They say every dog has its day and IT think every drug has its place Anyone who says ‘that drug is bad’ or that test is bad or that anything is bad is just being closed minded or not aware of the evidence because evidence and medicine comes down to numbers. The real statement should be I don’t think that drug is beneficial enough for the harm. However that is an opinion statement, it is what you think and that is when shared decision making comes into play because maybe your patient does think it is beneficial No more clearly see than in this viewpoint in Jama titled Balancing the Risks and Benefits of Benzodiazepines https://jamanetwork.com/journals/jama/fullarticle/2775180?guestAccessKey=fe7dd94f-653f-4da0-ad1f-21fb8c60e420&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jama&utm_content=olf&utm_term=010821 Which talks about the risk and benefits of benzos. A drug that I often here so many providers dis on with no real evidence to back it up—how do I know there is no real evidence?? Because as the authors point out To date, no published meta-analyses have compared benzodiazepines with selective serotonin reuptake inhibitors for anxiety People will often cite data from morbitiy and mortality weekly and say that rates of abuse are on on the rise and as an example- among US women aged 30 to 64 years, the rate of benzodiazepine-related deaths increased from approximately 0.5 per 100 000 population in 1999 to nearly 5 per 100 000 population in 2017; BUT BUT “I said benzodiazepine-related deaths” That is such a tricky number it just means that benzo were on board not that benzo killed them. If I said oxygen related deaths the number would be 100%. Everyone who breaths oxygen dies. and, these data do not distinguish benzodiazepine monotherapy related death from coadministration with other medications. from 1993 to 2014, the rate of benzodiazepines and opioids combined increased from 9.8 to 62.5, per 100 000 outpatient visits Sure benzos can be addictive but so can SSRI! Have you every tried to take someone off an SSRI?!? You can’t just stop it cold turkey most of the time and lets be honest if you are addicted to drugs you fix isnt coming from benzos. in 2017 among 2 005 395 admissions to publicly funded substance abuse treatment programs only 1% identified benzodiazepines as their primary drug of abuse. I am not saying benzos are perfect and give them to everyone. Of course not, and I agree fewer people needs benzos but Every dog has its day and every drugs has its use practice guideline from the American Psychiatric Association includes benzodiazepines among first-line pharmacologic treatment strategies for panic disorder I bring all this up because https://www.fda.gov/drugs/drug-safety-and-availability/fda-requiring-boxed-warning-updated-improve-safe-use-benzodiazepine-drug-class September 2020, the US Food and Drug Administration (FDA) announced an update to the boxed warning on all benzodiazepines to explicitly “address the serious risks of abuse, addiction, physical dependence, and withdrawal reactions” My fear is most physicians will see this headline, never critically think about it and mimic what they read and it will come off as “benzos are addictive, abusivie, and a terrible drug” with little thought to the limitations of the evidence. They will likely then go on writing for their SSRI which also has addictive properties with results that are slower for onset and not better than the benzo. I am not saying these are great drugs but if you are saying they are terrible drugs then you need to remember Every dog has its day. https://www.practiceupdate.com/c/111407/2/6/?elsca1=emc_enews_daily-digest&elsca2=email&elsca3=practiceupdate_primary&elsca4=primary-care&elsca5=newsletter&rid=MzU5ODQyMjUwMDM1S0&lid=20849334 Not all things are created equal and not test are created equal. This is no more clearly seen in this article i(continued)