Above is the link that shows in the graphic – may have to click on the graphic a couple of times to get it to resize properly
Link to make comment
I went back and did a few word searches. I really didn’t feel like reading 146 pages.
The words I searched for – but did not find:
LME ( lorazepam milligram equivalent ) but there is an app for that https://globalrph.com/medcalcs/benzodiazepine-converter-dosage-conversions/
Pharmacogenomics
I am concerned that some well-intentioned bureaucrats will take these guidelines, and go down a similar path that was done with the 2016 CDC guidelines, and take these guidelines and codify them in many different ways.
I am also concerned that these guidelines seem to follow the Beers Criteria https://my.clevelandclinic.org/health/articles/24946-beers-criteria with the exception that they lowered the age to 60 y/o.
I did find this interesting on page 20:
Considerations for Tapering BZD5
The recommendations in this CPG should be interpreted in the context of shared decision-1
making with patients. In other words, when a recommendation says, “Clinicians should 2
consider”, it should be understood to include “in partnership with the patient”
In 2020, the FDA updated the required Boxed Warning for BZD medications to describe the 6
risks of physical dependence, withdrawal, and SUD.33 The associated Drug Safety7
Communication encouraged prescribers to carefully weigh the risks and benefits of BZD8
medications, limit the dose and duration to what is needed to achieve the clinical goal, and 9
monitor patients for BZD misuse and use disorder. When prescribing BZDs, it is important for10
prescribers to have a thoughtful strategy for medication management that regularly reassesses the11
risks and benefits of continued prescribing, as well as a patient-centered plan for tapering the12
medication when the benefits no longer outweigh the risks.13
The risks of BZD use continue while a patient continues to take the medication. In addition, the14
risk for physical dependence and BZD use disorder, particularly in patients who use alcohol or15
other drugs, increases with time.34 As such, long-term BZD use is frequently associated with16
more risks than benefits. Significant risks include oversedation, cognitive impairment, falls,17
motor vehicle crashes, and nonfatal and fatal overdose. 9 Despite this, clinicians often encounter18
patients who have been taking prescribed BZD for months or years.19
While short-term BZD use is associated with decreased anxiety and insomnia, it is commonly20
recommended that use not exceed 4 weeks, because at that point clinical benefits often decrease21
while risks increase.28,35 Meta-analyses of patients taking BZD for insomnia demonstrated minor22
improvements in sleep onset, increased duration, and decreased nighttime awakenings.36,37
23
However, therapeutic effects diminish in days or weeks due to changes in BZD receptor density24
and/or affinity resulting from chronic use, while risks continue. A meta-analysis of RCTs25
comparing BZD to placebo for insomnia in adults over age 60 showed 3.8 -fold increase in26
daytime sedation, and 4.8-fold increase in cognitive impairment and increased incidence of27
psychomotor effects (e.g., falls, motor vehicle accidents). 36 Another meta-analysis showed28
increased risk for fractures associated with current and recent BZD use in older adults.
https://youtu.be/nDZggME3uUo?si=SJASo-arlnn_ZL2b
Filed under: General Problems
[…] UPDATED:Proposed tapering guideline by American Society of Addiction Medicine […]
Really? Are medical professionals that stupid today that it takes 146 pages to tell them how to taper a patient off of a drug? I can see our profession has gone down the tube, but this is ridiculous.
A month ago I took my husband to the cardiologist saying he needs a cardiac cath because he has a blockage of the veins from his CABG. $15,000 worth of tests later, and we got the message that he has a major blockage and needs a cardiac cath. What’s wrong with this picture?
IMO, our healthcare system has drifted from the “practice of medicine” to the “science of medicine”, Probably having a lot to do with insurance paying for a procedure. A couple of years ago, I had to have a tooth pulled because it was “cracking”. Our Dentist (in his early 40s) is the son of the Dentist we started with in the late 70s. After about the 3rd X-ray he took and was still not happy with the image. I asked him, are you just trying to get a image for insurance reimbursement? I told him that my dental insurance (Master Card) has never questioned/refused to pay a claim submitted by this office. He put the X-ray machine away and got to the business of pulling my “defective tooth”.
Once we get done with getting rid of the CSA and attacks on pain managment, we need to make it law that medical professionals cannot be owned/employed by hospitals. I think a lot of the cost of medicine today is for these organizations to make money. Medicare is going bankrupt. If all doctors were independent, we would save 100’s of billions of dollars yearly in unnecessary testing.
I know that our PCP told me – before it was made public – about 12 yrs ago that the 6 man practice that he was in – one of the first to implement EMR that the year before he had seen more pt visits than ever and brought home $40,000 less and they were selling out to the local hospital – we are a one hospital small county. 2-3 yrs later our hospital merged ( sold out) to a larger hospital system in a large city in an adjacent state. All of the hospitals in the region we live in are now owned by one of the three major hospital systems in that city. There is 3 major hospital system, a medical school, 2 regional ped hospitals and a level one trauma center and Barney Clark – the first artificial heart transplant in the country in 1983 at one of those hospitals. Barb’s pain doc is in the teaching hospital. all the hospital systems are now using the EPIC EMR system.
AND YOUR A DOCTOR,,,DR.CHEEEK,,,,WHAT DO U THINK US PATIENTS GO THRU???YIKES,,,,,,,,,Short story here,i had my 1st cath at 27,,never knew or how important it was to stay flat for at least 8 hours,I came back from cath lab on a gurnee of course,,got to my room,,to my bed,,jump up of the gurnne,,got into bed MYSELF,,I WAS GONNA DO IT MYSELF DAMMIT,,STUBBORN IDIOT,,young and dumb,, everyone in the dang room just about fainted,,as did I once they got the blood stopped from pouring out my groan area,,dahhhhhhhhhhhhhhhhh,,,maryw