Safe Benzodiazepine Prescribing

These guidelines were developed for a Medicaid population with high rates of substance use disorders and may not be appropriate for other populations.

1. Alprazolam (Xanax) is not prescribed by our Clinics.

There are many reasons for this:
a. Xanax enters the brain very rapidly and this has been shown to increase the risk of becoming addicted
b. Xanax can often make anxiety worse in between doses as its levels in the brain decrease. This effect is called rebound anxiety.
c. The rebound anxiety often caused by Xanax also increases the likelihood that patients will require higher doses and become more dependent over time.

2. Benzodiazepines and benzodiazepine agonists, such as Ambien, are not prescribed to individuals who have had difficulties with alcohol or illicit substances within the past year.

The reason for this is that studies have demonstrated that patients with recent alcohol or drug addiction have a higher risk of relapse if started on a benzodiazepine or benzodiazepine agonist.

3. A benzodiazepine contract, which provides rules for safely using a benzodiazepine or benzodiazepine agonist, must be signed and followed by the patient to start and continue treatment with a benzodiazepine.

The reason for this is that benzodiazepines can cause significant harm, including death, if not taken correctly or combined with illicit drugs. Both the physician and patient must agree on safe prescribing practices.

4. Random drug testing is required for treatment with a benzodiazepine or benzodiazepine agonist.

The reason for this is the same as 3. above: when benzodiazepines are combined with alcohol, narcotics, or other sedatives they can cause the breathing center in the brain to shut down and result in death.

5. Benzodiazapines or benzodiazepine agonists should not be prescribed to patients taking an opioid narcotic.

Please see our handout explaining the reasons for this.

6. Benzodiazapines should not be combined with other benzodiazepines e.g. Klonopin with Librium or with benzodiazepine agonists.

The reason for this is that studies have not demonstrated safety or effectiveness for combining two different benzodiazepines.