PRN “As Needed” Prescriptions For Anxiety, Depression May Lead To Benzodiazepine Abuse
New research presented this month at the American Academy of Addiction Psychiatry (AAAP) 27th Annual Meeting revealed that prescribing benzodiazepines on a PRN or “as needed” basis may lead to misue. In fact, these patients were significantly more likely to exhibit markers of benzodiazepine abuse.
Markers for benzodiazepine abuse, which researchers identified, included requesting an early prescription renewal, violation of the clinic’s prescription drug monitoring program, and patient conflicts with the healthcare provider.
As opposed to being on a regular regimen, physicians likely assume that their instructions to a patient to take medication as needed will decrease the chances that they will take them. However, researchers found that the opposite appears to be true. Patients may be assuming “as needed” actually means “as much as I need.” And “need” is subjective.
Prescriptions for benzodiazepines, or benzos for short, have been increasing steadily in the last two decades. Indeed, the number of people receiving prescriptions has increased, and so has the dosages prescribed. As a result, adverse effects of benzos have increased, including overdose deaths.
Benzodiazepines are not really deadly on their own. However, they are often prescribed along with opioids and other central nervous system depressants. When mixed in combination with these other drugs or alcohol, the effects of each substance multiplies, thus increasing the risk of overdose exponentially.
For the study, physicians from Mount Sinai Beth Israel collected data from April-May 2105 from their psychiatric outpatient clinic. Clinicians were asked to examine their caseload and provide information about for whom they were prescribing benzos and the doses, as well other medications they were prescribing,
Results revealed that 18 clinicians were prescribing a benzodiazepine to 241 patients. Most of the patients in the sample were women between 50-60 years of age, and had a diagnosis of major depressive disorder. Indeed, past research has confirmed that it is mostly women of this age who are receiving benzos, often for anxiety. It is important to note that benzos are indicated for anxiety and insomnia, but not depression.
In the study, 71% of these patients were prescribed a benzodiazepine, most often clonazepam. The average daily dose was the equivalent of about 2.8mg/day of lorazepam, but 11% were receiving 6mg/day, which is considered to be a high dose.
Also, 60% of the patients in the sample had been receiving benzos for at least 5 years. Another important note: benzos are not indicated for long-term use, but rather for a limited duration, partially due to their potential for dependency and abuse.
I have to wonder why it is mostly middle-aged women receiving this medication. What is special about them that they should be prescribed more than anyone else? It is menopause? Empty nest syndrome?
I could theorize that less men receive it due to the stigma of mental illness and anxiety in the male culture. I could also theorize that women this age often receive it when they have no real history of substance abuse. That is, they are mature, and deemed “safe” or unlikely to abuse.
The problem with addictive medication is that no one is immune to its effects. And ironically, it is those especially who suffer from a mental illness such as anxiety that are the most prone to misuse and addiction.
~ G. Nathalee Serrels, M.A., Psychology