Summers, Khan and the other doctors working at the clinic failed to conduct medical examinations or mental health examinations as required by law in order to legally prescribe these controlled substances. The amount of Suboxone and Klonopin which Khan and the other doctors prescribed depended on the amount of cash the customer paid rather than any medical reason.
Several customers who frequented this clinic testified that they were, in fact, drug dealers or drug addicts who sold the prescribed medications. Khan ignored the drug tests which showed that some of his customers were not taking the prescribed medications and he continued to prescribe them large doses of Suboxone and Klonopin. Summers, as well as two other doctors involved in this scheme, Dr. Keyhosrow Parsia and Dr.
Clarence Verdell, have pleaded guilty and have either already been sentenced or await sentencing. In this study, receipt of benzodiazepines during buprenorphine treatment was associated with an increased risk of overdose and death from all causes. The authors speculate that because benzodiazepines can increase respiratory depression, especially when combined with other sedating medications like buprenorphine, benzodiazepine use may increase the risk of overdose. While authors also mention the possibility that benzodiazepine prescription is simply a marker for more severe psychological symptoms, which themselves may place individuals at greater risk for relapse, their analyses controlled for anxiety and mood disorders and associated medications, making this alternative explanation for increased mortality risk in the benzodiazepine group possibly less plausible.
Though combining benzodiazepines with buprenorphine appears to increase risk for overdose and death, it also appears to decrease risk of buprenorphine treatment discontinuation.
It is possible that benzodiazepine treatment may lead to improved buprenorphine treatment retention because it can effectively treat factors like anxiety and sleep disturbance that can lead to relapse.
Additionally, the authors observed that former benzodiazepine receipt i. This might suggest that people formerly, but not actively prescribed benzodiazepines have under-treatment of anxiety and insomnia, leading to worse buprenorphine treatment adherence. It has previously been shown that having a psychiatric diagnosis in addition to opioid use disorder among those receiving buprenorphine is associated with improved treatment retention.
It is possible that this may have influenced this finding, such that those with co-occurring mental disorders who are inherently more likely to stay engaged in treatment, also happen to be more likely to receive benzodiazepines.
Alternatively, it may be that benzodiazepine use mediates the relationship between co-occurring psychological disorders and increased treatment retention. It is important to note here that the first-line treatments for anxiety and sleep disorders are cognitive-behavioral interventions.
Combining non-pharmacological approaches like cognitive behavioral therapy with buprenorphine treatment would be a safer, and probably more effective way to manage these co-occurring issues.
Park, T. Associations between prescribed benzodiazepines, overdose death and buprenorphine discontinuation among people receiving buprenorphine. Addiction , 5 , The Recovery Research Institute is a small donor-funded initiative. Your generosity makes our life-saving work possible. Mixing meds: Weighing the pros and cons of adding benzodiazepines to buprenorphine treatment for individuals with opioid use disorder Benzodiazepines a class of sedative medications best known by brand names like Valium, Xanax, and Klonopin may be prescribed to patients who are receiving buprenorphine treatment for opioid use disorder an opioid agonist medication best known in formulation with naloxone, marketed as Suboxone.
Figure 2. This could have biased the results in unknown ways. Massachusetts prescription records show fill dates, not collection dates. Thus, there may have been a lag between the fill date and the date the patient collected the medication. This could also have biased the results in unknown ways. Thus, they were not able to determine which opioids or benzodiazepines, contributed to or were actually present at the time of death. Is buprenorphine a synthetic opiate? When can I take Subutex?
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