Hello everyone, I’m new to this subreddit so please excuse me if this isn’t the right place to post this discussion. I’ve been practicing as a pharmacist for about a year and a half at this point and wanted to hear from prescribers their perspective on continual monthly prescribing of narcotics/benzos. I see these as two different but linked issues, but will address them differently.
Benzos: When I see a patient on straight Xanax 1-2 mg TID, with no other supportive psych meds, a huge red flag shoots up. My understanding is for the vast majority of situations, benzos should not be the backbone of therapy for anxiety. SSRI/SNRI and/or buspirone should be the backbone (I know there are other pharmacological classes like bupropion that can be tried as well). However time after time I see benzos dished out like candy. I spent about 30 mins talking to a patient yesterday about her therapy and she said her appointments consist of her coming in, her doc asking if she takes her meds and if things are ok, and then writing a script for more Xanax. Why isn’t there an active attempt to deescalate to a safer agent? Is there a fear the patient won’t come back? Is there just too much hassle?
Opioids: Dear god the amount of issues revolved around opioids are enough to make a sane man crazy. I have multiple patients that will call starting about a week out for their next fill of hydrocodone and ask daily “When can I get it? When did I get it last? Can I get it early (I fill 2 days early already), did the doctor send it in?” This will repeat monthly. I’m just curious if they call y’all the same amount. Anyways, I have some patient with obvious pain issues or cancer patients, this is not about them. This about the able bodied 40 year old dudes that have been unemployed for a decade and have nothing better than to try to score narcs. Why continue writing for them 1 q 4h prn QD? Why is there no plan to deescalate? I’ve seen some theorize that this type of prescribing is an easy guaranteed pay check every month because these patients will come back for their “appointments”. I’m hoping this isn’t true.
To summarize my questions:
Why are benzos used so commonly as monotherapy for anxiety?
Why do I never see any attempt (besides 1 patient who underwent successful surgery), to deescalate opioids?
The patients with obvious drug seeking behavior. What do you do to put a stop to it?
I hope none of this came out accusatory. I honestly want to hear your side. I have a corresponding responsibility as a pharmacist, and believe me I have refused to fill and dismissed patients who refuse to follow pain management/psych plans. But ultimately they can just walk down the street and fill elsewhere.
Edit: Thank you for my first gold :)!
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