The British National Formulary provides basic guidance on the responsibilities of the prescriber of controlled substances.1 The 3 basic areas suggested include that the drug is given for a sound medical reason, that the dose is not escalated, and that the physician does not become an “unwitting source of supply for addicts.”
A structured approach to prescribing benzodiazepines may be useful, but there is some evidence that there is a significant interpersonal component. Patients—especially new patients—who request treatment with benzodiazepines need to be carefully assessed.
The diagnosis and the rationale for treatment need to be clear. Reevaluation of the diagnosis and response to therapy over time is equally important. Consider urine toxicology to determine the presence of other drugs, particularly those that are often used with benzodiazepines (methadone, opioids,alcohol, stimulants). Urine toxicology can also confirm adherence rather than diversion.
For more on this topic, see: Understanding Benzodiazepines and Their Role in Substance Use Disorders, on which this quiz is based.
1. Anthierens S, Habraken H, Petrovic M, Christiaens T. The lesser evil? Initiating a benzodiazepine prescription in general practice: a qualitative study on GPs’ perspectives. Scand J Prim Health Care. 2007;25:214-219.