The State of California is playing doctor. In 2015, the Division of Industrial Relations promulgated Medical Treatment Utilization Guidelines (MTUS) that limit medical care provided to injured workers. I am writing a series of articles to point out some of the deceptions contained in these mandatory guidelines which are preventing injured workers from getting the medical care they need.
Xanax is one medication severely limited by the MTUS. The state sanctioned logarithm for Xanax as well as diazapine fall under the MTUS rule on page 24 of the Chronic pain guidelines for Benzodiazepenes as follows:
Benzodiazepines
Not recommended for long-term use because long-term efficacy is unproven and there is a risk of dependence. Most guidelines limit use to 4 weeks. Their range of action includes sedative/hypnotic, anxiolytic, anticonvulsant, and muscle relaxant. Chronic benzodiazepines are the treatment of choice in very few conditions. Tolerance to hypnotic effects develops rapidly. Tolerance to anxiolytic effects occurs within months and long-term use may actually increase anxiety. A more appropriate treatment for anxiety disorder is an antidepressant. Tolerance to anticonvulsant and muscle relaxant effects occurs within weeks. (Baillargeon, 2003) (Ashton, 2005)
The language, “ Chronic benzodiazepines are the treatment of choice in very few conditions” is somewhat of an enigma. Why refer to then leave out the conditions that benzodiazepines are the treatment of choice? The MTUS rule quotes Luci Baillargeon who conducted and published a study in 2003 that concluded; tapering of benzodiazepines were more effective in conjunction with cognitive behavioral therapy. The MTUS also quotes Heather Ashton’s article of 2005, The Diagnosis and Management of Benzodiazepine Dependence. The article concludes benzodiazepines are not indicated for long term treatment of depression or for those with alcohol or drug dependence. The article in the conclusion states, “when used for chronic psychiatric conditions such as…anxiety disorders and chronic insomnia, clinicians should examine the risk-benefit ratio at an early stage so the risk of dependence can be balanced against the any therapeutic benefits and abuse.” (Page 5.)
So one should reasonably conclude the mystery language “the treatment of choice” contained in the MTUS must be referring to chronic psychiatric conditions such as…anxiety disorders and chronic insomnia. Unfortunately, in reality and practice due to the vaguery of the MTUS rule for benzodiazepines, pretty much all prescriptions for Xanax for chronic conditions are being denied even though as note above they are the treatment of choice for a few conditions.
