As someone who suffers from anxiety disorder (or suffered, I should say, since it's very well controlled now with paxil) I find myself advocating for my anxious, panic attack-laden patients.
You know how nothing is more annoying than a patient who is anxious? Because you can't fix it for them and you can't get the docs to order benzos, because oh-my-god benzos will make the patient STOP BREATHING and become a crazed addict!
Seriously, doctors, 0.5mg of PO ativan will NOT hurt your very anxious patient, the patient with physical signs of having a panic attack, nevermind his subjective reporting. If he's this worked up, a little ativan will only bring him down to normal, the same amount of ativan that had he been normal and just a drug seeker would've brought him down to a RASS of -2.
It's like stairs. A small, appropriate dose of benzos will only bring you to the next step down from whatever step you're already on!
This particular patient is homeless and a known substance abuser with chronic pain. He came in with altered mental status after OD'ing on benzos at an ECF, benzos that were not prescribed. Maybe he wouldn't have felt the need to self-medicate had the staff there been able to give him an appropriate dose that gave him relief from his panic attacks? Maybe not, but still. What's the end goal for this guy? He's old, bed bound, and lives at a facility. He's not going to go through intensive psychotherapy or life style changes. Treat his anxiety and his pain, don't just give him nothing. And if he continues to self-medicate and use, oh well. At least we tried.
Give him nothing and I guarantee that he will self-medicate again, and probably OD again. And we will be right back here where we started, with me paging YOU every time he pushes the call light, which is every 2 minutes, for more pain meds/anxiolytics. No one's having very much fun right now!