A check-up for benzodiazepine prescribing practice

College of Physicians and Surgeons of Alberta Messenger, Prescribing Corner 3 Comments

This fall, benzodiazepines will be incorporated as Type 2 medications in the Triplicate Prescription program (TPP) and the College will begin monitoring benzodiazepine prescribing by Alberta physicians.

Canadians are the second highest users of benzodiazepines in the world according to the International Narcotic Control Board. While commonly prescribed to treat insomnia and anxiety conditions, benzodiazepine medications can lead to dependency in some patients and cause other adverse effects, particularly if misused.

Here are some guidelines for safe benzodiazepine prescribing in your practice:

Contraindications for benzodiazepines

  • NOT appropriate for treating short term mild anxiety or insomnia; non-pharmacological treatments should be offered first when treating these conditions
  • NOT appropriate for patients with known substance abuse issues
  • NOT recommended for the elderly – delirium, falls, hip fractures and cognitive impairment have all been associated with use in this population
  • NOT recommended for children or adolescents

Safe benzodiazepine prescribing

  • Prescribe the lowest dose necessary to control symptoms
  • Limit prescription to two to four weeks
  • Assess efficacy early and review regularly
  • Assess the need for more than one benzodiazepine ( including the use of Z-drugs, such as Zopiclone) rigorously and often
  • Be alert to the development of dependence. Tolerance to the effects of benzodiazepines develops quickly (within weeks) and more of the drug is needed to achieve the same effect. Dependence can develop after only three to six weeks at prescribed doses.
  • Slow taper: Withdrawal symptoms can occur after a few months of using therapeutic doses on a daily basis. Gradual withdrawal is recommended to minimize symptoms and may take months to complete.

Resources

Questions? Join the conversation below or email us at info@cpsa.ab.ca.

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Dylan Conn

So I have a question, if I was out from 4.5mgs of clonazepam a day to 18 within months then to 24mgs, now have faced a long hard taper resulting in depression, many stays in psych wards, physical health issues, mental health issues on top of already a PTSD GAD and borderline personality disorder, what recourse do I have to the dr that put me from 4.5mgs a day to 18 as he was a family dr.

CPSA

Hi Dylan,

Thank you for taking the time to submit your question. Please feel welcome to contact one of our Patient Advocates, who will be available to discuss your situation further and provide you with some guidance. Our Patient Advocates can be reached by calling 1-800-661-4689 or by emailing complaints@cpsa.ab.ca.

Thank you and have a nice day!

Dylan Conn

Thank-you I may just do that. I have a good dr now tapering me but it’s been far from easy and has taken now going on 4 years of my life at an incredibly high dose then this last one being incredibly hard to get off this drug, but at least benzodiazepines are now much harder to get prescribed as I don’t wish this on anyone.