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Benzodiazepines- How many of us are sick and tired of the battle of this class of medicines? Here is my rant- Alprazolam- The lipid solubility and short effect is the main problem with this drug. Although I do agree it has its place. IMHO the only time this drug should be prescribed is: Patient has an: MRI/CT and is claustrophobic, patient has a dental procedure in the AM and is nervous, flying for business and the patient is nervous, patient has Panic d/o. In the case of Panic d/o, if the patient needs more than 0.5 mg. 2-3 times per week they should be on an SSRI, NOT Xanax. What do you do in the case when a patient tells you that their pill bottle was: Lost/Stolen/Destroyed. You can’t just decline prescribing something as they could have withdrawal symptoms -at worst case seizures. Too many times I hear this one “ I had to take 1.5 or 2 tablets because 1 dose was not working. Now I am out X days early”. This is clearly abuse. About 6 weeks ago I was seeing a young man who was being prescribed Xanax 1.0 mg 2-3 times per day for anxiety. This is not one of my patients, I had never seen this patient prior to that time. The staff MD had been prescribing #90 tablets per month with 2 refills and the patient has been on increasing doses for the past 7 years. I checked the PMP (As I do for 100% of the patients for whom I will likely need to write for a controlled substance) and he had filled his prescription 27 days ago and had no refills remaining. Looking at the dates he has been filling his prescription at 27-28 day intervals for the past year. He proceeded to tell me that his dosage was too low and that he was needing to take 1.5 mg on several days to get relief from his anxiety. I was in the process of doing the calculation in my head -- and I was trying to figure out how much he should have remaining and he stated that he has been w/o his Xanax for 3 days. I asked him how he was feeling and he said he was anxious and he stated 'My internal organs feel like they are shaking'. He then proceeded to stare off into space, his eyes rolled back and he started convulsing. I immediately yelled out for help, removed his glasses and kept him from hitting his head on anything. His benzo withdrawal seizure lasted about 2 minutes. He was postictal for 5 minutes and the local rescue showed up. On a side note he was taken into custody by the local police BC he refused to ride in the ambulance to the hospital. The officer believed he was not safe to drive his vehicle. I have not seen this patient since. I am tired of this class of medicines. I never want to see this again but, I know that this is wishful thinking. Any comments on how we can better this situation? I feel that I need to pick my battles. I do not start my new patients on benzos, I tell the patients of the staff MDs that I will continue their meds for this appointment but, in the future I will start them on a taper down schedule. What else can I do?
Here is a dumb question- Has anyone had difficulty with patients filling Benzo's early?? Of course you have. Do you ever wonder why? I have been scratching my head about this for months now. Here comes the bullet- This is part of a draft of letter I want to send to the state board of Medicine about a particular pharmacy's business practices. This is a HUGE retail chain pharmacy. All 3 fills were at the SAME location. This is the text from the top of the letter: XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX February 11, 2015 RE: RX# 0XXXX To Whom It May Concern: Original prescription was written on 12/22/2014 for Xanax 1.0 mg. Take 1 tab three times daily #90, DS 30 According to the PMP database, the above referenced prescription was filled on 12/22/2014 for #90, refilled on 12/30/2014 for #90 and again on 1/3/2015 for #90. This spans a 12 day period where the patient was issued #270 Xanax 1.0 mg. tablets. The prescription was filled and subsequently refilled at name of Pharmacy at Address and store # of said pharmacy. How was the pharmacy able to Re-fill a 30 day prescription after 8 days then re-fill again in 4 days? I am concerned that this puts my license at risk. The pharmacy clearly did not follow the 30 day period on this prescription putting the patient in danger of overdose. Thank you for your attention to this matter. If you have any questions, please do not hesitate to contact me. Sincerely, Me, PA-C XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX Before anyone chimes in WRT the ridiculously high amount of Xanax this prescription was written for - Don't bother. This particular patient is a regular at our practice. Almost exclusively seen by 1 particular staff MD. I assure you, when I wrote this prescription I felt the pucker factor but, I was not going to reverse the treatment course that the MD was following. When I learned about the dispensed amount and dates of dispensing this medication I immediately bought it to the MD's attention. I also let the staff know I was not comfortable seeing this patient again and it was my belief that this constituted abuse. Thus violating the practice agreement. I suggested the patient be discharged from the practice. The MD was not willing to discharge this patient and agreed to exclusively see this patient. Thoughts??