Not sure about the NP’s, but the office staff you’re hiring may be specifically seeking out employment at offices like yours because they think they’ll have access to these scripts.
The part of the policy about not prescribing to staff and staff not asking to be prescribed meds exists because of this. It was a huge problem before we enacted it. It's fairly common for applicants to choose not to seek employment with us once we mention the policy.
I've been an admin in medicine for the last 6 years, and I could never imagine asking of the Dr's I support for a script for topical lidocaine, let alone a controlled substance. I *need* a high dose of Vyvanse to make it through the day, so there is no way in hell I'm (1) putting my job at risk or (2) getting a black mark on my medical record as a drug seeker. Just... just NO!
Isn't it standard practice to not get scripts from fellow employees? I could see maybe a big hospital allowing it, but all the smaller shops should avoid such practices right?
The comment I’m replying to is saying that people might be attempting to work for OP for nefarious purposes.
I related it to another profession that tends to have issues with people seeking work there for nefarious purposes.
I took it to mean necrophilia, which would be easier for men to achieve in a morgue than women🤢. Basically, people with specific addictions/fetishes will gravitate toward professions that facilitate their "needs", forcing those professions to weed out their applicants to minimize problems.
Research shows almost all young people with gender confusion eventually align with their biological reality.
What kind of people choose surgery as a career and then chop off / mutilate a child's reproductive organs, followed by the individual realizing they made a horrible mistake listening to adults who reinforced rather than resolved their confusion...
Isn't it super easy to get prescribed benzos by any other dr rather than specifically getting a job in that field, convincing the staff to prescribe it, and then risking your job? For real I may be out of the loop, but aren't benzos incredibly overprescribed? The amount of people who have anxiety these days and are given benzos is pretty high. It doesn't seem like it'd be worth all that trouble..maybe I'm wrong though
Your rules seem sensible and reasonable. I don’t get why anyone would jeopardise their job by breaking them unless they were stupid, so I suppose it’s also a good litmus test for that too.
Thank you. I don't understand it either. If it's not a rule they want to follow they have lots of options around us that are seemingly more permissive in these matters. I'd really prefer not to need this litmus test.
I’m a nurse practitioner and cannot understand why a fellow NP would break your simple and practical rules. We also do not prescribe benzos at my clinic and I’ve never broken that - it’s actually nice to blame it on clinic policies.
I had the same experience. I asked the doctor for help to come off of it safely. He told me I needed it and wouldn't help. I had to withdraw on my own. It was brutal.
When you are on a high daily dose you virtually have too go inpatient and be monitored because the dose has to be titrated down so slowly it is very hard for an addict to have that kind of discipline on an outpatient basis--but a doctor with a busy practice really cannot do this with you.
Did that same doctor get you on the dose to begin with?
He did, indeed. I was on 1 mg 3x daily. I don't think I was on it long enough to need to do all of that. I started by taking half of one of my doses for a couple of weeks, then dropping it. I did this all the way down. It took a while. I went back to get refills in the meantime without him knowing what I was doing. The panic attacks at every drop were insane. Ten times what they were before I started the xanex.
I have pretty bad anxiety and I refuse to take SSRI's. I have not found one doctor who would prescribe me something other than a SSRI. I wonder if this has anything to do with the abuse of those class of drugs. Instead, I'm just suffering through life lol.
It is extremely smart of you to do this from a legal perspective. You are giving your practice some barrier of defense against lawsuits from patients who become addicted (so many will!).
Best defense is to make your staff NPs contractors-make them sign the same contract as before but make them get their own malpractice insurance and assume their own liability for this negligent conduct. At this point you are still one patient away from a practice ending lawsuit.
I’m an NP and this absolutely boggles my mind….maybe it’s because I work in a reputable organization associated with academia, but I have never met any PAs or NPs who would be willing to do this. Hell, I hesitate to write codeine cough syrup for patients half of the time. The DEA tracks those prescribing trends on our individual license, I would suspect this could possibly be reported for prescribing to non-patients? It would be a cold day in hell before I would prescribe scheduled medications to office staff🤣
I report it as prescribing to non-patients and have never seen anything come if it.
I know other practices in the area allow it and I can't get my head around that either. Maybe it works for them though? I've never actively allowed it and when it's happened it's been a disaster.
I’d also file a complaint with the state licensing board. I’m not sure how prescriptive authority works if you’re in an independent vs collaborative state, but I’d want to make sure you’re covering yourself and your practice.
I know there are loopholes for prescribing non-scheduled medications, frowned upon but not “illegal” per se, however, I’m fairly certain there needs to be a paper trail of charting for scheduled especially with all of the constantly changing rules and requirements for in-person patient assessment. I hope you find an NP worth your time. It’s a shame these providers have chosen to be a reflection of our career. Are these NPs newer to practice? There are various alternative PRN medication options for anxiety, etc.
I'm not a fan of loop holes, too old to keep up with what is needed to follow them. There absolutely must be a paper trailer for scheduled, new rules and regulation take up enough of my attention.
Of the 10 I mentioned most have been less that 2 years in practice, the ones that lasted longest have been at it for 5+ years. I hope to fine one that lasts, they've all been liked by the patients and I think they've been very helpful with patient retention.
Maybe add this to the document they sign- that you will report it as prescribing to non-patients. Hopefully this even stronger boundary, that outright threatens their license, will help
I'm a pharmacy tech. It is insane that at least once a week we have to turn away a provider trying to write a control for themself. Some people do not seem to mind gambling their license.
I'm also baffled. Who dumps their career path for this? Who would even hire you after something like this? And who thinks they're going to get away with it after so many did not? So strange.
Spent much of my live in Appalachia. We get a lot of medical professionals who’ve been in trouble elsewhere and had to leave. Probably the same for poor urban areas. Who would want to work there? Only the people who have a record and can’t get work at any reputable place.
Grew up in the foothills of the Appalachia, and the doctor I saw as an adolescent and teen went to prison for basically running a pill mill. He was a creepy dude as well.
He offered to *counsel* me at age 14-15 instead of a therapist. Said he understood what I was going through. He also tried to insist on doing a Pap smear on me when he knew his nurse had just left the room to make a referral to a women’s clinic.
It’s wild to see the blatant stuff that goes on, particularly in smaller towns and cities where the corruption runs rampant.
It’s crazy how many people do! I work in criminal defense and we have had many many clients who are drs, pharmacists, etc. the feds watch them for YEARS before indictment so they have no idea they are being watched.
I tried that codeine cough syrup and it did nothing for my cough. I also don't understand why anyone would drink that stuff on a daily basis since it did nothing for me.
Some of us are just markedly less sensitive to opiate analgesia, it's a fairly common genetic quirk- look up "A118G". Both myself and my mother get more pain relief from naproxen or a tiny benzo dose than from codeine or morphine. I had 2 doses of oramorph in emergency with badly slipped discs, literally no difference made at all. All I've ever gotten from opiates was dizziness and constipation.
There's a whole list of possibilities. Red heads for instance tend to be resistant. Obviously other genetic mutations too. Then there's things like connective tissue disorders like EDS. There's things like leaky gut syndrome which can make pills not work right.
As a redhead, got cough syrup with codeine years ago for pneumonia. I either didn't listen or it wasn't instructed on how much water to drink. Constipation was rough.
I also get sick from anesthesia/narcotics. Tylenol/ibuprofen is what I use. Plus I have a high pain tolerance from having super horrible periods as a teen and not being able to swallow pills.
High pain tolerance, high anaesthesia tolerance, low cold tolerance, low tooth/mouth pain tolerance, and a whole list of others. The mutation that gives us red hair actually affects a lot of the body.
As a redhead I can confirm. I always have to have extra numbing at the dentist. I was prescribed opiates one time for severe tooth pain. It just made me feel worse. I can’t take anything with codeine, it hurts my stomach terribly.
Same. I shrug off lidocaine and novocaine like they’re nothing. High pain tolerance except when it comes to the dentist. I’ve had a lot of barely-restrained eye rolls from medical professionals when I try to explain any of this. I also have weird reactions coming out of anesthesia. But if I tell you this and you don’t believe me, you can’t get mad if I wake up and rip out everything attached to me and take off.
Promethazine with codeine works great- or at least it knocked me out so I have no idea if I was coughing in my sleep. The only thing I’d try to get prescribed is antibiotics because I get chronic sinus infections and polyps.
Yeah that's what everyone else says. It doesn't make me tired at all. For me it was just a waste of time and money. I will never take that stuff again. But there are a couple of meds that are supposed to make you hyper or sleepy and they don't do that to me.
Just because it did nothing for you doesnt mean someone else wouldnt gamble their license to get their hands on it. Your experience does not match 99.9% of the people who have been prescribed it or use it recreationally.
Now at what time I say anything about other people? I described a personal experience and indicated that I didn't know why people want that in the hopes someone would be able to explain it to me and not start gate keeping like.you did.
That’s wild. Next time before you hire someone spell out that SEVEN people before them have been fired for violating the regulations. Make sure they understand that they will be immediately fired. Put up signs in the break room. People are dumb and forgetful.
“Pshh those people only got fired for getting caught unlike me who’s so smart, now let me send a prescription that can be traced back to me, man aren’t I smart”
Stupid question incoming: Are they just reading and signing this policy, or are you specifically sitting them down and saying ‘We lose people to this policy more often than you would think, so before signing this I just wanted to go over it verbally and make sure you understand.’
Yes they may read it. But specifically pointing it out and making it clear that you follow it and they will be fired may help them internalize it.
If you are one of these folks who say ‘I shouldn’t have to explain a simple policy to an adult with an advanced degree!’ I agree. You shouldn’t have to. But that doesn’t mean you don’t have to.
All the comments criticizing not prescribing benzos…Doctors can practice however they want and patients are welcome to seek care elsewhere. If a doctor doesn’t want to prescribe a certain medication they are well within their right not to. Some surgeons choose not to do certain surgeries. That’s their choice as well. I wish more people understood the administrative burden practices are under.
You can count on redditors to take personal offense to someone providing a specific service that does not happen to include something they want or need.
I can't figure out how to quote, but the OP answered this question on another comment. Basically, they're a massive problem in that specific area and keeping up with the proper compliance was too much for the practice. Fortunately, there are several other larger places where patients may go if necessary.
To quote my other post
> Abuse and general misuse of benzos has been rampant in our area for years and dealing with that had become overwhelming to me and my staff. Before this policy existed we were spending an inordinate amount of time to dealing with benzo related issues and it was impacting patient care as a whole.
Wait, Neurol/Xanax is a benzo? The pill I got along with my very first anxiety diagnosis years ago, and that I stopped taking because I felt like it wasn't even doing anything (at least in the dosage they gave me)? Wow. Sounds like I've been missing out if people take that for recreation...
I think it's rare for the dosage prescribed by a doctor to be enough for recreational use, especially at first when they're giving you the most cautious dose. That or you're one of the people that specific medicine doesn't work on. It usually takes some tinkering to find the right prescription and dosage for each individual person.
Because the people at the top would rather us end up 6ft under than to trust doctors to do the right thing. My PCP basically told me that her hands were tied and that she couldn't prescribe me any benzos. I could tell she felt bad, but they have to protect themselves. It's ridiculous that my boomer grandmother had a regular script for Xanax but my Dr couldn't give them to me for a brief period of time.
I don't live in the US but here also psychiatrists tell in their bios they don't prescribe benzos. In my case, I have been able to get prescriptions but in practice I only need it renewed like every two years or so, and the doctor can see this from a national database. I have approximately a pill per month at max, so a bottle of 30 pills serves me just well and more. The biggest thing about it is that I know that I have them, so that when I have bad anxiety I get relief from that knowledge and I can push through the moment without medication, because I know if it gets worse I have the relief. The thing is, the baseline needs to be dealt with other meds, like ssri's or in my case a mild antipsychotic. Luckily my doctors have been understanding and also have had proof of my usage, so they have been happy to prescribe me, because I feel like dealing with my anxiety would be harder without them.
Thank you, this is exactly what I was trying to say! Some of us need a "rescue" option that can lessen the anxiety and panic when it gets to be too muxh.
I work in health insurance and I'd be happy to help look for loopholes to get it covered if you need it. My point is that you should have access to what works for you, not what they think should work for everyone.
My grandmother wasn't a junkie, but she was definitely dependent on it after my mom died. Let's not forget that the shit on the streets isn't coming from a pharmacy. I'm not saying to prescribe benzos to everyone who asks.
Clearly you don't understand why some people may need access to benzos. The one thing that FINALLY worked for me isn't even technically for anxiety, but combined with THC it works 🤷🏻♀️. Someone with a diagnosed anxiety disorder should have access to what works when they need it. They're not doing any good by denying people the shit that they know works. I asked for 10 with no refill and still got told "sorry but no", so the point doesn't stand.
My PCP manages my psych meds, so it's relevant. There aren't "PLENTY" of options when you've tried them all and had no success. I gave up my CDL because THC was my only option left.
My doctors office has main dr & NP. If I'm there for annual checkups I will see NP if the MD is unavailable. My hubs can only see the MD as his prescriptions are heavily regulated. NP's not allowed to prescribe certain meds (been this way last 20 yrs). I'm talking small town, not even a stoplight & we understand (well, I understand). Sad they are risking their livelihoods on stupid choices. Especially the schooling PA's have to go through.
With all respect to you and your profession, I must say that if 10 people all made the same mistake or behavior, it’s now reasonable to wonder if your communication skills are somehow amiss or if there is some confusion. At the very least your screening process is lacking. 10 is too many. Something is wrong.
What communication skills? Its in the damn contract. People that give out medicine should be reading important documents IMHO. And I cant imagine they dont get told, when signing it.
> communication skills are somehow amiss or if there is some confusion
The policy is both part of the contract all providers sign and on a totally separate form that they also sign. I'm very clear with everyone I hire about it before we ever get to signing paperwork. I'm not sure how much clearer it can be.
My old practice was one owned by a psychiatrist that specialized in addiction medicine. Our contracts specifically spelled out that an arrest or conviction for any drug or alcohol related crime was grounds for instant termination. Even the support staff was required to sign it. It was frequently mentioned in staff meetings as well. But it didn’t stop the front office person from showing up drunk on a Saturday morning, only to be found passed out in medical records. She drove herself to work, and later tried to sue over her firing.
As someone that's worked on healthcare, nah people have high egos and will purposely choose to go against what you said. I've noticed it to be especially prevalent coming from staff towards physicians, especially if it's a female physician.
People will be catty
It was a problem at the federally funded non profit I worked for, an NP prescribed our own regional manager and everyone else without being quiet about it. I was given scripts for benzos and adderall.
Those patients are welcome to seek care any of the 3 (soon to be 4) larger practices that are willing to prescribe and ensure compliant use of benzodiazpenes.
Abuse and general misuse of benzos has been rampant in our area for years and dealing with that had become overwhelming to me and my staff. Before this policy existed we were spending an inordinate amount of time to dealing with benzo related issues and it was impacting patient care as a whole.
I sell high end home treadmills sometimes. As in, the 4-8k life fitness home units. They are just commercial gym units repackaged for home use, and meant to run on 120. But, they need a dedicated receptacle that puts out a minimum of 25amps. Standard outlets do not do this. You have to run a dedicated line to use these units, which is not a big deal for the people purchasing them, they are filthy fucking rich. You know what they don't do? Listen. I explain this to them via email before delivery, in person, and explain to them we can test the unit, if you run on it for any extended period of time, even once, you will cook it. I show them the label on the motor that says the amperage requirement. Legitimately 50% of the people I sell these units to fire them up and cook them that day, or the next. Then I get angry calls and texts, and I send them the recording I made explaining to them that if they used the unit without running it on a dedicated receptacle with the proper amperage, they would destroy it. No refunds. Then I send my buddy to go get the cooked unit and we use it for parts. People who lie to everyone think everyone is lying to them, so they like to do the opposite of what you tell them to feel superior or some whack shit, I dunno. I just know those fucking idiots keep giving me money, and I keep getting back broken high end treadmills.
As someone who's worked in a client facing role, oh my fucking god you're so right. People absolutely do not read or listen. Even if you spell it out clear as fuck.
Yes, every single client-facing role I've had has put me into contact with people who refuse to listen to things spelled out to them verbally, on writing, and via signage. The issue with them is that they see all of us working these types of jobs as below them, due to being less rich or degree-holding or elite or whatever, and so they automatically think they know better than us despite all evidence to the contrary. And when their pride becomes their downfall, they still make it out to be our faults because they'll just double down the know-it-all attitude. But that's what happens when you don't treat everyone equally and fairly and with kindness.
I used to work in a fairly large psych practice (therapist) and can attest to the ass-pain benzodiazepines can cause. It’s definitely an example of one rotten apple spoiling the whole bunch.
My psychiatrist-owner originally had five locations. One had to be closed specifically due to benzo issues. It was in an adjacent county that was #1 of the 100 counties in our state for benzo scripts. That was the office that had someone crash into the building twice in one year, was repeatedly broken into, and had 50x the number of early refill requests, most with very long, involved stories about why.
My boss still wrote benzos, but he was also willing to fire patients for misuse, which he made clear from the get-go.
One more example was a doc in our county that also had his own pharmacy. He was eventually arrested for pharmacological shenanigans and closed his practice. His patients were SCARY. He had a lot of them on up to 12mg of Xanax or klonopin a day. The max my doc would do in rare circumstances was 3. Every practice in the area was flooded with these folks, and they all needed medical detox.
I totally get OP’s stance, especially for a small, independent clinic. If you’re affiliated with a large system, you have their attorneys and pockets to use in the case of a negative outcome. If it’s your own pocket, you’ve got to protect it.
As far as in house prescribing, **DUH!!** At least it weeds the problems out quickly.
People in my area are the reason I don't carry my Ativan nasal spray for my epilepsy. Benzo addicts will take it without a second thought.
You're doing good work and holding people accountable. Keep it up!
Maybe cite this exact comment in your edit. It has a few details (mainly that there are other accessible options for people who do need benzos and that it was not just a huge effort but actively impacting patient care) that seem to be important context
Yeah I had to take Valium for awhile because my anxiety got to insane levels and Xanax left me worse off when it wore off. I took two a day as needed and it made a world of difference. Eventually I noticed I only needed one a day and eventually none. Then one day I stopped because I just wasn’t needing them at all anymore. Those things saved my life.
Same! I was at two Valium a day for anxiety and a clonazepam at night to sleep. I don’t know what I would have done without. I’m on one Wellbutrin now and occasionally a melatonin to sleep but I don’t think I’d be here if it wasn’t for the benzos I needed before.
So I think you're all missing the point of the post. He never said that benzos didn't have their place, their place just isn't at his clinic. He's mentioned multiple times that the issues prescribing them caused outweigh the benefits of prescribing them but that there were multiple clinics near to his that would prescribe them
No I totally agree with the point of his post. It’s ridiculous they can’t keep staff because they all seem to refuse to follow a simple (and correct) rule of the clinic. Those people are informed and sign a contract knowing what will happen if they break that rule.
It’s obviously just bonkers to all of us commenting and focusing on the Benzos that a mental health clinic refuses to prescribe them at all. I understand they can be very addictive and easily abused if someone chooses to do so. If I had not already been on just about every ssri over the years plus Xanax at one point and found that they were not helping me, my doctor would not have resorted to Valium. So there are hoops you have to jump through (in my case) to prove that was needed as a last resort. I know not all measures clinics take can prevent abuse of prescription meds, but for those out there with a true need of them or that have been helped by them to completely deny access to them seems cruel.
It’s not cruel, and it’s a normal policy in plenty of places. Go to a place that prescribes them. Entitled people don’t like it, but doctors use their judgement for a reason.
I am far from entitled lol. I just think it’s weird to deny a medicine that can help people when other options have failed. Could they go to another doctor? Possibly. In the US though between insurance network limitations, or maybe even the option to travel to find a doctor or clinic near them without such restrictions as this clinic may also not be an option. Then the fear of jumping from doctor to doctor to find someone that will prescribe the meds you need will possibly make you look like you are doctor shopping to abuse the meds when all you are doing is trying to get the help you desperately need. A flag on your record like that follows you the rest of your life. So yes under some circumstances it would certainly be cruel to deny someone the help and medication they need.
You are entitled. You’re not a doctor. No one is obligated to prescribe to you.
This is how the opiate epidemic happened, people demanding doctors prescribe certain stuff and doctors using bad judgment.
I briefly had a script for small daily doses of Ativan. While my Dad was dying of cancer, and for a short while after his death. I’m the one who told my provider I didn’t want anymore refills. When I stopped them, I had bad insomnia for 4-5 nights but besides that, didn’t have a hard time.
I've got to say, the relief Xanax gave me for my PTSD after a car accident was what triggered me to finally realize I had an undiagnosed anxiety problem. I now get a standard and non-addicting treatment for my anxiety. Highly recommend, 10/10, would medicine again
Agree. I needed benzos after having my baby due to severe PPA, and took them very carefully and haven’t had them since. Depriving patients of helpful medication seems counterintuitive to why most people claim they get into healthcare in the first place.
Because “doctors” like this label everyone as an addict or an abuser before they even evaluate them or hear their symptoms and story. It’s literally why people struggle and end up resorting to getting them (or worse alternatives) from their local dealer. The middle class trash whose diets consist of Zinfandel and Xanax and their 15 year olds who cop from them for their friends to party with have done irreparable damage to doctor’s trust in anyone, and at the expense of innocent people’s well-being and sanity.
That's literally not what he said LOL he said they did allow it for a while but they were spending so much time dealing with the issues prescribing them caused and that took away from the actual time they had to spend with all of their clients.
And do you honestly not think people who are addicts can't come up with stories and symptoms?
Thank you for the benzos rule. Legally prescribed benzos turned my mother into a junkie who thought of nothing but her next fix. They are dangerous. Sure you can take them safely, the same way guns can be handled safely by the people properly trained to use them. They're still a problem in the hands of people who don't respect them. I'm sorry you're having to do this, but at the same time, I'm really glad docs like you understand the true nature of the drug.
ITT: People who don't work in healthcare and have no experience dealing with patients. Providers are not just vending machines to give you whatever drug you think you need. Not every provider is required to prescribe the medications within their scope of practice. If you don't like it, take your case elsewhere. And recognize that a few bad apples (or in OP's case, many bad apples) spoil the bunch and OP has drawn a hard line for the practice. Perfectly within his or her rights to do with their OWN PRACTICE.
From someone who suffers debilitating panic attacks I am grateful my provider prescribes me benzos. I might need about two pills a year and they help when I need them. They also give me peace of mind to know I have something there just in case.
Doctors like this guy are so upsetting. Refusing to prescribe a needed medication is a failure to perform his duty as a doctor. What if he doesn’t believe in insulin? Would he tell diabetics to hoof it up the road?
Yes, some people are going to abuse the medicine I need, but does that mean I shouldn’t have access to the best medication for my condition?
Yes yes yes. He’s a psychiatrist. Psychiatrists prescribe psychotropic drugs. Benzos are psychotropic drugs with certain indications relating to psychiatric care. The fact that he can’t even understand that sometimes benzos are INDICATED is wild. I work on an inpatient psychiatric hospital unit, so I understand my experience is a bit skewed but it seems so is his. I’m sure he understands the risk of TD when he prescribes antipsychotics but he scripts them out because they are INDICATED. Don’t be a doctor if you choose kissing the DEAs ass over your patients mental and emotional well-being.
I’m surprised they don’t get anything from you having reported them. I’ve been a practicing PA for 14 years; when I was in IL, I’d show the students and other folks who shadowed me the professional regulation and licensing website. The vast majority of dings against a provider’s license were inappropriate prescribing and DUI. We’re licensed professionals, and society expects more of us.
At any rate, I hope you find some good people. I’m in command of an operational stress control unit in the Reserves, and have some great behavioral health folks. They’re out there.
I have been on benzos for years following the death of my daughter and granddaughter. I never abused them. I am ready to get off them as I feel like they have done their job. I really needed them to be able to keep working. Very low dose and never increased. My doc and I mapped out a plan and schedule, a slow one. He told me that people getting off benzos scares him more than anything else.
Lorazepam is a lifesaver when it comes to anxiety. I didn’t even realize that most of my verbal venting and stress from work was a form of being anxious; taking a dose helped a LOT. However, I am extremely careful with it and never take it more than 2 days in a row, and oftentimes I will only take it half a handful of times a year. I never even realized how serious a class of drug it was until I recently had to sign a form at my doctor’s office.
I am so thankful I have access to what I need, and I am very aware that I have a responsibility to use these safely and responsibly. I’m so sorry you have had difficulties in the past.
It just seems like such a waste to me. NPs make a lot more money than I do. Why throw the job away? Especially after working so hard yo get the education and license.
What kind of psychiatrist doesn’t EVER prescribe one of the major drugs used for acute psychosis and anxiety? We all know there’s a risk for abuse, but sometimes people need a mfing benzo.
The kind of psychiatrist who doesn’t see decompensated or severely mentally ill patients. Such psychiatrists were rare when psychologists and LCSWs monopolized low-acuity mental health with talk therapy, but now because everyone gets SSRIs there’s a plenty of business for low-acuity therapists who have access to the scrip pad.
The government makes it outrageously risky to prescribe benzos and opioids in any kind of non-acute setting.
the kind of psychiatrist who knows there's 3 larger practices in the area who do prescribe them, and whose practice was so bogged down with the administrative process around prescribing benzos that patient care was impacted.
You may want to verbally address this issue when hiring and on their first day. And stress that they WILL absolutely be immediately fired. And just ask them if their job is worth it for 'doing a favor' for a co-worker.
Are you doing drug tests prior to employment? Idk it seems wild that you hire someone, that does not have a problem. And then they immediately have a problem.
Why not do Interview, Drug test, then background check.
I cant imagine drugtests would not weed out and be cheaper then hiring, onboarding, firing.
Also, i dont know the rules. Im not sure if Drs. And nirses have the same HiPAA rules. But are you not allowed to look at prescribed medications and prescribing history?
This is actually really wild. My psychiatrist gives me Xanax just so I can go to the dentist because I have dental trauma. Some people legitimately need them to help them be calm in certain situations. My psychiatrist only gives me like ten at a time to make sure they aren't abused (even though I wouldn't I can't stand how they make me feel but I have to take them for dental appointments). You're doing a disservice to your patients.
Have you tried to go to some dentist that is better for these issues. I slept through a root canal at my dentist and they gave me some light sleeping pill. Best root canal ever.
Unfortunately no, the only other option I've been told is to have dental work done in a hospital setting. I've only found one dentist in my area that's willing to actually listen to me and respect my trauma. >!I was sexually assaulted as a child by my uncle who was a dentist while he was examining me!<
Have you tried like a university school or dentistry? That's where I got my root canal and everything else done as I had dental issues as a child. And since they have both sexes there, you could ask for an only female team to work on you.
From all the visits, I never had any pain and they took me more serious than any dentist office I ever went to.
Besides this, dentist offices send patients there where the offices pain management doesn't work anymore.
So I am not sure where you are but I can highly recommend university dental schools. Or at least the one in San Antonio Texas.
I tried the one in my city but they said they don't offer that and when I contacted my dental office about they were flabbergasted and felt bad because that's where they referred all their patients too who need a hospital setting.
I am sorry to hear that. While I don't know how it feels, since I never had something happen like it did to you, I have a friend and she had a similar experience as a child. From her I know at one point it will get better. She was afraid of large hands and I have large hands. But she overcame it. I hope you will get to that point as well.
Wait... so you don't want to prescribe stuff that might actually help?!? I literally broke my back and my f*ing doctor told me to take Tylenol... F*ing TYLENOL! I went to a specialist and they put me in emergency surgery and made a formal complaint on my behalf.
Benzos are highly addictive and not indicated for long term use (because of addictive potential) even for anxiety and panic disorders. They work on the same receptor as alcohol. Sure they can “calm” you down during an acute panic attack or use of stimulant, but that’s an acute situation.
Because of its addictive potential certain states hold docs responsible for monitoring its use very closely. Pill counts, urine toxin screens, checking the National database for repeat prescriptions, and monitoring refills are just SOME of the things I know pain docs have to go through to prescribe opioids, i image it’s similar for benzos. Imagine that for 100s of patients, it’s just not sustainable.
I had to google what benzos were. Imo especially in a workplace environment where drug abuse is common, this policy sounds sensible. Super upfront. Like, dont shit where you eat type situation.
I tell all my doctors I don't want this shit. It's a bandaid and doesn't help the actual problem. Same thing with pain pills. I try to just live my life with pain and anxiety because the alternative with pills just makes me dull and boring. Benzos are a sad part where they help make me feel normal but it's an artifical normal. It's not natural like being outside on a sunny day with no shoes on in the grass.
I got a lit cigarette in my eye and they gave me perc 10mg. When I took 1 for the first time I couldn't drive and I couldn't even talk. I couldn't go to work that day because I was drugged up. I asked for the lowest dose possible and they gave me that??? Like I was gone and also only weighed like 125lbs. Who likes that feeling?? It's so terrible.
As somebody who works in a pain clinic that doesn't prescribe short acting narcotics, I get where you're coming from. Our rules are very strict, and patients, pharmacists, and potential hires always have something to say.
Hang on, you fire the person who wrote the script for an in-house worker, but _not_ the employee who asked?
If the rule is “no one prescribes benzos to staff”, shouldn’t the policy _also_ be “staff must not ask for benzos”?
I can totally see a situation where a new NP may feel pressured by an office worker who’s been there longer to prescribe to them, or even an office worker thinking it’s funny to screw with the noob by demanding they break the rules and telling them “nah, it’s ok, they never enforce that!”
Especially since you seem to have an office of predators, if so many of them see the new NPs as an opportunity to score. Sounds like your NPs are getting harassed and threatened by the office staff to give them the scripts.
Have you _talked_ to any of these former employees and asked _why_ they wrote the scripts? Maybe the one who sent it to your in-house pharmacy felt (or was threatened) that they couldn’t say anything directly and so sent it in-house in the hopes it would get flagged and the office person would get pulled up for _also_ breaching the policy.
Currently, it sound very “rule for thee and not for me”. If an employee asks, they should be fired immediately, too.
>So many NPs seem to take that policy as a challenge to prescribe as much of the benzo of their choice to the first office worker who asks so they can get fired. **To say nothing of my office workers who seem to take having a new NP on staff as on opportunity to score...and then promptly lose their jobs.**
You have to read the whole post.
NPs aren’t doctors. OP is the supervising doctor for the NPs she employs. As the supervising doctor, she essentially co-signs every prescription they write. Yes, she can dictate what they prescribe while they prescribe under her license at her practice.
Some NPs are doctors. DNP, not MD, but they have doctorates and have the same prescribing capabilities. And depending on the state, NPs can practice independently, unlike PAs.
Not sure about the NP’s, but the office staff you’re hiring may be specifically seeking out employment at offices like yours because they think they’ll have access to these scripts.
The part of the policy about not prescribing to staff and staff not asking to be prescribed meds exists because of this. It was a huge problem before we enacted it. It's fairly common for applicants to choose not to seek employment with us once we mention the policy.
I've been an admin in medicine for the last 6 years, and I could never imagine asking of the Dr's I support for a script for topical lidocaine, let alone a controlled substance. I *need* a high dose of Vyvanse to make it through the day, so there is no way in hell I'm (1) putting my job at risk or (2) getting a black mark on my medical record as a drug seeker. Just... just NO!
Isn't it standard practice to not get scripts from fellow employees? I could see maybe a big hospital allowing it, but all the smaller shops should avoid such practices right?
It's easier to offer to write a script than pay for insurance for staff at a small practice.
100%. My mother is addicted to benzos and based her whole career, as an administrative assistant in medical settings, around it.
Reminds me of a tweet I saw the other day that was basically: Morgues prefer to hire women. Yeah, that’s the reason.
This is why we can’t have nice things.
>Morgues prefer to hire women. Morgue ? Women ? Benzos ? wut
The comment I’m replying to is saying that people might be attempting to work for OP for nefarious purposes. I related it to another profession that tends to have issues with people seeking work there for nefarious purposes.
I took it to mean necrophilia, which would be easier for men to achieve in a morgue than women🤢. Basically, people with specific addictions/fetishes will gravitate toward professions that facilitate their "needs", forcing those professions to weed out their applicants to minimize problems.
I hate this planet sometimes
Research shows almost all young people with gender confusion eventually align with their biological reality. What kind of people choose surgery as a career and then chop off / mutilate a child's reproductive organs, followed by the individual realizing they made a horrible mistake listening to adults who reinforced rather than resolved their confusion...
what are you on about?
Isn't it super easy to get prescribed benzos by any other dr rather than specifically getting a job in that field, convincing the staff to prescribe it, and then risking your job? For real I may be out of the loop, but aren't benzos incredibly overprescribed? The amount of people who have anxiety these days and are given benzos is pretty high. It doesn't seem like it'd be worth all that trouble..maybe I'm wrong though
Yes, they are incredibly overprescribed. I agree with your assessment.
Your rules seem sensible and reasonable. I don’t get why anyone would jeopardise their job by breaking them unless they were stupid, so I suppose it’s also a good litmus test for that too.
Thank you. I don't understand it either. If it's not a rule they want to follow they have lots of options around us that are seemingly more permissive in these matters. I'd really prefer not to need this litmus test.
I’m a nurse practitioner and cannot understand why a fellow NP would break your simple and practical rules. We also do not prescribe benzos at my clinic and I’ve never broken that - it’s actually nice to blame it on clinic policies.
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I had the same experience. I asked the doctor for help to come off of it safely. He told me I needed it and wouldn't help. I had to withdraw on my own. It was brutal.
When you are on a high daily dose you virtually have too go inpatient and be monitored because the dose has to be titrated down so slowly it is very hard for an addict to have that kind of discipline on an outpatient basis--but a doctor with a busy practice really cannot do this with you. Did that same doctor get you on the dose to begin with?
He did, indeed. I was on 1 mg 3x daily. I don't think I was on it long enough to need to do all of that. I started by taking half of one of my doses for a couple of weeks, then dropping it. I did this all the way down. It took a while. I went back to get refills in the meantime without him knowing what I was doing. The panic attacks at every drop were insane. Ten times what they were before I started the xanex.
I have pretty bad anxiety and I refuse to take SSRI's. I have not found one doctor who would prescribe me something other than a SSRI. I wonder if this has anything to do with the abuse of those class of drugs. Instead, I'm just suffering through life lol.
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I'm glad that you found something that works for you!
Can I ask why you are scared of SSRIs? They're much safer than benzos and really good for anxiety
Alpha Genomics has an awesome genetics panel that they run for medications! I’m so glad I paid cash to do it years ago!
It is extremely smart of you to do this from a legal perspective. You are giving your practice some barrier of defense against lawsuits from patients who become addicted (so many will!). Best defense is to make your staff NPs contractors-make them sign the same contract as before but make them get their own malpractice insurance and assume their own liability for this negligent conduct. At this point you are still one patient away from a practice ending lawsuit.
Addicts will try anything they can
I’m an NP and this absolutely boggles my mind….maybe it’s because I work in a reputable organization associated with academia, but I have never met any PAs or NPs who would be willing to do this. Hell, I hesitate to write codeine cough syrup for patients half of the time. The DEA tracks those prescribing trends on our individual license, I would suspect this could possibly be reported for prescribing to non-patients? It would be a cold day in hell before I would prescribe scheduled medications to office staff🤣
I report it as prescribing to non-patients and have never seen anything come if it. I know other practices in the area allow it and I can't get my head around that either. Maybe it works for them though? I've never actively allowed it and when it's happened it's been a disaster.
I’d also file a complaint with the state licensing board. I’m not sure how prescriptive authority works if you’re in an independent vs collaborative state, but I’d want to make sure you’re covering yourself and your practice.
I know there are loopholes for prescribing non-scheduled medications, frowned upon but not “illegal” per se, however, I’m fairly certain there needs to be a paper trail of charting for scheduled especially with all of the constantly changing rules and requirements for in-person patient assessment. I hope you find an NP worth your time. It’s a shame these providers have chosen to be a reflection of our career. Are these NPs newer to practice? There are various alternative PRN medication options for anxiety, etc.
I'm not a fan of loop holes, too old to keep up with what is needed to follow them. There absolutely must be a paper trailer for scheduled, new rules and regulation take up enough of my attention. Of the 10 I mentioned most have been less that 2 years in practice, the ones that lasted longest have been at it for 5+ years. I hope to fine one that lasts, they've all been liked by the patients and I think they've been very helpful with patient retention.
Oh so it’s a you problem, not a benzo problem lol
No I'm pretty sure it IS a benzo problem 🤣
Maybe add this to the document they sign- that you will report it as prescribing to non-patients. Hopefully this even stronger boundary, that outright threatens their license, will help
I'm a pharmacy tech. It is insane that at least once a week we have to turn away a provider trying to write a control for themself. Some people do not seem to mind gambling their license.
I'm also baffled. Who dumps their career path for this? Who would even hire you after something like this? And who thinks they're going to get away with it after so many did not? So strange.
Spent much of my live in Appalachia. We get a lot of medical professionals who’ve been in trouble elsewhere and had to leave. Probably the same for poor urban areas. Who would want to work there? Only the people who have a record and can’t get work at any reputable place.
Grew up in the foothills of the Appalachia, and the doctor I saw as an adolescent and teen went to prison for basically running a pill mill. He was a creepy dude as well. He offered to *counsel* me at age 14-15 instead of a therapist. Said he understood what I was going through. He also tried to insist on doing a Pap smear on me when he knew his nurse had just left the room to make a referral to a women’s clinic. It’s wild to see the blatant stuff that goes on, particularly in smaller towns and cities where the corruption runs rampant.
Never underestimate how incredibly stupid a human being can be.
It’s crazy how many people do! I work in criminal defense and we have had many many clients who are drs, pharmacists, etc. the feds watch them for YEARS before indictment so they have no idea they are being watched.
I tried that codeine cough syrup and it did nothing for my cough. I also don't understand why anyone would drink that stuff on a daily basis since it did nothing for me.
Some of us are just markedly less sensitive to opiate analgesia, it's a fairly common genetic quirk- look up "A118G". Both myself and my mother get more pain relief from naproxen or a tiny benzo dose than from codeine or morphine. I had 2 doses of oramorph in emergency with badly slipped discs, literally no difference made at all. All I've ever gotten from opiates was dizziness and constipation.
Finally someone that can explain that to me. Your answer absolutely worth the down votes I got.
There's a whole list of possibilities. Red heads for instance tend to be resistant. Obviously other genetic mutations too. Then there's things like connective tissue disorders like EDS. There's things like leaky gut syndrome which can make pills not work right.
As a redhead, got cough syrup with codeine years ago for pneumonia. I either didn't listen or it wasn't instructed on how much water to drink. Constipation was rough. I also get sick from anesthesia/narcotics. Tylenol/ibuprofen is what I use. Plus I have a high pain tolerance from having super horrible periods as a teen and not being able to swallow pills.
High pain tolerance, high anaesthesia tolerance, low cold tolerance, low tooth/mouth pain tolerance, and a whole list of others. The mutation that gives us red hair actually affects a lot of the body.
As a redhead I can confirm. I always have to have extra numbing at the dentist. I was prescribed opiates one time for severe tooth pain. It just made me feel worse. I can’t take anything with codeine, it hurts my stomach terribly.
Same. I shrug off lidocaine and novocaine like they’re nothing. High pain tolerance except when it comes to the dentist. I’ve had a lot of barely-restrained eye rolls from medical professionals when I try to explain any of this. I also have weird reactions coming out of anesthesia. But if I tell you this and you don’t believe me, you can’t get mad if I wake up and rip out everything attached to me and take off.
I'm not really a redhead but I must have the gene because everything here tracks.
If you’re interested in medication genetics testing look up Alpha Genomics: they have reasonably priced medication genetics panels.
Promethazine with codeine works great- or at least it knocked me out so I have no idea if I was coughing in my sleep. The only thing I’d try to get prescribed is antibiotics because I get chronic sinus infections and polyps.
Yeah that's what everyone else says. It doesn't make me tired at all. For me it was just a waste of time and money. I will never take that stuff again. But there are a couple of meds that are supposed to make you hyper or sleepy and they don't do that to me.
Just because it did nothing for you doesnt mean someone else wouldnt gamble their license to get their hands on it. Your experience does not match 99.9% of the people who have been prescribed it or use it recreationally.
Now at what time I say anything about other people? I described a personal experience and indicated that I didn't know why people want that in the hopes someone would be able to explain it to me and not start gate keeping like.you did.
You have used the word gatekeeping incorrectly. Nowhere in your comment did you ask for clarification as to why people use codeine to get high.
That’s wild. Next time before you hire someone spell out that SEVEN people before them have been fired for violating the regulations. Make sure they understand that they will be immediately fired. Put up signs in the break room. People are dumb and forgetful.
A " ## days since we sacked someone for prescribing benzos" sign?
lol YES!
Perfect solution!
Sadly it’s more likely they think it’s a scare tactic only and no one will catch them as they are soooo smart. The textbook examples of FAFO.
“Pshh those people only got fired for getting caught unlike me who’s so smart, now let me send a prescription that can be traced back to me, man aren’t I smart”
Stupid question incoming: Are they just reading and signing this policy, or are you specifically sitting them down and saying ‘We lose people to this policy more often than you would think, so before signing this I just wanted to go over it verbally and make sure you understand.’ Yes they may read it. But specifically pointing it out and making it clear that you follow it and they will be fired may help them internalize it. If you are one of these folks who say ‘I shouldn’t have to explain a simple policy to an adult with an advanced degree!’ I agree. You shouldn’t have to. But that doesn’t mean you don’t have to.
All the comments criticizing not prescribing benzos…Doctors can practice however they want and patients are welcome to seek care elsewhere. If a doctor doesn’t want to prescribe a certain medication they are well within their right not to. Some surgeons choose not to do certain surgeries. That’s their choice as well. I wish more people understood the administrative burden practices are under.
You can count on redditors to take personal offense to someone providing a specific service that does not happen to include something they want or need.
Can I ask why all benzos are banned?
I can't figure out how to quote, but the OP answered this question on another comment. Basically, they're a massive problem in that specific area and keeping up with the proper compliance was too much for the practice. Fortunately, there are several other larger places where patients may go if necessary.
To quote my other post > Abuse and general misuse of benzos has been rampant in our area for years and dealing with that had become overwhelming to me and my staff. Before this policy existed we were spending an inordinate amount of time to dealing with benzo related issues and it was impacting patient care as a whole.
Wait, Neurol/Xanax is a benzo? The pill I got along with my very first anxiety diagnosis years ago, and that I stopped taking because I felt like it wasn't even doing anything (at least in the dosage they gave me)? Wow. Sounds like I've been missing out if people take that for recreation...
I think it's rare for the dosage prescribed by a doctor to be enough for recreational use, especially at first when they're giving you the most cautious dose. That or you're one of the people that specific medicine doesn't work on. It usually takes some tinkering to find the right prescription and dosage for each individual person.
Because the people at the top would rather us end up 6ft under than to trust doctors to do the right thing. My PCP basically told me that her hands were tied and that she couldn't prescribe me any benzos. I could tell she felt bad, but they have to protect themselves. It's ridiculous that my boomer grandmother had a regular script for Xanax but my Dr couldn't give them to me for a brief period of time.
I don't live in the US but here also psychiatrists tell in their bios they don't prescribe benzos. In my case, I have been able to get prescriptions but in practice I only need it renewed like every two years or so, and the doctor can see this from a national database. I have approximately a pill per month at max, so a bottle of 30 pills serves me just well and more. The biggest thing about it is that I know that I have them, so that when I have bad anxiety I get relief from that knowledge and I can push through the moment without medication, because I know if it gets worse I have the relief. The thing is, the baseline needs to be dealt with other meds, like ssri's or in my case a mild antipsychotic. Luckily my doctors have been understanding and also have had proof of my usage, so they have been happy to prescribe me, because I feel like dealing with my anxiety would be harder without them.
Same. Prescription lasts for a year, but knowing it is there helps.
Thank you, this is exactly what I was trying to say! Some of us need a "rescue" option that can lessen the anxiety and panic when it gets to be too muxh.
This. Like my GMA has had Xanax for over 20 years
Same with mine and a benzo. She was definitely addicted to her "sleeping pills" and it probably factored into her dementia.
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I work in health insurance and I'd be happy to help look for loopholes to get it covered if you need it. My point is that you should have access to what works for you, not what they think should work for everyone.
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My grandmother wasn't a junkie, but she was definitely dependent on it after my mom died. Let's not forget that the shit on the streets isn't coming from a pharmacy. I'm not saying to prescribe benzos to everyone who asks.
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Xanax isn't a pain reliever...
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Clearly you don't understand why some people may need access to benzos. The one thing that FINALLY worked for me isn't even technically for anxiety, but combined with THC it works 🤷🏻♀️. Someone with a diagnosed anxiety disorder should have access to what works when they need it. They're not doing any good by denying people the shit that they know works. I asked for 10 with no refill and still got told "sorry but no", so the point doesn't stand.
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My PCP manages my psych meds, so it's relevant. There aren't "PLENTY" of options when you've tried them all and had no success. I gave up my CDL because THC was my only option left.
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OP is a psychiatrist, correct? They won't prescribe them, that's my point 🙄
You absolutely can ask them for Xanax. That’s how I got it.
I wonder if people are joining JUST so they can do this.
My doctors office has main dr & NP. If I'm there for annual checkups I will see NP if the MD is unavailable. My hubs can only see the MD as his prescriptions are heavily regulated. NP's not allowed to prescribe certain meds (been this way last 20 yrs). I'm talking small town, not even a stoplight & we understand (well, I understand). Sad they are risking their livelihoods on stupid choices. Especially the schooling PA's have to go through.
With all respect to you and your profession, I must say that if 10 people all made the same mistake or behavior, it’s now reasonable to wonder if your communication skills are somehow amiss or if there is some confusion. At the very least your screening process is lacking. 10 is too many. Something is wrong.
What communication skills? Its in the damn contract. People that give out medicine should be reading important documents IMHO. And I cant imagine they dont get told, when signing it.
> communication skills are somehow amiss or if there is some confusion The policy is both part of the contract all providers sign and on a totally separate form that they also sign. I'm very clear with everyone I hire about it before we ever get to signing paperwork. I'm not sure how much clearer it can be.
My old practice was one owned by a psychiatrist that specialized in addiction medicine. Our contracts specifically spelled out that an arrest or conviction for any drug or alcohol related crime was grounds for instant termination. Even the support staff was required to sign it. It was frequently mentioned in staff meetings as well. But it didn’t stop the front office person from showing up drunk on a Saturday morning, only to be found passed out in medical records. She drove herself to work, and later tried to sue over her firing.
As someone that's worked on healthcare, nah people have high egos and will purposely choose to go against what you said. I've noticed it to be especially prevalent coming from staff towards physicians, especially if it's a female physician. People will be catty
Nah man people are dumb and shameless. In my counrry we have a say that is dont kill the hen with the golden eggs.
Addicts are gonna addict. Policies mean nothing, potential consequences fade when they get that close to feeding their beast.
It was a problem at the federally funded non profit I worked for, an NP prescribed our own regional manager and everyone else without being quiet about it. I was given scripts for benzos and adderall.
I get the banning of prescribing ‘in house’ to other staff but what if a patient actually does need them?
Those patients are welcome to seek care any of the 3 (soon to be 4) larger practices that are willing to prescribe and ensure compliant use of benzodiazpenes. Abuse and general misuse of benzos has been rampant in our area for years and dealing with that had become overwhelming to me and my staff. Before this policy existed we were spending an inordinate amount of time to dealing with benzo related issues and it was impacting patient care as a whole.
I sell high end home treadmills sometimes. As in, the 4-8k life fitness home units. They are just commercial gym units repackaged for home use, and meant to run on 120. But, they need a dedicated receptacle that puts out a minimum of 25amps. Standard outlets do not do this. You have to run a dedicated line to use these units, which is not a big deal for the people purchasing them, they are filthy fucking rich. You know what they don't do? Listen. I explain this to them via email before delivery, in person, and explain to them we can test the unit, if you run on it for any extended period of time, even once, you will cook it. I show them the label on the motor that says the amperage requirement. Legitimately 50% of the people I sell these units to fire them up and cook them that day, or the next. Then I get angry calls and texts, and I send them the recording I made explaining to them that if they used the unit without running it on a dedicated receptacle with the proper amperage, they would destroy it. No refunds. Then I send my buddy to go get the cooked unit and we use it for parts. People who lie to everyone think everyone is lying to them, so they like to do the opposite of what you tell them to feel superior or some whack shit, I dunno. I just know those fucking idiots keep giving me money, and I keep getting back broken high end treadmills.
As someone who's worked in a client facing role, oh my fucking god you're so right. People absolutely do not read or listen. Even if you spell it out clear as fuck.
Yes, every single client-facing role I've had has put me into contact with people who refuse to listen to things spelled out to them verbally, on writing, and via signage. The issue with them is that they see all of us working these types of jobs as below them, due to being less rich or degree-holding or elite or whatever, and so they automatically think they know better than us despite all evidence to the contrary. And when their pride becomes their downfall, they still make it out to be our faults because they'll just double down the know-it-all attitude. But that's what happens when you don't treat everyone equally and fairly and with kindness.
I used to work in a fairly large psych practice (therapist) and can attest to the ass-pain benzodiazepines can cause. It’s definitely an example of one rotten apple spoiling the whole bunch. My psychiatrist-owner originally had five locations. One had to be closed specifically due to benzo issues. It was in an adjacent county that was #1 of the 100 counties in our state for benzo scripts. That was the office that had someone crash into the building twice in one year, was repeatedly broken into, and had 50x the number of early refill requests, most with very long, involved stories about why. My boss still wrote benzos, but he was also willing to fire patients for misuse, which he made clear from the get-go. One more example was a doc in our county that also had his own pharmacy. He was eventually arrested for pharmacological shenanigans and closed his practice. His patients were SCARY. He had a lot of them on up to 12mg of Xanax or klonopin a day. The max my doc would do in rare circumstances was 3. Every practice in the area was flooded with these folks, and they all needed medical detox. I totally get OP’s stance, especially for a small, independent clinic. If you’re affiliated with a large system, you have their attorneys and pockets to use in the case of a negative outcome. If it’s your own pocket, you’ve got to protect it. As far as in house prescribing, **DUH!!** At least it weeds the problems out quickly.
I was ready to say you're being unreasonable until this. This makes a lot of sense.
People in my area are the reason I don't carry my Ativan nasal spray for my epilepsy. Benzo addicts will take it without a second thought. You're doing good work and holding people accountable. Keep it up!
Maybe cite this exact comment in your edit. It has a few details (mainly that there are other accessible options for people who do need benzos and that it was not just a huge effort but actively impacting patient care) that seem to be important context
Yeah I had to take Valium for awhile because my anxiety got to insane levels and Xanax left me worse off when it wore off. I took two a day as needed and it made a world of difference. Eventually I noticed I only needed one a day and eventually none. Then one day I stopped because I just wasn’t needing them at all anymore. Those things saved my life.
Same! I was at two Valium a day for anxiety and a clonazepam at night to sleep. I don’t know what I would have done without. I’m on one Wellbutrin now and occasionally a melatonin to sleep but I don’t think I’d be here if it wasn’t for the benzos I needed before.
So I think you're all missing the point of the post. He never said that benzos didn't have their place, their place just isn't at his clinic. He's mentioned multiple times that the issues prescribing them caused outweigh the benefits of prescribing them but that there were multiple clinics near to his that would prescribe them
No I totally agree with the point of his post. It’s ridiculous they can’t keep staff because they all seem to refuse to follow a simple (and correct) rule of the clinic. Those people are informed and sign a contract knowing what will happen if they break that rule. It’s obviously just bonkers to all of us commenting and focusing on the Benzos that a mental health clinic refuses to prescribe them at all. I understand they can be very addictive and easily abused if someone chooses to do so. If I had not already been on just about every ssri over the years plus Xanax at one point and found that they were not helping me, my doctor would not have resorted to Valium. So there are hoops you have to jump through (in my case) to prove that was needed as a last resort. I know not all measures clinics take can prevent abuse of prescription meds, but for those out there with a true need of them or that have been helped by them to completely deny access to them seems cruel.
It’s not cruel, and it’s a normal policy in plenty of places. Go to a place that prescribes them. Entitled people don’t like it, but doctors use their judgement for a reason.
I am far from entitled lol. I just think it’s weird to deny a medicine that can help people when other options have failed. Could they go to another doctor? Possibly. In the US though between insurance network limitations, or maybe even the option to travel to find a doctor or clinic near them without such restrictions as this clinic may also not be an option. Then the fear of jumping from doctor to doctor to find someone that will prescribe the meds you need will possibly make you look like you are doctor shopping to abuse the meds when all you are doing is trying to get the help you desperately need. A flag on your record like that follows you the rest of your life. So yes under some circumstances it would certainly be cruel to deny someone the help and medication they need.
You are entitled. You’re not a doctor. No one is obligated to prescribe to you. This is how the opiate epidemic happened, people demanding doctors prescribe certain stuff and doctors using bad judgment.
I briefly had a script for small daily doses of Ativan. While my Dad was dying of cancer, and for a short while after his death. I’m the one who told my provider I didn’t want anymore refills. When I stopped them, I had bad insomnia for 4-5 nights but besides that, didn’t have a hard time.
Valium is saving my life now.
I've got to say, the relief Xanax gave me for my PTSD after a car accident was what triggered me to finally realize I had an undiagnosed anxiety problem. I now get a standard and non-addicting treatment for my anxiety. Highly recommend, 10/10, would medicine again
In a case like this, your GP/primary care doctor would probably prescribe them for you.
Agree. I needed benzos after having my baby due to severe PPA, and took them very carefully and haven’t had them since. Depriving patients of helpful medication seems counterintuitive to why most people claim they get into healthcare in the first place.
Because “doctors” like this label everyone as an addict or an abuser before they even evaluate them or hear their symptoms and story. It’s literally why people struggle and end up resorting to getting them (or worse alternatives) from their local dealer. The middle class trash whose diets consist of Zinfandel and Xanax and their 15 year olds who cop from them for their friends to party with have done irreparable damage to doctor’s trust in anyone, and at the expense of innocent people’s well-being and sanity.
That's literally not what he said LOL he said they did allow it for a while but they were spending so much time dealing with the issues prescribing them caused and that took away from the actual time they had to spend with all of their clients. And do you honestly not think people who are addicts can't come up with stories and symptoms?
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A psychiatrist is an MD.
The genius has entered the chat
Makes me curious what sort of neighborhood you practice in. Like how affluent is it.
We serve mostly middle class, some upper middle.
Thank you for the benzos rule. Legally prescribed benzos turned my mother into a junkie who thought of nothing but her next fix. They are dangerous. Sure you can take them safely, the same way guns can be handled safely by the people properly trained to use them. They're still a problem in the hands of people who don't respect them. I'm sorry you're having to do this, but at the same time, I'm really glad docs like you understand the true nature of the drug.
ITT: People who don't work in healthcare and have no experience dealing with patients. Providers are not just vending machines to give you whatever drug you think you need. Not every provider is required to prescribe the medications within their scope of practice. If you don't like it, take your case elsewhere. And recognize that a few bad apples (or in OP's case, many bad apples) spoil the bunch and OP has drawn a hard line for the practice. Perfectly within his or her rights to do with their OWN PRACTICE.
From someone who suffers debilitating panic attacks I am grateful my provider prescribes me benzos. I might need about two pills a year and they help when I need them. They also give me peace of mind to know I have something there just in case.
Doctors like this guy are so upsetting. Refusing to prescribe a needed medication is a failure to perform his duty as a doctor. What if he doesn’t believe in insulin? Would he tell diabetics to hoof it up the road? Yes, some people are going to abuse the medicine I need, but does that mean I shouldn’t have access to the best medication for my condition?
Yes yes yes. He’s a psychiatrist. Psychiatrists prescribe psychotropic drugs. Benzos are psychotropic drugs with certain indications relating to psychiatric care. The fact that he can’t even understand that sometimes benzos are INDICATED is wild. I work on an inpatient psychiatric hospital unit, so I understand my experience is a bit skewed but it seems so is his. I’m sure he understands the risk of TD when he prescribes antipsychotics but he scripts them out because they are INDICATED. Don’t be a doctor if you choose kissing the DEAs ass over your patients mental and emotional well-being.
I’m surprised they don’t get anything from you having reported them. I’ve been a practicing PA for 14 years; when I was in IL, I’d show the students and other folks who shadowed me the professional regulation and licensing website. The vast majority of dings against a provider’s license were inappropriate prescribing and DUI. We’re licensed professionals, and society expects more of us. At any rate, I hope you find some good people. I’m in command of an operational stress control unit in the Reserves, and have some great behavioral health folks. They’re out there.
I have been on benzos for years following the death of my daughter and granddaughter. I never abused them. I am ready to get off them as I feel like they have done their job. I really needed them to be able to keep working. Very low dose and never increased. My doc and I mapped out a plan and schedule, a slow one. He told me that people getting off benzos scares him more than anything else.
If your rules and policies are clearly communicated, I can’t fathom why anyone would risk losing their license for something like this.
Lorazepam is a lifesaver when it comes to anxiety. I didn’t even realize that most of my verbal venting and stress from work was a form of being anxious; taking a dose helped a LOT. However, I am extremely careful with it and never take it more than 2 days in a row, and oftentimes I will only take it half a handful of times a year. I never even realized how serious a class of drug it was until I recently had to sign a form at my doctor’s office. I am so thankful I have access to what I need, and I am very aware that I have a responsibility to use these safely and responsibly. I’m so sorry you have had difficulties in the past.
What's benzos and what is it normally prescribed for?
Anxiety
It just seems like such a waste to me. NPs make a lot more money than I do. Why throw the job away? Especially after working so hard yo get the education and license.
What kind of psychiatrist doesn’t EVER prescribe one of the major drugs used for acute psychosis and anxiety? We all know there’s a risk for abuse, but sometimes people need a mfing benzo.
The kind of psychiatrist who doesn’t see decompensated or severely mentally ill patients. Such psychiatrists were rare when psychologists and LCSWs monopolized low-acuity mental health with talk therapy, but now because everyone gets SSRIs there’s a plenty of business for low-acuity therapists who have access to the scrip pad. The government makes it outrageously risky to prescribe benzos and opioids in any kind of non-acute setting.
the kind of psychiatrist who knows there's 3 larger practices in the area who do prescribe them, and whose practice was so bogged down with the administrative process around prescribing benzos that patient care was impacted.
You may want to verbally address this issue when hiring and on their first day. And stress that they WILL absolutely be immediately fired. And just ask them if their job is worth it for 'doing a favor' for a co-worker.
Are you doing drug tests prior to employment? Idk it seems wild that you hire someone, that does not have a problem. And then they immediately have a problem. Why not do Interview, Drug test, then background check. I cant imagine drugtests would not weed out and be cheaper then hiring, onboarding, firing. Also, i dont know the rules. Im not sure if Drs. And nirses have the same HiPAA rules. But are you not allowed to look at prescribed medications and prescribing history?
As a former benzo addict, I think your policies are awesome!
This is actually really wild. My psychiatrist gives me Xanax just so I can go to the dentist because I have dental trauma. Some people legitimately need them to help them be calm in certain situations. My psychiatrist only gives me like ten at a time to make sure they aren't abused (even though I wouldn't I can't stand how they make me feel but I have to take them for dental appointments). You're doing a disservice to your patients.
Have you tried to go to some dentist that is better for these issues. I slept through a root canal at my dentist and they gave me some light sleeping pill. Best root canal ever.
Unfortunately no, the only other option I've been told is to have dental work done in a hospital setting. I've only found one dentist in my area that's willing to actually listen to me and respect my trauma. >!I was sexually assaulted as a child by my uncle who was a dentist while he was examining me!<
Have you tried like a university school or dentistry? That's where I got my root canal and everything else done as I had dental issues as a child. And since they have both sexes there, you could ask for an only female team to work on you. From all the visits, I never had any pain and they took me more serious than any dentist office I ever went to. Besides this, dentist offices send patients there where the offices pain management doesn't work anymore. So I am not sure where you are but I can highly recommend university dental schools. Or at least the one in San Antonio Texas.
I tried the one in my city but they said they don't offer that and when I contacted my dental office about they were flabbergasted and felt bad because that's where they referred all their patients too who need a hospital setting.
I am sorry to hear that. While I don't know how it feels, since I never had something happen like it did to you, I have a friend and she had a similar experience as a child. From her I know at one point it will get better. She was afraid of large hands and I have large hands. But she overcame it. I hope you will get to that point as well.
Thank you ❤️
> Some people legitimately need them to help them be calm in certain situations. Then they should go somewhere other than OP's practice.
Are you in Florida?
I was thinking maybe suburban Atlanta?
Funny, I was thinking Australia.
Wait... so you don't want to prescribe stuff that might actually help?!? I literally broke my back and my f*ing doctor told me to take Tylenol... F*ing TYLENOL! I went to a specialist and they put me in emergency surgery and made a formal complaint on my behalf.
Don't you know that SSRIs and SNRIs solve every problem from anxiety to pain? /s
Benzos are highly addictive and not indicated for long term use (because of addictive potential) even for anxiety and panic disorders. They work on the same receptor as alcohol. Sure they can “calm” you down during an acute panic attack or use of stimulant, but that’s an acute situation. Because of its addictive potential certain states hold docs responsible for monitoring its use very closely. Pill counts, urine toxin screens, checking the National database for repeat prescriptions, and monitoring refills are just SOME of the things I know pain docs have to go through to prescribe opioids, i image it’s similar for benzos. Imagine that for 100s of patients, it’s just not sustainable.
Not a medical professional, but found this interesting >Everyone resigns every year Is this normal in medical practices?
I think it means everyone re signs the policy every year not leaves the company. At least that’s how I read it.
Thanks. That makes more sense!
I had to google what benzos were. Imo especially in a workplace environment where drug abuse is common, this policy sounds sensible. Super upfront. Like, dont shit where you eat type situation.
This is why you hire actual physicians
>The NP in this case even sent the script to our pharmacy So the prescription wasn't fulfilled because your pharmacy doesn't have any benzos, right?
people also don’t understand that physicians legally take the fall for crimes or negligence that their staff commits. respondeat superior.
I tell all my doctors I don't want this shit. It's a bandaid and doesn't help the actual problem. Same thing with pain pills. I try to just live my life with pain and anxiety because the alternative with pills just makes me dull and boring. Benzos are a sad part where they help make me feel normal but it's an artifical normal. It's not natural like being outside on a sunny day with no shoes on in the grass. I got a lit cigarette in my eye and they gave me perc 10mg. When I took 1 for the first time I couldn't drive and I couldn't even talk. I couldn't go to work that day because I was drugged up. I asked for the lowest dose possible and they gave me that??? Like I was gone and also only weighed like 125lbs. Who likes that feeling?? It's so terrible.
Who likes that feeling? The millions of opiate addicts across the world, maybe? How hard is it to understand that not everyone is you? Yikes.
As somebody who works in a pain clinic that doesn't prescribe short acting narcotics, I get where you're coming from. Our rules are very strict, and patients, pharmacists, and potential hires always have something to say.
Hang on, you fire the person who wrote the script for an in-house worker, but _not_ the employee who asked? If the rule is “no one prescribes benzos to staff”, shouldn’t the policy _also_ be “staff must not ask for benzos”? I can totally see a situation where a new NP may feel pressured by an office worker who’s been there longer to prescribe to them, or even an office worker thinking it’s funny to screw with the noob by demanding they break the rules and telling them “nah, it’s ok, they never enforce that!” Especially since you seem to have an office of predators, if so many of them see the new NPs as an opportunity to score. Sounds like your NPs are getting harassed and threatened by the office staff to give them the scripts. Have you _talked_ to any of these former employees and asked _why_ they wrote the scripts? Maybe the one who sent it to your in-house pharmacy felt (or was threatened) that they couldn’t say anything directly and so sent it in-house in the hopes it would get flagged and the office person would get pulled up for _also_ breaching the policy. Currently, it sound very “rule for thee and not for me”. If an employee asks, they should be fired immediately, too.
No, they fired both. Pretty clear.
It’s literally the 2nd rule they listed.
>So many NPs seem to take that policy as a challenge to prescribe as much of the benzo of their choice to the first office worker who asks so they can get fired. **To say nothing of my office workers who seem to take having a new NP on staff as on opportunity to score...and then promptly lose their jobs.** You have to read the whole post.
Wait...you run the office and you tell the doctors what and who they can prescribe what too? Are you a Dr?
NPs aren’t doctors. OP is the supervising doctor for the NPs she employs. As the supervising doctor, she essentially co-signs every prescription they write. Yes, she can dictate what they prescribe while they prescribe under her license at her practice.
Some NPs are doctors. DNP, not MD, but they have doctorates and have the same prescribing capabilities. And depending on the state, NPs can practice independently, unlike PAs.