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Benzodiazepine Policy

1. We feel that Benzodiazepine’s have no place in the treatment of chronic pain, and we will not under any circumstances prescribe them.

2. We strongly encourage you to taper off of Benzodiazepine’s; however, if you are prescribed them it must be done by one physician. It may be either your PCP or psychiatrist.

3. You must understand the following:

A.) Benzodiazepines do not provide pain relief.

B.) Benzodiazepine’s are highly addictive and create physical

dependence.

C.) Benzodiazepines in combination with narcotics may cause

respiratory depression or death.

D.) Benzodiazepines are not good long term anti-anxiety

medications.

E.) Benzodiazepine’s cause on-going mental slowing and may

cause long term brain damage.

F.) Abruptly stopping a Benzodiazepine may cause seizures or

death.

Patient_______________________________________

(Print Name)

Patient_______________________________________

(Signature)

Date_________________________________________

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