Every now and then a patient will come in and explain they had to "take a pill" to be less anxious. I totally understand the rationale. Millions of people avoid coming to see guys like me, and have to take measures to relax. I'm a big fan of how effective that choice is for patients.
But self-medicating comes with significant risks. Take, for example the aforementioned patient. She drove herself to the visit while under the influence of the drug. I don't care if it's a time-release capsule or there is a late onset of effect from the drugs. That's a black-and-white no-no without a driver or an escort. It's a recipe for impaired judgement, a motor vehicle accident, or an accidental injury.
May people are surprised when I tell them it is a serious medical risk without close monitoring and controlled prescribing and dosing efforts. "But I feel perfect!" some say. Most every common sedative will create respiratory depression, or mess with the brain's ability to regulate stable and consistent breathing. Then there's the physical changes to balance and communicating. The ability to reason starts to diminish. And most patients I see are using at least one other medication. Some patients metabolize or process the drugs differently; some get quick effects, some get little effect. That needs close management. There are countless drug interactions with sedatives. And those interactions need to be studied and managed for patients prior to taking the drugs.
So back to the question: why do patients self-medicate with sedatives instead of letting us administer them? It's mostly due to cost avoidance, in my experience. I get that. But I can't take on the liability of patients using sedatives unless I can closely monitor administer, and control the drugs. And there's the point: risk management and monitoring patients while using sedatives will cost money. But ultimately the costs are lower given the numerous risks every patient faces.
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