Managing Benzodiazepines with MAT: The Philadelphia Story

April 14, 2014

Maureen Fitzgerald

Editor, ATTC Network Coordinating Office and NIATx

With this month’s Third Thursday iTraining (2:00pm EST, April 17, 2014) coming up, “Management of Benzodiazepines in Medication-Assisted Treatment,” I took a few minutes to chat with Roland Lamb, Director of the Office of Addiction Services at Philadelphia’s Department of Behavioral Health and Intellectual disAbility Services (DBHIDS).

Lamb and colleagues at DBHIDS got the ball rolling to create a set of practice guidelines for benzodiazepines back in 2011, in response to what they saw as a very confusing environment for Philadelphia providers and their constituents. 

“We were seeing a lot of different approaches to benzodiazepines and MAT for opioid dependence,” says Lamb. “Some providers were medicating patients with benzodiazepines and others refused to treat anyone who was using them. There were also providers who just didn’t know what to do with patients who continually tested positive for benzodiazepines while receiving MAT. And then there were patients who were getting prescriptions for benzodiazepines but not testing positive—so they must have been dealing. It was a very confusing environment for providers and for patients, but our main concern at DBHIDS was that we did not want to see people discharged from treatment for the very reason they needed treatment.”

A suggestion from Dr. Trusandra Taylor led Lamb to consider creating a resource similar to the ATTC buprenorphine treatment blending product. He then reached out to Dr. Arthur Evans, Commissioner of DBHIDs, Dr. Matthew Hurford, Chief Medical Officer at DBHIDS, Dr. James Schuster, Chief Medical Officer at Community Care Behavioral Health Organization, and Mike Flaherty, then director of IRETA, to get the project going.  Drs. Hurford and Schuster, along with Dr. Dawn Lindsay of IRETA, will present the April 17 iTraining.

“We saw this as not just a Philadelphia problem, but a statewide and national problem,” says Lamb. “The end result we hoped would be a set of guidelines that would focus on treating the person rather than managing the medications.”

The resulting guidelines, developed by IRETA, join the of Practice Guidelines for Recovery Oriented Treatment that DBHIDS has created as part of its Tools for Transformation initiative. Jessica Williams provides a great overview of the guidelines in her article in this month’s ATTC Messenger. For more about the Transformation Initiative, see Jon Korczykowski’s recent story in Behavioral Healthcare, "Transformation in Philadelphia". 

“Philadelphia providers have welcomed the benzodiazepine guidelines, but at the same time they’ve given some providers reasons to question use of benzodiazepines. We still need to figure out how to fit this all together in terms of risk management,” says Lamb. “We’re hoping that providers will begin to tell us which guidelines are useful, and we also want to hear from those they’re treating.”

Overall, says Lamb, creating the guidelines demonstrates how payers like DHBIDS can enhance quality of care. “Partnering with providers serves our constituents better, and creating guidelines like these allows us to extend the partnership with greater continuity.”