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‘I’m anxious and would like valium’ What to Cover in a 10min Consultation

‘I’m anxious and would like valium’ What to Cover in a 10min Consultation. Aled Davies . Case study 30yr old male Recently moved to area from Bristol No fixed abode Previous psych hx Drug abuse in the past – ‘tried everything’

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‘I’m anxious and would like valium’ What to Cover in a 10min Consultation

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  1. ‘I’m anxious and would like valium’What to Cover in a 10min Consultation Aled Davies

  2. Case study • 30yr old male • Recently moved to area from Bristol • No fixed abode • Previous psych hx • Drug abuse in the past – ‘tried everything’ • Started citalopram for low mood, now come back as meds not working, wants something stronger

  3. Explore reasons for wanting it • Anxiety/depression • Insomnia • Help comedown from amphetamines, ecstasy, cocaine or crack cocaine. • Withdrawal of alcohol • Counteract non-euphoric effect of methadone • Have they taken it before? • Help with voices

  4. Drug Cocktails • Benzodiazepines use in opioid users is prevalant and a major problem • Opioid users largest group needing help with this problem. • Opioid problem needs stabilizing initially with substitute • Used to enhance a primary drug, counter withdrawal symptoms of other drugs or for own intoxicating effects.

  5. Street Value: • Easily available illegally – are we contributing to this? • 10mg Diazepam sells for 50p to £1

  6. Risk taking behaviour: • Drug users show higher rates of risk taking behaviour • Chance to screen for HIV/HCV and engage in risk management.

  7. Where and when to use diazepam - NICE • Anxiety • Panic Disorders – not recommended • Generalized anxiety – not to be used beyond 2-4 wks • Depression • Short term use of benzodiazepines in mod to severe depression with agitation • Insomnia • Recommended newer anxiolytics e.g. Zopiclone and zolpidem for short periods of time.

  8. Available options: • CBT • Medications – SSRIs • Self help • Sleep hygeine

  9. What if prescribing diazepam is reasonable: • Give short course – can prescribe for instalment dispensing on FP10(MDA) • Start low • Urine tests x2 – to establish benzo use • Set clear goals and time frame • If using other types of benzodiazepams try and get onto one preparation

  10. What the pt should be clear about: • Addictive • Potentially more difficult to come off than opioids • Paradoxical aggression • Withdrawal symptoms in chronic daily users • Some evidence of cognitive damage with high doses over long period • Emotional suppression and reduce coping ability. • Unsafe injecting

  11. Reducing-dose prescribing • For future consultations • Regime for doing this • Needs to be properly monitored - ?within scope of GP.

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