Benzodiazepine prescription regulation: autonomy and outcome

Article Abstract:

Two major issues today in health care are physician autonomy and the use of outcome results to measure the quality of medical care. In general, physicians resent the intrusion by government and managed-care types of insurance programs. Ideally, a physician's freedom to use his medical judgement on behalf of a patient should be preserved, with certain limitations to insure the patient receives appropriate care. To this end, practice guidelines have been developed. Measures of outcome, if based on randomized controlled clinical trials, have long been accepted in medicine. However, the use of outcome data (such as hospital death rates) as measures of quality of medical care are questionable when they are not derived from random, controlled studies. In the November 6, 1991 issue of the Journal of the American Medical Association, the results of a study appears that involves both of these key issues, outcome assessment and physician autonomy. Benzodiazepines are widely prescribed drugs, but available evidence supports the view that this reflects a high prevalence of the disorders they treat. Most benzodiazepine use is short-term, although a small group with chronic disorders may require long-term treatment, in which there is a possibility that the patient will develop a physiologic dependence. The impact is assessed of a New York State requirement that all prescriptions for benzodiazepines (anti-anxiety medication) be written in triplicate on special forms. The intent of the requirement was to decrease inappropriate prescriptions and divert these drugs away from the illicit market. According to this study, the New York State restrictions did decrease the number of prescriptions written for benzodiazepine; however, there was also a large increase in the use of alternative sedatives that are less effective and considerably less safe. It would be unfortunate if the inability to differentiate between physiologic dependence and drug abuse leads to fear and undertreatment of the conditions for which benzodiazepines are prescribed. Both the positive and the negative results of the New York State restrictions on prescribing benzodiazepines must be considered in evaluating the success of this intervention. (Consumer Summary produced by Reliance Medical Information, Inc.)

Drugs, Laws, regulations and rules, Prevention, New York, Prescription writing, Dosage and administration, Drug abuse, Drug administration and dosage, Benzodiazepines

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The medical outcomes study

Article Abstract:

The Medical Outcomes Study (MOS) is an attempt to relate the outcomes of medical intervention with the structures of the health care system that renders the care. In this study, involving hundreds of physicians and thousands of patients over a two year period, eight common areas of chronic physical illness and depression were studied. Reports over time will empathize the structures, such as type of practice, process and outcome, including both objective data and the patients' own feelings. The study is also concerned with the inter-relationships of two or more of these factors as patients suffering from multiple diseases are more common than those with a single disease. Patients with a depressive disorder or with depressive symptoms are being studied with extra attention. Initial findings show that these patients have decreased physical, social and role functioning, a reduced personal view of their health and greater bodily pain. The study is a bold attempt to get at some important epidemiologic issues, but the investigators invite criticism of their methodology in many areas. Although there seems to be bias in the selection of the type of practice, the large sample of patients seems to provide some reassurance. Ultimately, the study is about outcome. What is the physician's and the patient's perception regarding the outcome? Do they differ? How is the process affected by the medical structure in which it occurs? Answers to these and more related questions should be instructive, and should emphasize the old law, "treat the patient, not the disease."

Research, Case studies, Chronic diseases, Depression, Mental, Depression (Mood disorder), Patient monitoring, Physiologic monitoring, Outcome and process assessment (Health Care), Outcome and process assessment (Medical care), editorial

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Methadone maintenance: new research on a controversial treatment

Article Abstract:

Treatment of heroin addicts with methadone hydrochloride was first started in the 1960s. A 1965 research article found that daily treatment with methadone was effective in alleviating the craving for heroin. Methadone treatment also enabled addicts to stabilize for different types of psychosocial treatment and rehabilitation. This type of treatment also contributed to the viewpoint of addition as a disease. Despite the benefits of methadone maintenance, this type of treatment has remained controversial. Some individuals object to the use of an addictive drug to treat drug addiction. Methadone treatment is strictly regulated by the government to prevent methadone abuse or diversion. Two research studies found that addicts in a methadone maintenance program who received counseling and other support services were more likely to recover than those who were treated with methadone alone.

Care and treatment, Usage, Drug addicts, Drug abusers, Methadone maintenance, Heroin habit

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