Activity Dates: 10/06/2022 - 10/06/2025
If you are a pharmacist, nurse practitioner or other healthcare professional involved in the comprehensive medication management of psychiatric patients, we invite you to participate in this online course.
Over the past several years there have been rising concerns about the misuse of benzodiazepines. It is estimated that 30.6 million adults (12.6%) reported benzodiazepine use in the year 2015-2016 (Maust et al., 2019). Among them they report that 2.2% have misused a BZD prescription. Among adults and adolescents, benzodiazepines are the third most commonly misused illicit or prescription drug in the USA (Bachuber et al, 2016). Over the past few decades, benzodiazepine use has increased tremendously. A study done by Bachhuber et al. showed that the number of adults who filled a benzodiazepine prescription increased by 67%, from 8.1 million to 13.5 million between the years 1996 and 2013. The quantity obtained also increased from 1.1 kg to 3.6 kg lorazepam-equivalents per 100,000 adults (Bachuber et al., 2016)
To complicate matters, during the pandemic anxiety, sleep and mood disorders have skyrocketed. Data show an increase in use of benzodiazepines, making it imperative BCPPs be prepared to assist in monitoring an tapering as appropriate. In the USA, a study was done comparing the unique dispense of medications from January 2019 to May 2020 (Niles et al., 2021). The monthly number of unique patients dispensed as benzodiazepines (mean = 4,781,043 [SD = 166,850]; range = 4,478,448 to 5,011,279) was relatively stable until March 2020. Since March 2020 the number of unique patients dispensed benzodiazepines (5,128,721) was statistically and significantly higher than forecast estimates. In March 2020, an estimated additional 450,074 (95% CI:189,999 to 710,149) unique patients were dispensed benzodiazepines, compared to forecast estimates (Niles et al., 2021). Another study was done in Italy by analyzing hair samples to see drug use patterns during the COVID-19 pandemic. It revealed the percentage of samples positive for benzodiazepines ranged from 16.7% (5/30 cases) in the period before the lockdown to 53.3% (16/30 cases, p<0.01) during the lockdown and remained high (43.3%, 13/30 cases, p<0.01) even after the lockdown (Gili et al, 2021). The benzodiazepines reported in this study were not prescribed and their intake indicated illicit use. The study revealed changes in the overall trend of drug intake during the considered study period; 11/30 (37%) patients switched from single-drug use in the two pre-lockdown period controls to poly-drug use in the post-lockdown period. According to an Italian report during COVID-19, there has been a concerning increase in the prescription of hypnotics/sedatives with the potential for misuse, which has almost doubled and increased by about 17-19%, In another study in Ontario, data from January 1 to May 31, 2019, were compared with data from January 1 to May 31, 2020. There was a 43.7% increase in benzodiazepine dispensing in the first five months of the year compared to the year prior (Yu et al., 2021) The same study also reported that the number of benzodiazepine tablets dispensed monthly during the COVID-19 pandemic was statistically higher compared to the previous year (1037.4 ± 122.24, 721.6 ± 156.87, respectively, z=-2.402, p=0.016).
Prescribing guidelines do not recommend the long-term use of benzodiazepines since their effectiveness with chronic use is outweighed by risks including dependence, memory and cognitive impairment, hip fractures and traffic accidents. Discontinuation of benzodiazepines has proven to be of benefit, as it is followed by improvements in cognitive and psychomotor function, particularly in elderly patients. An interprofessional effort, focusing on the primary care setting, is required to address benzodiazepine misuse and to ensure appropriate pharmaceutical care. Pharmacists must be an integral part of this inter-professional effort, not least because they are uniquely positioned as the health professional with most frequent patient contact. There is already some supporting evidence that pharmacists’ involvement in interventions to reduce benzodiazepine use can have positive effects on patient outcomes (Gallagher, 2013).
To receive ACPE credit for this session, you must:
Upon successful completion, ACPE credit is reported within 24 hours to CPE Monitor although transcripts can be retrieved by participants online in their ACPE Transcript.
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Kristina Ward, PharmD, BCPS, BCPP
View biographical information
The College of Psychiatric and Neurologic Pharmacists is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.
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2022 Planning Committee
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Ericka Crouse, PharmD, BCPP, BCGP, FASHP, FASCP Associate Professor VCU School of Pharmacy Richmond, VA External Consultant Activities, Advisory Panels, Speakers Bureaus, etc.: ASHP - PAM Behavioral Health Committee (volunteer), Editorial Board - The Medical Letter (paid), American Society of Consultant Pharmacists - speak at meetings/webinars on GeroPsych topics (paid), Wolters-Kluwer, paid consultant |
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Cassandra Davis, PharmD, BCPP, BCPS Mental Health Clinical Pharmacy Specialist Orlando VA Medical Center Orlando, FL No Relevant Financial Relationships to Disclose |
 Megan J. Ehret, PharmD, BCPP, MSBCPP Program Director Professor University of Maryland Baltimore, MD External Consultant Activities, Advisory Panels, Speakers Bureaus, etc.: Psych U Section Advisor, Lexi-Comp Consultant/Reviewer, SMI Adviser; Pharmacist Consultant Educational Grants, Research Grants or Contracts: FDA/University of Maryland CERSI, Maryland Behavioral Health Department, NIH |
 Sarah Melton, PharmD, BCPP, BCACP, FASCPChair Professor of Pharmacy Practice Gatton College of Pharmacy Johnson City, TN Non-Financial Interests: One Care of Southwest Virginia, Virginia Board of Pharmacy, Virginia Opioid Abatement Authority, Overmountain Recovery, Virginia Department of Health Professions Board, Virginia Medicaid Pharmacy and Therapeutics Committee |
Troy Moore, PharmD, MS, BCPP |
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Erika Titus-Lay, PharmD, BCPP, BCPS Assistant Professor California Northstate University College of Pharmacy Elk Grove, CA Educational Grants, Research Grants or Contracts: Sponsor, ASHP Pharmacy Leadership Scholars Research Grant |
2022 Reviewers
Audrey Abelleira, PharmD, BCPP, BCPS |
David Dadiomov, PharmD, BCPP |
James J. Gasper, PharmD, BCPP |
Cindy A. Gutierrez, PharmD, MS, BCPP |
Dara L. Johnson, PharmD, BCPP, BCACP |
Benjamin Miskle, PharmD |
Marnie Noel, PharmD, BCPP |
All relevant relationships have been mitigated.
All relevant relationships have been mitigated.
Off-Label Use: This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA (see faculty information). The opinions expressed in the educational activity do not necessarily represent the views of AAPP and any educational partners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Disclaimer: Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications on dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Presentation-Specific Disclosure: My presentation will include discussion of off-label, experimental, and /or investigational use of drugs or devices: pregabalin, melatonin, carbamazepine, and propranolol.
It is the policy of AAPP to ensure independence, balance, objectivity, scientific rigor, and integrity in continuing education activities. Those involved in the development of this continuing education activity have made all reasonable efforts to ensure that information contained herein is accurate in accordance with the latest available scientific knowledge at the time of accreditation of this continuing education activity. Information regarding drugs (e.g., their administration, dosages, contraindications, adverse reactions, interactions, special warnings, and precautions) and drug delivery systems is subject to change, however, and the reader is advised to check the manufacturer’s package insert for information concerning recommended dosage and potential problems or cautions prior to dispensing or administering the drug or using the drug delivery systems.
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