This addiction treatment case involves a 58-year-old veteran in California who was prescribed diazepam by her family medicine physician to treat post-traumatic stress disorder. She previously had trouble sleeping and frequent anxiety distress due to traumatic events that had occurred during her service in the military. The patient was doing well on the medication for the past few years and was showing diminished signs of anxiety. However, the physician abruptly ended the patient’s prescription without prescribing an alternative or allowing time for the patient to adjust. As a result, she developed significant side effects and cognitive deficits.
Question(s) For Expert Witness
- 1. Do you routinely prescribe diazepam to patients?
- 2. If so, should the prescription be "tapered" rather than abruptly stopped, to avoid the outcome described above?
Expert Witness Response E-023800
I think that this case has merit. Benzodiazepine withdrawal can be dangerous, but tapering off drugs is almost foolproof in avoiding complications. As Family Medicine Physician, I prescribe diazepam judiciously as there are some important safety concerns about the drug. However, I have several patients who do receive prescriptions for diazepam regularly. Obviously, when discontinuing diazepam it should be tapered, not stopped abruptly. I have also served as an expert witness in multiple cases in the past. I enjoy this work to make sure that the best medicine is being practiced and represent quality healthcare to the broader public.
Expert Witness Response E-023780
I do not routinely prescribe Diazepam for my patients. I do have patients that take benzodiazepines on a regular basis for generalized anxiety disorder. All benzodiazepines, especially long acting ones, definitely need to be tapered when weaning off. I have not published on the subject, but I was the Medical Director at an Alcohol and Drug Rehab detox center for 2 years. I also have lectured to community groups and medical students on drug addiction and all of the complexities. I have served as an expert witness a few times as an addiction specialist and as a family physician.