Patient education about benzodiazepines is key

Here at IRETA, we’ve been thinking about patient safety in medication-assisted treatment for a number of years, and have more recently zeroed in on the issue of benzodiazepine use among methadone and buprenorphine patients.

We’ve heard from providers that their patients need educational materials about benzodiazepine use, so we put together a simple infographic that addresses immediate consequences, long-term effects, and the relationship between benzo use and recovery.  Please feel free to use and share it.

BZD Infographic

Here are some ways to get started educating your patients (and yourself) about benzodiazepine use in medication-assisted treatment:

Access this infographic online and share it with others in your online network

Download and print this infographic to post publicly or hand out to patients

Read more about benzodiazepine use on suboxone prescriber Jana Burson’s outstanding blog (Part I and Part II), including the comment section where patients weigh in on anxiety and insomnia

The following is excerpted from a longer piece in this month’s ATTC Messenger.  Read the whole article here.

Some of our most urgent questions revolve around client use and abuse of benzodiazepines during MAT…and it’s a messy issue, to be sure. Research shows that benzodiazepines (a family of central nervous system depressants often used to treat anxiety, known to many by brand names like Xanax and Valium) can have severe acute consequences for MAT clients and, in the longer-term, can compromise an individual’s recovery and adversely impact physical and mental health.

As such, the risks of benzodiazepine use are of great concern to treatment providers, who may be liable for acute outcomes like overdose deaths or accidents caused by impairment and whose work may be hindered by longer-term effects that interfere with clients’ access to recovery.

Treatment providers are also heavily invested in the proper management of benzodiazepine use in medication-assisted treatment because of the sheer numbers of users. Estimates of methadone maintenance patients who abuse or are dependent on benzodiazepines range from 18-50% and lifetime users of benzodiazepines are estimated to be 66-100% of the global methadone maintenance population.

How can we address this issue in the absence of strong empirical support for what to do?

benzo podium sign useThe sorts of dilemmas that providers encounter were wonderfully articulated at a 2012 conference in Philadelphia, “Management of Benzodiazepines in Medication-Assisted Treatment,” when public servants, payors, some of the foremost researchers and clinicians in the field, and MAT clients explored the issue more deeply.

An often-cited issue was that published research does not offer clear instructions for providers to follow. “How can we address this issue in the absence of strong empirical support for what to do?” asked Arthur Evans, Jr., PhD, Commissioner of Philadelphia’s Department of Behavioral Health and disAbility Services (DBHIDS).

Another theme at the conference was the difficulty of untangling co-occurring anxiety from opioid addiction, which makes clients’ need for benzodiazepines difficult to determine in the context of MAT. “Addiction is an anxiety provoking disease,” presenter Peter DiMaria, Jr., MD, FASAM, DFAPA reminded the attendees.

And, frustratingly: “There are legal and clinical issues associated with taking someone off and with keeping them on benzodiazepines,” said Louis Baxter, Sr., MD, FASAM. Abrupt discontinuation of benzodiazepines can be life-threatening. On the other hand, MAT induction in the context of uncontrolled benzodiazepine use is ill-advised as it can lead to impairment and overdose.

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Free Risk Management curriculum for Opioid Treatment Providers

Management of Benzodiazepines in Medication-Assisted Treatment, practice guidelines for providers