New psych NP question

[Jmartin2376]

I'm a new psych NP practicing in MS. My collaborating physician is basically no help. He's reluctantly agreed to mentor me, but it's basically only on paper barring a crisis. So, I'm kind of on my own.

Here's my question. When do you prescribe a benzo? I'm trying to taper down anyone that comes to me and is currently on xanax daily. I get a lot of patients that are referred from pain management to manage their "anxiety" that they have been on a benzo for chronically. I feel like at least half of my patients are seeking either a benzo or a stimulant. I feel thrown to the wolves. This is my first job out of school (and this one was damn hard to get). Help is greatly appreciated.

[Jules A, MSN]

Hopefully your practice isn't adverse to you either firing or being fired if in fact these patients aren't just unfortunate in that they had a poor prescriber but are drug seeking. I'd recommend consider reaching out to your previous preceptors or instructors. It is unconscionable you don't have experience with this prior to graduating and starting to work but then again not surprising based on the state of NP education. The stimulant dilemma is easy for me personally because if I don't think its appropriate and in 95% of adults I don't I will not continue it. There are other options to try if their "ADHD" is that bad and they are employed or in school. If a patient is on opioids with benzos, using alcohol or geriatric they are at high risk of adverse event. Benzos are tricker than stimulants because depending on the type and dose they likely need a taper. There are some excellent strategies, cross tapers etc. to manage this however not appropriate to advise on particulars on an online forum so again seek out assistance from those signed off on you being competent to start practicing.

[Jmartin2376]

Thanks for your advice! I tend to prescribe a lot of Buspar and ssri's for anxiety, and they roll their eyes and take it from me. I'm sure many of them won't be back...

So many pcp refer to psych if their pt even mentions adhd or anxiety. It's frustrating that so many of them won't just say NO, YOU AREN'T GETTING XANAX AND ADDERALL!

[Jules A, MSN]

Thanks for your advice! I tend to prescribe a lot of Buspar and ssri's for anxiety, and they roll their eyes and take it from me. I'm sure many of them won't be back...

So many pcp refer to psych if their pt even mentions adhd or anxiety. It's frustrating that so many of them won't just say NO, YOU AREN'T GETTING XANAX AND ADDERALL!

Preaching to the choir! PCPs and even other psych prescribers don't have the stones to say NO and offer alternative solutions especially when patients start screaming, crying and threatening. It can be maddening and exhausting but stay the course with what you know to be prudent prescribing. SSRIs should be first line for depression and or anxiety imo. The few who actually give it a chance and participate in therapy will see real growth and that is priceless.