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C58. Managing the Care of Patients with Pre-existing Benzodiazepine Prescriptions in PHP/IOP Level of Care

C58. Managing the Care of Patients with Pre-existing Benzodiazepine Prescriptions in PHP/IOP Level of Care

Learner category:

  • Beginning Level
  • Novice Level

Learning objectives:

  • Participants will be able to describe the risks of benzodiazepines
  • Participants will understand how to evaluate and manage complex patients with co-occurring
    psychiatric and substance use disorders with special attention to PHP/IOP level of care.
  • Participants will be able to determine how to appropriately and safely taper benzodiazepines
  • Participants will understand how to increase safety and decrease discomfort/distress during discontinuation

Abstract

While the opioid epidemic has taken center stage, another epidemic may be looming. According to Lembke et al. (2018), from 1996 to 2013, prescriptions for benzodiazepines increased by 67%. Overdose deaths involving benzodiazepines increased from 1,135 in 1999 to 8,791 in 2015 (). Despite these statistics, the rate at which benzodiazepines continue to be dispensed is alarming. As a result, clinicians are often faced with the quandary of inheriting patients who have been prescribed high-dose benzodiazepines for a significant length of time. Managing these patients presents a significant challenge, particularly at the PHP or IOP level of care, as when patients present for admission, they are often highly distressed, despite pre-existing benzodiazepine prescriptions. Therefore, clinicians may be reluctant to quickly switch their medication regimen due to fear of further decompensation that may necessitate a higher level of care. Also, patients are often reluctant to change due to attachment or dependence on the benzodiazepine. It is vital that clinicians are prepared to effectively evaluate and manage patients who are present with pre-existing prescriptions for benzodiazepines (Lin & Weaver, 2019). This presentation will educate on the risks of benzodiazepines and their management in complex patients. It will cover indications for benzodiazepines, risk factors for misuse, and signs of intoxication and withdrawal. Lastly, the presentation will touch on developing rapport, monitoring, recognizing withdrawal/intoxication, tips for effectively managing these patients in PHP or IOP settings, and determining the appropriate level of care.

Authors

Morgan Borine
CNP, PMHNP-BC Rogers Behavioral Health

Morgan Borine, MA, MS, PMHNP-BC, is a board-certified psychiatric mental health nurse practitioner who primarily works with adults in partial hospitalization and intensive outpatient care at Rogers Behavioral Health in St. Paul, MN. Borine is a dual bachelors (BS, Nursing, BA, Psychology) and dual masters (MS, Nursing, MA, Counseling Psychology) degree holder. She graduated summa cum laude from Virginia Commonwealth University (VCU) with a BS in Nursing and received her MS in Nursing from VCU. She brings a unique combination of experience in professional psychology, psychiatric nursing, and addiction, with over 12 years of academic training and clinical experience across a wide variety of settings.

Comments (5)

  1. Shari Harding

    Thank you for this presentation. I appreciated the real life case examples, which were definitely relatable to what many of us see in practice. Your point about letting the patient guide us is essential, the buy-in from patients certainly makes a much more successful plan.

  2. Dennis Hagarty

    Very good presentation, So many of my physicians don’t take the time to listen to the patients who have been on long term Benzo treatment. Holding is an option that does support the patient and allows then some control over their own treatment. Thank you.

  3. Rachel Shuster, BSN, RN, CARN, CAAP

    In case #1, I found it fascinating that both alprazolam and clonazepam were prescribed concurrently with both written as PRN. Do you know if they were both prescribed by the same provider pre-admission to your program and what the rationale was?
    I also noticed that case #2 had both these meds onboard as well, but both were scheduled. I have the same question for this case – was it the same prescriber and what was the rationale?
    I was also surprised by case #2 with all the co-prescribed controlled substances. It’s difficult to even get all of those onboard together with how insurers and prior authorizations would be barriers of even starting the medications in the first place. I saw later in your presentation some of the rationales for this and how different providers with different practices/specialties could lead to this, and it’s certainly something we see in practice occasionally as well.
    Great point about how in reality, it’s not as easy to discontinue short-term BZD after an anti-depressant medication begins to work, especially if the perception is that benefits were from the BZD rather than the anti-depressant.
    Lastly, thank you for emphasizing the importance of meeting patients where they are at. Harm reduction is radical love! 🙂
    Thank you again for your presentation!

  4. Rita Hanuschock

    Thanks, Morgan for your detailed and organized presentation.
    I mtoanage patients w/drawing from bzo’s who are hospitalized; they usually present having had a seizure or sent by their prescriber who will not continue scripts.
    My team has had great results using phenobarbital in tapering doses, often with gaba as an adjunct.
    I remember when xanax was first introduced; we learned quickly of its danger; I wish the FDA would take it off the market, or at least place a black box warning. So many safer bzos available.

  5. Virginia Coletti

    great presentation. Very well orgnized. Easy to follow the process for MAT and so needed .

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