IRETA Developes Guidelines for the Management of Benzodiazepines in MAT

November 1, 2013

EXECUTIVE SUMMARY

In  2012,  under  contract  with  the  Philadelphia  Department  of  Behavioral  Health  and  Intellectual disAbility Services (DBHIDS), and with additional support from Community Care Behavioral Health Organization  (Community  Care),  the  Institute  for  Research,  Education  and  Training  in  Addictions (IRETA)  conducted  a  project  to  determine  best  practice  guidelines  for  the  management  of  benzodiazepines in medication-assisted treatment (MAT). The project was conceived in response to frequent  benzodiazepine  use  among  individuals  in  MAT  and  a  relative  absence  of  research -based guidance  on  clinically  effective  treatment  strategies  for  managing  their  use.  Designed  to  be  a resource for clinicians, these guidelines aim to distinguish areas of scientific/clinical consensus and areas where that does not exist.   They are not intended to dictate clinical practice.

This  report  details  the  development  of  the  project,  methods,  results  and  the  final  list  of  practice guidelines.  IRETA  utilized  the  RAND/UCLA  Appropriateness  Method  to  determine  appropriate guideline statements based on the research and clinical experience of a panel of experts in the field. The two-round rating process and half-day expert panel meeting yielded 225 guideline statements, which IRETA  distilled into  a  shorter list of guidelines for practitioners to  use in real-world clinical settings.

Recommendations from the expert panel members include:

• CNS depressant use is not an absolute contraindication for the use of either methadone or buprenorphine in MAT, but is a reason for caution because of potential respiratory depression. Serious overdose and death may occur if MAT is administered in conjunction with benzodiazepines, sedatives, tranquilizers, antidepressants, or alcohol.

• Individuals who use benzodiazepines, even if used as a part of long-term therapy, should be considered at risk for adverse drug reactions including overdose and death.

• Many people presenting to services have an extensive history of multiple substance dependence and all substance abuse, including benzodiazepines, should be actively addressed in treatment.

• MAT should not generally be discontinued for persistent benzodiazepine abuse, but requires the implementation of risk management strategies.

• Clinicians should ensure that every step of decision-making is clearly documented.

During  the  half-day  meeting  in  September  2012,  expert  panelists  added  an  additional  guideline statement:  “Clinicians  would  benefit  from  the  development  of  a  toolkit  about  the  management  of benzodiazepines in methadone treatment that includes videos and written materials for individuals in  MAT.”   This  recommendation  is  consistent  with  the  overarching  theme  of  patient  education, which was discussed lengthily at the project’s Kickoff Conference in February 2012 and emerged as a significant issue in the final practice guidelines.

Download: Management of Benzodiazepines in MAT

Resource:  IRETA