Psychiatrist Decision-Making Towards Prescribing Benzodiazepines: The Dilemma with Substance Abusers

Psychiatric Quarterly, 04/30/2012

Psychiatrist self–reported dilemma and behavior in prescribing BZDs largely reflected concerns with substance abuse and less frequently workload or time issues.

Methods

  • An anonymous survey of outpatient psychiatrists in an academic–affiliated public mental health center was conducted using a 45–item questionnaire developed based on the results of a previous study.

Results

  • Sixty–six percent of responses indicate that, at times, psychiatrists experienced requests for behaviors suspicious for abuse, including ‘lost/missing prescriptions’ and ‘use of BZD by others’.
  • Patient characteristics such as ‘history of abuse’, ‘unknown patient’, and ‘patient use of illicit substances’ were occasional or common reasons for NOT prescribing BZDs (75 %).
  • The most common contexts in which the majority of the authors' sample was uncomfortable prescribing BZDs involved a patient history of substance abuse, fear of initiation of dependence, diversion, and feeling manipulated by the patient.
  • Time limitations were a dilemma for 20 %.

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