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One in three benzodiazepine prescriptions last over a year, GPs warned



A quarter of a million patients may be prescribed benzodiazepines and Z-drugs for over 12 months by GPs, despite guidance that states they must be prescribed for no longer than four weeks, shows a new study.

The study, published in the BJGP, suggests that just under 300,000 patients nationwide are taking benzodiazepines or Z-drugs for longer than recommended.

The BNF recommends that benzodiazepines should be prescribed in short courses only and for no longer than four weeks, due to the high risk of dependency, potential adverse neurological and cognitive outcomes and difficulty in withdrawing.

But a research team from the University of Roehampton looked at data from just under 100,000 benzodiazepine and Z-drug users in GP practices and found 35% were taking benzodiazepines and Z-drugs for at least 12 times longer than the BNF recommends.

The RCGP said that there were currently not enough specialist addiction-management services, and this was behind the problem.

The data were collected by the Bridge Project, a prescribed drug withdrawal support charity and they showed 0.69% of patients had been prescribed benzodiazepines and Z-drugs for more than a year.

The research paper said: ‘The results also suggest that 35% of all users of [benzodiazepines and Z-drugs] are taking these drugs long term — that is, for at least 12 times longer than the BNF recommends.’

The team also found that 43% of patients in the study group were interested in being supported to come off the drugs, suggesting that just over 119,000 patients in the UK may also be interested in making use of withdrawal services.

They said: ‘The first recommendation is to reduce prescribing levels by ensuring adherence to existing guidelines for prescribing and withdrawal, and develop new guidelines where needed.

‘Many of the patients experiencing problems with prescribed medicines may have avoided the associated harms if existing prescribing guidelines had been followed.’

They also recommended that GPs should be more active in identifying long-term users and helping them to withdraw safely .

This comes as a recent study suggests that patients starting benzodiazepines for the first time are not at any increased risk of death compared with non-users.

RCGP chair Professor Helen Stokes-Lampard said: ‘Benzodiazepines and other psychotropic drugs can be very effective when they are prescribed appropriately and in accordance with clinical guidelines, something that GPs are highly trained to do, taking into account the unique physical, psychological and social factors potentially affecting the health of the patient in front of us, and in conversation with them.

‘But they can also be very addictive – and withdrawal from benzodiazepines requires careful management by healthcare professionals, so it’s vital that there are sufficient addiction-management services available in the community to facilitate this, and at present this unfortunately is not the case.

‘Some patients taking these drugs will be particularly vulnerable and will require additional specialist services.’

She added that the RCGP ‘would strongly support’ the researchers’ call for patients dependent on prescription drugs to ‘have easy, consistent, but also confidential access to support’, as well as ‘more guidance’ for healthcare professionals to ‘appropriately manage prescriptions’.

Br J Gen Pract 2017; available online 18th July