Addressing long-term use of benzodiazepines

Abstract

Even though several psychiatric organisations advise against the use of benzodiazepines, they are still considered as one of the major class of drugs which are continuously misused and overprescribed. This is especially unfavourable in the older population. These concerns support strategies for deprescribing and ensuring safe and rational use. Such a scenario brought about the research question namely: what strategies could be adopted to address misuse of benzodiazepines. The aim was to understand local trends of benzodiazepine use and propose strategies and address appropriate use of this class of drugs. The objectives of this study were to obtain evidence of status of use of benzodiazepines and to develop frameworks which support prescribers, pharmacists and patients in addressing the concerns of over-use. The methodology was intended to identify barriers that a prescriber encounters in deprescribing processes. Data available within the National Health System on benzodiazepine usage was analysed and factors including age, gender, medication, dose and regimen were noted. A data collection tool was developed and patients visiting community pharmacies and filling benzodiazepine prescriptions were interviewed on use of benzodiazepines. A focus group made up of medical experts in the field was set-up to discuss the evidenced based data using analysed trends. Discussions were held regarding the potential irrational prescribing of benzodiazepines, the barriers prescribers face, access to the medication, and regulatory challenges. Within the National Health System, 7,683 patients were on a long-term benzodiazepine and approximately 7 million benzodiazepine tablets were consumed per year. The most prescribed medicines were lorazepam (n=2,449,684), followed by bromazepam (n=2,004,240) and diazepam (n=1,174,912). These results were also reflected within the community pharmacies through the completion of the developed data tool. In the study population (n=113), statistical significant differences between duration of treatment were observed (p<0.05) for benzodiazepine prescribed, age groups, diagnosis, original prescriber, and dose, as well as diagnosis versus benzodiazepine prescribed. The focus group panel identified patient assuming doctor’s approval, patient not aware of adverse effects and alternatives, benzodiazepine are highly effective and are hard to replace, patient feels reliant and fears return of symptoms, deprescribing is time-consuming and demanding, and devolving of responsibility as the most significant enablers and barriers when deprescribing benzodiazepines. As primary dispensers, pharmacists are in the optimal role to campaign and raise awareness about the adverse effects associated with benzodiazepines. Through the focus group meetings, information was gathered to construct and propose a plan which would serve as a guideline for prescribers to deprescribe benzodiazepines and to prescribe benzodiazepines long-term in a safer way. This plan could also serve as a guide for other healthcare workers to engage patients and support deprescribing. A multidisciplinary approach, contributes towards better implementation and outcomes.