can be difficult to switch to a low benzo, or no benzo, policy. That’s because once someone is on a benzodiazepine, it can be a challenge to get them tapered off.
In an ideal world, having as few patients as possible using a benzo is the best option. But, there are effective alternatives when that’s not the case:
- For patients experiencing anxiety, starting an SSRI, which is the gold standard first-line treatment for anxiety, is a good alternative.
- Prescribing a low-dose mood stabilizer can help reduce the risk of withdrawal seizures.
- The most effective long-term solution for tapering someone off the medication is long-term cognitive-behavioral therapy (CBT), which is more effective and safer than starting somebody on a controlled substance.
The first step to decreasing the number of benzos your organization prescribes is education. It can be an uncomfortable change for some providers, but providing education as to why it’s so important and the risks associated with benzos is critical. The next thing you want to do is start tracking your prescription trends to know whether your organization is making progress. Having a monthly or weekly report on how many benzodiazepine prescriptions you’re writing can make a big difference.
How Iris Telehealth approaches benzodiazepines
At Iris Telehealth, we try to find providers who share our prescribing philosophy, which means being very cautious with all controlled substances. We think it’s important to understand there is a time and a place for each of these medications, and we don’t want providers who are inflexible or don’t see the shades of gray that inherently come with medicine. But, at the end of the day, we want providers who are educated on the alternatives and make an effort to not default to medications like benzodiazepines.
For your organization, it’s important to ask any prospective provider about their prescriber philosophies before you onboard them so you can ensure they will fit well with your organization’s goals. And remember, even if you or your providers don’t ever want to prescribe benzos, you need to be skilled and willing to help safely taper somebody off them because stopping them cold can be dangerous.
If you’re interested in working with Iris to identify high-quality psychiatrists and PMHNPs who can help your organization achieve its goals and serve your patient populations, contact us today, and we can get that conversation started.