mortiz095

Recently, a colleague asked my opinion on the use of anti-anxiety medications called benzodiazepines in people either struggling with or recovering from an addiction (to something else of course.) Benzodiazepines (benzos for short) include common medications such as alprazolam (Xanax,) lorazepam (Ativan) and clonazepam (Klonapin.) Here is my reply: First, I personally think that the idea that no-one who is in recovery from an addiction should ever ever be prescribed another potential intoxicant is a remnant of the all or none thinking in 12 step groups and programs. It's not based in fact. Yes, there may be a relative increase in risk, but the risk of true addiction to benzos (as opposed to development of tolerance and physical dependence) in an anxious pt is near zero in most people so the absolute risk is pretty low in someone with alcohol or opioid addiction, for example. The same holds true for pain medication in alcohol dependent people. I try to balance risks and benefits as ...

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Here is a response I recently wrote to a colleague inquiring about my impression of pain management at United Hospital in St. Paul. The questions were about what proportion of inpatients were addicted to opioids and how to improve pain management in the hospital. Hi XXXX, The question about proportion of inpts with opioid addiction is complicated. First, the number of clear opioid addicts is small. These addicts are people who use heroin for example, or inject or snort other opioids. This also includes people who clearly have use that is out of control. Remember,  addiction is compulsive, destructive drug use.  Examples of this latter group are people who use far in excess of what is prescribed, who go to multiple doctors, who use to get intoxicated, and whose use is clearly dysfunctional. Pain management for this group is difficult and these patients are usually grossly undertreated, out of both ignorance and moral condemnation. However, the approach to these patients in...