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Similaire à BZDs Patients Substance Abuse97-03Mode
Similaire à BZDs Patients Substance Abuse97-03Mode (20)
BZDs Patients Substance Abuse97-03Mode
- 1. Mara Zuschlag December 12, 2010 Argosy University
Notes de l'éditeur
- Abstract: Benzodiazepines (BZDs), have been found to be addictive and abused, thus medical professionals prescribing them should reduce orders or replace with alternative treatment plans for mental health problems. several studies to substantiate the safety risks associated with BZDs prescribed to those with anxiety, depression, family mental health disorders and substance abuse. Studies have found significance in BZDs abuse potential, prescriptions are continually handed out to those with reported substance abuse. Medical professionals need broader educational aspects, patient history and cross-pharmacy checks prior to prescribing BZDs, to reduce harm in patients and others resulting from BZDs abuse. This research has summarized the findings, with a current understanding about the safety of BZDs prescribed for patients with substance abuse and the need for change in methods currently used to prescribe them.
- Reduction of harm will not occur without acute coordination of patient care. Due to the fatal risks of BZDs use with patients with substance abuse, alternative treatment methods are available and should be exhausted prior to consideration of prescribing BZDs. BZDs use is not safe in patients with substance abuse.
- Since BZDs’ have been introduced in the treatment field for mental health disorders, controversy as to their safety to be prescribed to patients with substance abuse has been studied and debated. With any medication, risks and benefits must be weighed for treatment consideration.
- Posternak and Mueller found much ambiguity over the definitions of BZDs abuse and dependence, to include those with a history of substance abuse being a major risk factor to abuse and dependency on BZDs (2001). This study is contradictory for support of BZDs treatment for those patients with reported substance abuse as found with Ciraulo and Nace, hence the abuse comes from the obtaining from non-medical sources, use in higher than prescribed amounts and use for poorly defined conditions (2000).
- BZDs are prescribed without review of the patient’s medical, drug use/abuse and family history of which studies have found a correlation between mental health disorders and their potential of BZDs abuse increases risk of harm. Fløvig, Vaaler and Morken’s study methods found that the use of substances is usually by subjective reporting, thus inclusion of the frequency and quantity with which the substance is necessary (2009). For example, it is not uncommon to request the quantity and frequency of other chemical substances such as cigarettes and alcohol during a specified period. These answers are significant to potential BZDs abuse. . Patients abusing BZDs can be detoxed from them safely without suffering, thus discovering and obtaining alternative treatment for their symptoms of which they were initially prescribed. BZDs abuse slows the recovery process from other substance abuse addictions such as opiates of which is a continuing substance abuse risk.
- This author found that the standard prescribed use to prevent dependency is 2 – 4 weeks; however BZDs are prescribed for longer periods. It is baffling as to the contradiction of studies that indicate the efficacy and use of BZDs in patients with psychological disorders are well tolerated, but lack potential harm with those with dual diagnosis to include substance abuse addiction. This author had not found substantiated reports to support continued BZDs use with patients with dual diagnosis that included substance addiction. Elliott, Glenday, Freeman, Ajeda, Johnston, Christie, et al, study from a census from Australia and the United Kingdom, found that BZDs included in polydrug abuse is a contributing factor in overdose among opiate users (2005). Why is it that some methadone treatment modalities will not treat persons prescribed BZDs and others allow it? Research studies need to continue to validate findings to the safety concerns with patients with dual diagnosis, hence chemical substance addiction and mental health disorder, such as anxiety, depression and insomnia. In addition, Ashworth, Gerada and Dallmeyer found that larger doses of methadone is associated with better treatment outcomes and that methadone should remain unchanged during BZDs detox (2002).
- Consideration to potential addiction coordination of care is necessary to limit BZD use (Salzman, 1998). Addiction to BZDs is highly associated with personal and familial antisocial personality disorder, of which includes trouble with the law and family members that were antisocial (Van Valkenburg and Akiskal, 1999). If there is any report of this type of history, further records need to be obtained. The patient may be anxious and frustrated with delay of treatment; however their safety is at the forefront, where it belongs.
- Consideration of family mental health disorders is part of prevention. Van Valkenburg and Akiskal study did find that “Anxious patients with-out antisocial relative and who maintain stable longstanding personal relationships are at very low risk of sedative abuse” (1999, p. 5). Prevention of abuse is preferable, however with the current BZDs dependency and abuse, reduction of BZDs should be considered with a tapering process. Prevention of abuse is preferable, however with the current BZDs dependency and abuse, reduction of BZDs should be considered with a tapering process. Several studies, that included meta-analyses that involved treatment strategies for BZD-dependent patients, found focus on alternative approaches that would achieve abstinence that included complete BZD withdrawal. The parent compound contained in Diazepam has a very rapid onset of euphoric effect. This euphoric effect is effective for the anxiety symptoms that will be evident during a detox. Again, a slow taper to abstinence is the goal. BZDs tapers successful with patients in methadone maintenance treatment (Weizman, Gelkopf, Melamed, Adelson and Bleich, 2003; Ciraulo and Nace, 2000).
- Particular attention to Fenton, Keyes, Martins and Hasin, findings that anxiety medications have clinical utility, thus greater clinical attention should be given to the potential for their abuse among patients with history or current substance abuse (2010). The purpose of the BZD script is one of which is to partner with the fixing of the clinical diagnosis and not issuing an indefinite Band Aid. This approach is treating the thoughts associated with diagnosis, in addition to addictive behaviors. Behaviors need to change of which BZDs are not the magical fix.
- There is a considerable overlap between drug and alcohol dependence and psychiatric disorders that include BZDs abuse, therefore should medical care professionals increase managed care responsibilities with those involved in treatment of substance use disorders (SUDs) prior to prescribing BZDs? Those seeking treatment to recover from opiate addictions need managed care with dual-diagnosis in addiction and mental health disorders (Weizman, Gelkopf, Melamed, Adelson and Bleich, 2003). Detox is possible from BZDs addiction with those in methadone maintenance treatment programs. It does not make sense to continue BZDs for a mental health treatment method, as the safety risks increases with BZDs use and those substance abuse patients in methadone treatment. Results from several studies warrant the necessary close monitoring of patients’ history prior to prescribing BZDS for anxiety, depression, insomnia and other mental health disorders. Other treatment methods must be exhausted, with documentation to substantiate progress or failed attempts.