Agreement regarding Benzodiazepine

Agreement Regarding Benzodiazepine Prescription

Overview

Your clinician at YES in Psychiatry has prescribed a benzodiazepine medication for you. Common medications in this class include diazepam (Valium), lorazepam (Ativan), clonazepam (Klonopin), and alprazolam (Xanax). In psychiatry, these medications are primarily used to help manage anxiety disorders, though they may also be prescribed for muscle spasms or seizure disorders.

General Information

Benzodiazepines are typically not recommended for long-term treatment of anxiety. Medical studies show that their effectiveness may decrease over time with prolonged use. These medications are closely monitored by the FDA and by your provider through state prescription monitoring programs.

To ensure continuity of care:

• Request refills at least 7 business days in advance.
• Lost or stolen prescriptions cannot be replaced or refilled early due to federal and clinical monitoring regulations.

Possible Side Effects

All benzodiazepines may cause similar side effects. Commonly reported ones include:

• Drowsiness, dizziness, or confusion
• Difficulty concentrating or forgetfulness
• Slurred speech and poor coordination
• Depression or emotional blunting

Use extreme caution when driving, operating machinery, or engaging in tasks requiring alertness, as benzodiazepines can impair reaction time.

Risks and Safety Considerations

Misuse of benzodiazepines can be dangerous.

Taking more than prescribed may result in overdose, causing severe drowsiness, respiratory depression, coma, or death — especially when combined with alcohol or other sedating substances.

Tolerance (needing higher doses for the same effect) can develop, leading your provider to adjust, taper, or discontinue the medication.

If you suddenly stop taking a benzodiazepine after regular use, you may experience withdrawal symptoms, including anxiety, irritability, insomnia, tremors, sweating, panic attacks, nausea, palpitations, muscle pain, or seizures. Do not stop your medication without medical guidance. Your clinician will develop a safe tapering plan if discontinuation becomes necessary.

Substance Use Monitoring

Because benzodiazepines can be habit-forming, it is essential to disclose any history of drug or alcohol use to your provider.

• Periodic urine drug screenings or laboratory tests may be required.
• Individuals with a substance use history may only receive benzodiazepines under strict monitoring or be offered alternative treatments.

Your clinician will partner with you to create a comprehensive treatment plan that may include therapy, lifestyle changes, or non-controlled medications.

Patient Agreement

When you begin treatment with a benzodiazepine at YES in Psychiatry, you agree to the following conditions:

• I will participate in all recommended treatments, including therapy or non-controlled medications.
• I will not adjust my dose, schedule, or stop taking the medication without provider guidance.
• I will not sell, share, or give my medication to anyone else.
• I will attend all scheduled appointments. Missing or canceling two appointments within one business day or missing two or more visits may result in discontinuation of my prescription.
• I will notify my clinician of any new prescriptions for controlled substances (e.g., opioids, stimulants, barbiturates) or any hospitalizations.
• I understand that seeking similar medications from other providers may result in discontinuation of this prescription.
• I understand that lost or stolen medications may not be replaced and early refills will not be provided.
• I will abstain from alcohol and illicit drugs according to my provider’s recommendations.
• I will complete required lab work and drug screening upon request.
• I will take responsibility for monitoring my medication supply and will request refills at least 7 business days in advance, during normal business hours.

Safe Storage and Use Guidelines

• Keep your medication in a locked container in a secure location away from others.
• Carry only a one-day supply when leaving home. Your pharmacist can provide a second labeled bottle if necessary.
• Never share or sell your medication.
• Keep track of how many pills you have remaining. If you feel tempted to take extra doses, contact your clinician immediately.
• If anyone ingests your medication accidentally, call 911 or Poison Control immediately.

Discontinuation Policy

Your clinician at YES in Psychiatry may discontinue your benzodiazepine prescription if any of the following occur:

• You miss two consecutive or multiple regularly scheduled appointments.
• You experience significant or unsafe side effects.
• You develop a rapid tolerance and the medication loses effectiveness.
• You refuse required drug screens or are found to be misusing, selling, or combining the medication with illegal substances.
• Your clinician determines that benzodiazepine treatment is no longer safe or clinically appropriate.
• You fail to meet your responsibilities outlined above, including compliance with treatment recommendations.

By proceeding with benzodiazepine treatment, you acknowledge understanding of and agreement with the terms and conditions stated above.