Clonazepam prescribing patterns and abuse by methadone patients in a medical center setting

Methadone patients who require inhospital detoxification from self-administered clonazepam (CZM) were interviewed. Patients enrolled in drug dependency (DDTP), combined addiction psychiatry (CAPP) and methadone maintenance (MM) were surveyed. Twenty out of 20 DDTP and 15 out of 30 CAPP patients responded indicating no knowledge of CZM as a drug of abuse. MM patients were reluctant to respond, but the 18 out of 72 who did, indicated knowledge of CZM abuse. Ten identified CZM as a "downer," 11 indicated its use to "get high," 10 knew other people who abused, and 6 believed abuse to be common. Six identified a street value as $1-5 per mg and 5 identified the amount to get high as 2 mg or more. A 90 day monitoring of prescription writing by all physicians at the same institution used a threshold of benzodiazepine potency equivalent to 40 mg diazepam daily with unmonitored refills. Using this arbitrary descriptor of potentially hazardous prescribing, CZM was the most commonly "excessively" prescribed benzodiazepine. (Fifty cases out of 194 prescriptions as compared to 14 cases of all other benzodiazepines combined.) Psychiatrists wrote 68%, neurologists 15% and internists 14%. As a result of this information, physicians are cautioned and prescription monitoring mechanisms are recommended.