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P. Sharma: 使用常见抗焦虑药将像滚雪球一样越来越大并最终引发一种流行病  

2016-05-28 10:57:59|  分类: 医疗安全 |  标签: |举报 |字号 订阅

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Pravesh Sharma: Use of common anti-anxiety medication could snowball into an epidemic




It was 2:30 a.m. After non-stop pages from the emergency department had bombarded me that night, I was about to lie down in my warm, cozy bed, just when my pager rang for the tenth time.

“Got a lady admission, Doc. She is suicidal,” said the psychiatry assessor when I called.

“You better be right this time, Mike,” I said.

Rubbing my eyes, I looked through the pivot window of the patient’s room in the emergency department. She was sitting at the corner of her bed, her forehead resting on her right hand purlicue, eyes fixated on the floor. I went through the patient’s chart and found her urinary drug screen was positive for benzodiazepine (BZD).

The moment I entered her room, she stood up and shook my hand. The wetness of her shaky palm woke me up completely. Before I could ask her anything, she said, “I am not suicidal, I just need Xanax.”

I see a dozen such patients every month. They seem to know what they want and assert their right to have it without even being screened by a physician — a psychiatrist in my case. When patients come not with a list of symptoms, but a shopping list for pills, one may assume something is not right. Some of my patients lash out at me because of not getting BZDs, while a few get admitted to the inpatient psychiatry unit for a detox, ironically, with another BZD. Some get sober, while others find their way back to the unit.

Of late, some newspapers and TV programs have harped on the problem of the “opiate epidemic.” Television shows host documentaries and talk shows, inviting former professional football players and people who are in recovery as guests. It is unfortunate that a disease gets noticed and widespread coverage only when it is out of control or when it becomes an “epidemic.” In this hoo-ha, we are ignoring another epidemic waiting to happen. Some people call it a shadow epidemic, the one brought about by an unchecked abuse of BZDs.

BZDs are wrongly considered the sole panacea for treating anxiety disorder, in part because the drug provides instant relief. It is like switching off the anxiety button in your body. And how much does our generation love the click of buttons! The alternative, which should be the first line of treatment, is antidepressants and cognitive behavioral therapy. That treatment has evinced strong empirical evidence in the effective treatment of anxiety disorders. But, they cannot match the pace of BZDs. Small wonder, physicians and patients prefer the fast-acting magic pill.

From a notorious fast-food nation, we are quickly becoming a fast-medication nation, too. But at what cost?

According to the Centers for Disease Control, in 2010 pharmaceutical drugs caused 60 percent of all overdose deaths. Approximately three out of four such deaths were attributed to opiates analgesics such as oxycodone or hydrocodone, while benzodiazepine was involved in 30 percent of these deaths. (Often patients overdose on multiples drugs, so these percentages are not mutually exclusive.)

Interestingly, the prescription of acetaminophen/hydrocodone, the most commonly prescribed opiate pain medication, dropped between 2010 and 2014, but the prescription of alprazolam, is a commonly prescribed BZD prescription for anxiety disorder, surged.

Patients’ reluctance to visit psychiatrists and overburdened primary care practices gives birth to over-zealous prescriptions of BZD, especially Xanax. A study by Elisa Cascade and Amir Kalali published in Psychiatry found that 55 percent of BZD prescriptions in a year were filled by primary care physicians while only 16 percent by psychiatrists. Education about judicious use of BZDs should be provided to primary care doctors, emergency physicians, and other physicians. We should encourage doctors to prescribe BZDs as little as possible, and when BZDs are needed, use the lowest effective dose for the shortest period of time. The prescribing physicians ought to use the state Prescription Drug Monitoring Program to share information with other physicians on patients’ prescription drug use, to identify possible abuse.

Just like opioids, BZDs pose a serious health risk to patients. It is time to recognize the issue before it snowballs into a epidemic.

Pravesh Sharma is a chief resident at the department of psychiatry at Texas Tech University Health Sciences Center. Email: drpraveshsharma@hotmail.com


http://www.dallasnews.com/opinion/latest-columns/20160526-pravesh-sharma-we-are-becoming-a-fast-medication-nation.ece
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