For the record I am boarded in IM and Palliative Medicine. We use off label meds in Palliative and Hospice all the time. And yes for intractable nausea and vomiting, when standard anti-emetics fail, we will use other meds. In particular, in chemotherapy associated nausea and vomiting we will try benzos, ask an oncologist and you will understand. In other refractory nausea and vomiting that is not a mechanical issue, we will use antipsychotics like haldol and olanzepine. As for your comment about referral to a GI, good luck, almost all of them would have their Np see it since they couldn’t be bothered as they are too busy scoping. That’s the reality. But like you said, it’s not your area so I wouldn’t expect a psychiatrist to know this. But UpToDate is not the ultimate arbiter in anything, even though it’s a great starting point.
As for prescribing benzos this isn't the 1980s: all controlled substances have to be logged into Texas PDMP , as you should be aware, and since your are required by the Texas Medical Board to check PDMP when prescribing these meds, doctor shopping or multi source rx is not as likely. If you are stupid enough not to check or are unscrupulous, it’s easy to get busted. But you already knew that, right? You can even check and see the patient’s controlled substance activity in other states , you knew that, right?
User name checks out.