How Skyler Health Helps Reduce Doctor Liability in Prescribing Benzos
The opioid epidemic has gained nationwide recognition in the past few years, but there’s been little attention paid to the parallel, equally-threatening rise in the prescription of benzodiazepines. More than one in eight US adults used benzodiazepines in 2018, and misuse of these powerful prescriptions accounted for more than 17% of overall drug use¹.
Benzodiazepines (“benzos”), such as Xanax and Valium, are approved by the FDA to treat a diverse set of conditions, including anxiety, insomnia, seizures, and acute alcohol withdrawal². And, while these medications do serve a specific purpose for short-term use, doctors routinely prescribe them for long-term use and for things other than anxiety, insomnia, or their intended use.
Unfortunately, doctors are inadvertently contributing to the rise in benzo dependency and the risk of overdose by prescribing and co-prescribing these powerful medications liberally.
What are the risks of prescribing benzodiazepines?
Like opioids, there is a time and place for the prescription of benzos. Benzodiazepines are proven to be effective when used intermittently and for less than one month at a time³. However, when used daily and for an extended period, benzos become less beneficial and more addictive. Few prescribers realize that when taken daily, benzos can actually worsen anxiety, cause insomnia, and lead to other risks, such as accidental falls and cognitive decline⁴.
Tapering off benzos can also cause problems. Patients may find they lack information or support services when coming off benzodiazepines. Most doctors who keep patients on long-term use of benzodiazepines due so because they may not know how to differentiate withdrawal symptoms, like irritability, insomnia, feelings of panic, headaches, or even life-threatening ones, from the patient’s original symptoms.
For instance, let’s imagine a patient comes in for anxiety from a transient situational stressor that would likely resolve without any medical intervention. When that patient is placed on a benzo, their body becomes dependent on it. That patient, in turn, develops anxiety from their body’s response to the benzo. So although the transient stressor/anxiety-provoking situation resolves, the benzo-induced anxiety persists, and so begins the endless cycle of escalating benzos.
Or, considering abrupt cessation of benzo use can result in severe withdrawal, doctors simply may not know how to taper patients off of benzos.
Doctor liability in prescribing benzodiazepines
Despite the risks of benzodiazepines, they are still commonly prescribed for a variety of conditions. Certain populations, such as the elderly, are disproportionately affected than others.
“Benzodiazepines comprise 20% to 25% of inappropriate prescriptions in the elderly, with a reported prevalence of use ranging from 5% to 32% in community-dwelling older adults,” found one study⁵. “Although physicians recognize the risks associated with benzodiazepines, almost 50% continue to renew prescriptions, citing patient dependence and benefit as justification for their actions.”
Compounding the problem, few guidelines exist to help physicians safely prescribe these potent medications. The same study found that many doctors are co-prescribing benzodiazepines with other sedating medications, as well as with opioids. Despite the high risk of overdose for patients taking both benzos and opioids, the rates of co-prescribing these medications nearly doubled from 9% in 2001 to 17% in 2013⁶.
Patient advocates have begun to lead the way in raising awareness of the risks of benzos, lobbying pharmaceutical companies like Kaiser Permanente to change their doctor guidelines. But, many say more is needed to help doctors and patients fully understand the liability of prescribing and co-prescribing benzos.
More education is needed to safely prescribe benzos
While the industry struggles to catch up to the risks of benzos, early efforts at patient education and interventions like Skyler Health are stepping in to help struggling doctors and patients.
Direct-to-consumer education is one method that’s shown to have a lot of promise in preventing benzo dependency. One study found that providing the elderly with evidence-based information proved useful in diverting the prescription of benzos to something more safe and effective. “Without a direct-to-patient educational component, promotional efforts for deprescription to physicians may fail or have a smaller impact,” wrote researchers⁷.
Skyler Health is another effective way to lower liability for doctors and improve patient outcomes. For patients struggling to taper their patients from benzos, Skyler Health offers individualized treatment and strategies based on a mental health assessment. In addition to private telehealth visits and therapy services, members can access 24/7 support, whether they are in crisis or simply have a question about treatment. It’s an especially effective approach for patients on benzodiazepines who struggle with anxiety and are open to receiving treatment from the comfort of their home.
Our counselors monitor for addiction and medication misuse and provide evidence-based interventions that have been shown to help patients taper off benzodiazepines. This service takes the burden off doctors who may not have the time, knowledge, or resources to help patients taper safely. What’s more, our therapists use CBT, which has been proven to help significantly when combined with benzodiazepine tapering in patients with anxiety and insomnia. In fact, patients with anxiety receiving CBT are twice as likely to achieve a successful taper (75% vs 38%).⁸ ⁹
Our counselors also use psychotherapy and motivational enhancement techniques to help patients resolve their ambivalence towards tapering and reach their goals.
Visit us at Skyler Health to learn more about how we empower people to prevent and stop medication and substance dependence with professional, licensed, and vetted counselors that you can trust.
¹ “Study Finds Increasing Use, and Misuse, of Benzodiazepines,” American Psychiatric Association, December 17, 2018.
² “Our Other Prescription Drug Problem”, Lembke, Anna M.D., Papac, Jennifer M.D., and Humphreys, Keith Ph.D., New England Journal of Medicine, February 22, 2018.
³ “Our Other Prescription Drug Problem”, Lembke et al.
⁴ “Our Other Prescription Drug Problem”, Lembke et al.
⁵ “Reduction of Inappropriate Benzodiazepine Prescriptions Among Older Adults Through Direct Patient Education: The EMPOWER Cluster Randomized Trial,” Tannenbaum, Cara MD, MSc; Martin, Philippe BSc; Tamblyn, Robyn PhD; Benedetti, Andrea PhD; Ahmed, Sara PhD, JAMA Intern Med. 2014.
⁶ “Our Other Prescription Drug Problem”, Lembke et al.
⁷ “Reduction of Inappropriate Benzodiazepine Prescriptions Among Older Adults Through Direct Patient Education: The EMPOWER Cluster Randomized Trial,” Tannenbaum et al.
⁸ Gosselin, Patrick, et al. “Benzodiazepine discontinuation among adults with GAD: A randomized trial of cognitive-behavioral therapy.” Journal of consulting and clinical psychology 74.5 (2006): 908. https://psycnet.apa.org/record/2006-13014-012.
⁹ Baillargeon, Lucie, et al. “Discontinuation of benzodiazepines among older insomniac adults treated with cognitive-behavioural therapy combined with gradual tapering: a randomized trial.” Cmaj 169.10 (2003): 1015–1020.
