One Nation, Under Sedation

https://www.propublica.org/article/medicare-paid-for-nearly-40-million-tranquilizer-prescriptions-in-2013

More than a decade ago, when lawmakers created Medicare’s drug program, called Part D, they decided not to pay for anti-anxiety medications. Some of these drugs, known as benzodiazepines, had been linked to abuse and an increased risk of falls and fractures among the elderly, who make up most of the Medicare population.

But doctors didn’t stop prescribing the drugs to Medicare enrollees. Patients just found other ways to pay for them. When Congress later reversed the payment policy under pressure from patient groups and medical societies, it swiftly became clear that a huge swath of Medicare’s patients were already using the drugs despite the lack of coverage.

In 2013, the year Medicare started covering benzodiazepines, it paid for nearly 40 million prescriptions, a ProPublica analysis of recently released federal data shows. Generic versions of the drugs — alprazolam (which goes by the trade name of Xanax), lorazepam (Ativan) and clonazepam (Klonopin) — were among the top 32 most-prescribed medications in Medicare Part D that year…

Some geriatric psychiatrists worry that doctors may have turned to the drugs in place of antipsychotic medications to sedate patients with conditions such as dementia. In the past several years, Medicare has pushed to reduce the use of antipsychotics, particularly in nursing homes, because of strong warnings about their risks…

Fall River, Mass., psychiatrist Claude Curran wrote more than 11,700 prescriptions for benzodiazepines (including refills) in 2013, ranking him behind only four other doctors, all from Puerto Rico. He said the drugs worked well for his patients, many of whom are trying to kick addictions to narcotics but struggle with anxiety and depression.

“First of all, they’re reliable,” he said. “Second of all, they’re cheap because they’re all generic … They tickle the brain in the same way alcohol does.”  Without benzodiazepines, he added, patients in recovery often need higher doses of methadone, which carries significant risks of its own…

The vast majority of Curran’s Medicare patients were younger than 65 and qualified for coverage based on a disability. Disabled patients made up about a quarter of Part D’s 35 million enrollees in 2013, but used benzodiazepines disproportionately, accounting for about half of all prescriptions…

Rodriguez readily acknowledged the risks of the drugs for elderly users — recently, researchers found that the longer a person took benzodiazepines, the higher his or her risk of being diagnosed with Alzheimer’s Disease. The drugs’ labels say they are generally for short-term use but many patients take them for years…

Many paid out of pocket for the relatively inexpensive drugs, which can cost less than $10 for a 30-day supply…

A worrisome aspect of the newly released data is that some doctors appear to be prescribing benzodiazepines and narcotic painkillers to the same patients, increasing the risk of misuse and overdose. The drugs, paired together, can depress breathing.

ProPublica found that this pattern was most common in southeastern states, which struggle with opioid abuse and overdoses. In 2013, 158 doctors in Florida wrote at least 1,000 prescriptions each for opioids and for benzodiazepines, tops in the nation. Alabama, Kentucky and Tennessee also had unusually high numbers of doctors who often prescribed both narcotics and benzodiazepines. The data does not indicate if the prescriptions were given to the same patients, although that prospect worries experts…

Dr. Leonard J. Paulozzi, a medical epidemiologist at the Centers for Disease Control and Prevention, co-authored an analysis showing that benzodiazepines were involved in about 30 percent of the fatal narcotic overdoses that occurred nationwide in 2010.

“It increases the possibility of overdoses,” he said.

Click to access select-benzodiazepines-10-16-14.pdf

Select Benzodiazepines to Have Daily Quantity Limits (Vermont)

The National Institute of Drug Abuse (NIDA) and the DEA has identified benzodiazepines as one of the classes of prescription drugs with a high potential for diversion and abuse…

http://www.justice.gov/usao-edtn/criminal-division/drug-diversion-task-force

The Drug Diversion Task Force was created to help combat the growing abuse and trafficking of prescription drugs. Unscrupulous doctors, physician assistants, and pharmacists may be involved in the illegal distribution of controlled substances, including oxycodone, oxycontin, morphine, methadone, fentanyl, hydrocodone, and xanex…

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