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Tag Archives: Prescribing Philosophy

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.

Tag Archives: Prescribing Philosophy

Access to high-quality substance-use disorder treatment has never been more important. As the opioid epidemic continues to grow and impact more and more lives, families, and communities across the country, healthcare organizations must include some form of medication-assisted treatment (MAT) services for patients with substance use disorders.

However, building an effective MAT program at your organization doesn’t have to involve a massive overhaul of your organization’s services. And, if you’re just getting started, working with a dedicated telehealth or telepsychiatry partner can go a long way towards expanding your program and hiring qualified providers to deliver your MAT services.

Note: This piece will focus predominantly on building out a standard Office-Based Opioid Treatment program (OBOT) rather than a more intensive Opioid Treatment Program (OTP). If you’re hoping to learn more about providing OTP services, including methadone clinics, check out our full whitepaper on building out an MAT program.

Building an MAT program from scratch

Generally speaking, you’ll want to build out an OBOT program if you’re planning on prescribing Suboxone to treat patients with opioid-use disorders (OUDs). An OBOT program will allow prescribers with an X waiver to prescribe schedule III, IV, and V controlled substances to help treat those patients.

If that kind of treatment would be a good fit for your patients, make sure to keep in mind these key considerations when building your program:

    • Any providers participating in your OBOT program (i.e., prescribing these controlled substances, including Suboxone/buprenorphine) will need to have their X waiver. If your current providers don’t have their X waiver, they can undergo training from the DEA and apply for their waiver.
    • While your provider is receiving the appropriate training for their X waiver, your organization can start building what your OBOT program would look like. Alternatively, you can hire a provider who has their X waiver and specialized experience working with patients experiencing OUD who can help support your program. Remember, working with a telepsychiatry partner can expand your access to highly qualified providers for your program.
    • To have a Suboxone program, you need to be able to refer patients to a counselor. If you don’t have internal counseling services available, you should have a formalized referral relationship with another provider or organization in your community that does.
    • Plan on having clinic staff available on-site to monitor patients when they start their first day of Suboxone.
    • When starting patients on Suboxone, you may initially have them come in once a week. Then you will likely see them once every three months for maintenance.
    • Your OBOT program will have record-keeping requirements that your organization must meet. You’ll need to comply with 42 CFR, a federal regulation requiring an additional standard of privacy than typical HIPAA requirements. You will need to keep a log of all patients currently (or previously) prescribed Suboxone. Generally, you can keep these records in your standard EMR.

Challenges and opportunities you might face

The number one challenge your healthcare organization will likely face is dealing with stigma. People with substance use disorders are often the victims of stigma, stereotypes, negative portrayals in the media, and preconceived notions around what those disorders look like.

However, there are steps you can take to overcome that challenge, and it all starts with education:

  1. Educate your staff: Provide comprehensive education to your team. Include an overview of medications (including medications like naltrexone, which doesn’t require any special licensing or certifications for prescribers). An MAT program doesn’t have to mean a methadone clinic. MAT services can be easily and seamlessly incorporated into the work your team is already doing.
  2. Educate your community: Stigma in your community may be a significant barrier, so it will be essential to educate your community on what substance use disorders are (and what they aren’t) and that they do not discriminate based on social status, economic status, race, or background.
  3. Educate your patients: Spread the word. Let your patients know about these valuable resources, regardless of whether they have a documented SUD or not. Current patients may serve as an excellent referral source for community members in need of treatment.

As you work to get buy-in from your staff and your community, remember that the most significant benefit of building an MAT program is providing a valuable service to your community that will save lives.

Finding the right provider for your program

As you build out your program, it’s important to make sure you hire the right provider for your patient population, the kind of substance use disorders you are treating, and your organization’s culture.

Here are some best practices for finding the right provider for your MAT program:

  • Make sure your provider has dedicated experience treating substance use disorders and is familiar with a wide range of treatment options.
  • If your organization serves patients experiencing opioid use disorders and plans on prescribing Suboxone, you should only consider providers with their X-waiver or willing to get their X Waiver.
  • Look for providers who have worked with patients like yours in communities like yours and understand the particular challenges they face.
  • If your organization is in a rural or underserved community, consider utilizing telepsychiatry to open up your provider pool.

Supporting your program through telepsychiatry

Fortunately, you don’t have to build out your MAT program all by yourself. Telepsychiatry partners like Iris Telehealth can be valuable resources to help your healthcare organization source and vet potential behavioral health providers for your program.

Here are some benefits to using a telepsychiatry partner to optimize your MAT program:

  • Telepsychiatry will allow you to access high-quality providers from across the country who have their X-waiver and can prescribe Suboxone.
  • Through a dedicated partner relationship with a telepsychiatry vendor, your organization will be able to draw on the expertise and experience of organizations and providers who have been through this exact process and have seen effective MAT programs in action.
  • A telepsychiatry partner will be able to support the long-term, sustainable growth of your MAT program — decreasing the burden of recruitment and program implementation on your team.

If you’ve encountered challenges in finding highly qualified providers in your area, we highly recommend considering telepsychiatry as an option to help you better serve your community.

Some key resources to get started

Countless clinics and healthcare organizations before you have successfully navigated this process, and you will be able to benefit from their guidance and experience. You will also have valuable, comprehensive resources at your disposal to help you through the stages of building up your program.

Some resources to start with include:

Then, if you’re planning on utilizing telepsychiatry to build up your program or source highly qualified providers, Iris Telehealth can help your organization through that process. If you want to learn more about getting started, contact us today or download our comprehensive whitepaper on building out an effective MAT program for more information.