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Benzodiazepine Guidelines for Sedative-Hypnotic Safety in Opioid Treatment Programs

Learn about the comprehensive benzodiazepine guideline developed to ensure safe prescribing practices in opioid treatment programs, addressing risks and evaluations. Implementation and highlights detailed for prescribers.

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Benzodiazepine Guidelines for Sedative-Hypnotic Safety in Opioid Treatment Programs

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  1. Sedative-hypnotic guideline, BHS Judith Martin, Md Medical Director of Substance use services, SFDPH

  2. Disclosures: • No conflicts of interest for this talk.

  3. Quality Management incident reports, 2010-2011 reviewed • 55 deaths came to the attention of CBHS during 2010-2011, of patients enrolled in MMT. (most from incident report, collected by Melissa Bloom, QI) • Focused on 14 opioid unintentional overdose deaths of patients in treatment (2 week window) • Tried to obtain medical examiner report • Collateral check of list from Phillip Coffin, Director of SUD Research, who is doing research on all city opioid overdose deaths.

  4. 2010/2011 accidental opioid overdose deaths reported by methadone clinics

  5. Cause of death and tox screen

  6. Possible areas to address: • 8/14 had sedatives present. • 8/14 had cocaine present. • Several noted lung disease as a co-morbidity. ( opioid overdose is related to breathing) • Most deaths occurred in patients long into treatment, ie “they’ve been on it for years” isn’t protective, misconceived as safe.

  7. Patients receiving buprenorphine at CBHS: Sedative/Hypnotic Prescriptions by CURES report: Michelle Geier, Pharm D

  8. Study Findings: Buprenorphine and Sedative/Hypnotic Prescriptions

  9. Active Infoscriber Orders Dec 2013 Benzodiazepines and Zolpidem Comparison

  10. Next steps taken: Presented information to CBHS executive team and to Medication Use Improvement Committee (MUIC) which formed a subgroup that developed a benzodiazepine guideline. CBHS prescriber quarterly meeting on January 9th dedicated to presenting data, guideline, and getting BHS prescriber responses CURES registration drive Implementation varies Use active prescriptions as measure

  11. Highlights of CBHS benzodiazepine guideline: (see handout) • Components: • - using non-sedative options • - risk analysis • - peer consultation • check CURES when prescribing or considering benzodiazepines • Evaluate for opioid use: pain, methadone, buprenorphine, etc. • Evaluate for history of or active substance use disorder, including alcohol. • Evaluate fragility, fall risk, age • Discontinue, taper, consult if above checks positive.

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