Benzodiazepine Project

 

Deaths resulting in accidental overdoses related to benzodiazepines have been rising in Ventura County. Alprazolam, brand name Xanax, is no longer the drug of first choice for most conditions. Alprazolam has consistently been the most commonly prescribed medication offered by general practitioners 80% of the time. Of all benzodiazepines, alprazolam is the most commonly prescribed, misused and diverted. To help reduce morbidity, mortality and drug diversion, Ventura County Health Care Agency focused on incorporating good practices into medical decision making regarding controlled substances. This project helped to learn whether providers were prescribing safely. This challenge was multifaceted: dealing with a growing epidemic of prescription drug abuse in the community, consumers’ lack of awareness of the dangers these substances pose, providers’ lack of awareness of evidenced-based practices and resistance to change on the part of both patient and prescriber.

VCHCA’s Safe Prescribing Initiative uses a multi-level approach, beginning with the establishment of practice guidelines. The initiative also accesses reports from the CURES prescription drug monitoring program, uses a medication treatment agreement (MTA) between prescriber and patient, utilizes urine drug screens, and ensures that patients have access to non-pharmacologic treatment options, which has included training therapists in cognitive-behavioral therapy. The project was innovative by using data to design report cards, offering medical providers feedback about their prescribing practices, and providing them with data that reflected how their practice compared to the practice of their peers and the organization as a whole. Through the initiative, VCHCA has cut its number of patients prescribed alprazolam to less than a third of what it was in 2014, it has doubled its rate of medication treatment agreements, and increased the percentage of CURES reports run from 18.7% to 97.7%.


The Ventura County Health Care Agency won the prestigious 2016 CAPH/SNI Quality Leaders Award for Data-Driven Organizations for “Safe Alprazolam Prescribing”. This award was presented to the HCA team at the CAPH/SNI Annual Conference, December 2016 at the Langham Hotel in Pasadena, CA. On December 12, 2017, the County of Ventura Board of Supervisors presented the California State Association of Counties (CSAC) Challenge and Merit Award for the Safe Alprazolam Prescribing and Benzodiazepine Monitoring Program.

 



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