Procedure - Clonazepam Prescription

Purpose

To restrict the use of Clonazepam within correctional facilities.

1. Process

The health care of prisoners will be better enhanced by prescribing safer alternatives than Clonazepam.

The use of Clonazepam in the correctional setting should be restricted and its ongoing prescription is limited to specialists only. Refer appendix - Additional Information - Clonazepam.

2. Therapeutic uses of Clonazepam

2.1 Psychotropic

Clonazepam may sometimes be prescribed for psychiatric conditions, however, there are other less potent alternatives available.

In the correctional system, only psychiatrists are authorised to prescribe Clonazepam for psychiatric reasons if alternatives are considered inappropriate. It should be remembered that 0.5mgm (not 2mgm) of Clonazepam is equivalent to 5mgm of Diazepam.

2.2 Anticonvulsant

Clonazepam is a third line drug and as such, should not be prescribed or continued in the correctional system for epilepsy in the absence of appropriate evidence that the prisoner has epilepsy and that Clonazepam is the only effective or appropriate drug.

New receptions claiming to suffer epilepsy controlled by Clonazepam must-

1. be referred to the doctor who will ascertain the relevant history, ensure appropriate hospitals and outside medical attendants are contacted to substantiate the history and its investigation and decide as to whether to prescribe Clonazepam;
2. if there is no clear evidence of previous assessment and investigation from external health providers or when the prescription has been instituted by a non specialist, the prisoner must be referred to a physician for assessment of epilepsy;
3. if Clonazepam is to be continued, the doctor must refer the prisoner to a physician for assessment and follow up of epilepsy.

3. Treatment of withdrawal syndrome

New receptions on Clonazepam must undergo withdrawal. Refer to procedure - Alcohol and Drug Withdrawal for benzodiazepine and polydrug withdrawal.

F P Rockett
Director-General