Long-term Benzodiazepine Use and Negative Socioeconomic Outcomes: Are physicians to blame?

In early 2014 I participated in a health care economics course led by University of Colorado-Denver healthcare economist Andrew Friedson. Throughout this course we surveyed topics in healthcare economics and reviewed related economic literature with a focus on how certain econometric techniques are applied in practice. I walked away adept in reviewing economic literature and enjoyed a fantastic opportunity to write a research proposal that comments on an under-addressed topic in medical malpractice literature.

Most likely you’ve heard of pharmaceuticals such as Ambien, Xanax, and Klonopin. These and many other related drugs are psychoactive compounds known as benzodiazepines; these are prescription drugs frequently used to treat insomnia, anxiety, and depression. Long term usage of these substances can lead to dependence and side effects that often exacerbate the condition they were initially prescribed for. To complicate matters, withdrawal has been documented to be more extreme than that of illicit substances such as heroin, crack-cocaine, or methamphetamine.

In general, these drugs should only be used on a short-term  basis, prescribing guidelines caution against long-term use. Nevertheless this advice is frequently ignored in practice causing benzodiazepines to be inappropriately prescribed long-term. In these cases, American Psychiatric Association guidelines suggest cautious usage while reassessing continued need on a regular basis. Furthermore, benzodiazepines tend to lose their efficacy after a few weeks or months of regular use due to tolerance building, this can leading to withdrawal symptoms even while the user continues to take the drug.

While the medical literature has been reasonably informed on this issue little work has been done to shed light on the socioeconomic consequences of this irresponsible prescription behavior. Users driven into anxiety and depression can suffer marital and/or domestic problems, job loss, engage in self-harm and/or attempt suicide at the hands of emotional and cognitive impairment.

Given the dangers of long-term use and the myriad of individuals who have experienced negative health and socioeconomics outcomes, many of these prescriptions are being made irresponsibly. However, the question of whether or not this prescription behavior is negligent has received little, if any, attention in economic and medical malpractice literature. For this reason I have proposed breaking ground on a new area of research to investigate the possibility of widespread negligent prescribing of benzodiazepines.

By modeling risk of an adverse reaction it is possible to identify physician’s marginal contribution to suicide risk in long-term users.  The current level of long-term use comes at great cost to individuals, families, society: costs that may not be justified by their benefits. If this is a case of widespread negligence then victims deserve access to compensation. On the other hand, if negligent prescribing behavior is not to blame then more research must be done to identify strategies that can mitigate the harms of long-term benzodiazepine use.

Click here to download my research proposal.

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