Benzodiazepine Prescribing Benzodiazepine Prescribing in Primary Carein Primary Care

Newton Rigg Jan 2008

Jeff RudmanJeff Rudman

Cumbria PCT GP Prescribing Lead

prescribing influences medicine management

other pressures

cumbrian position background

backgroundbackground

? alcoholalcohol1864 barbituratesbarbiturates bayer1911 phenobarbitone

1950s addiction1950s benzodiazepinesbenzodiazepines chlordiazepoxide ‘librium’ diazepam ‘valium’

2000s flunitrazepam ‘rohypnol’

BarbituratesBarbiturates

benzodiazepinesbenzodiazepinesZZZZZZZZ drugsZZZZZZZZ drugs

BenzodiazepinesBenzodiazepines

temazepamdiazepam nitrazepam lorazepam loprazolam

Z drugsZ drugs zopliclone zolpidem zaleplon

Effects

Relieve tension worry anxietyPromote calm and relaxationInduce sleep

Side Effects

Aggression hostilityExcitementAntisocial behaviourAnxietyInsomniaAltered perception

Addictive Tolerance 3-14 d Abuse + alcoholWithdrawal Syndrome: Insomnia Anxiety Tremor Loss of appetite Confusion

Sudden Withdrawal

convulsionspsychoses

CSM adviceshort term relief (2-4 weeks)

anxietyanxiety only when severe, disabling or causing extreme distress

insomniainsomnia only when severe, disabling or causing extreme distress

short term mild anxietyshort term mild anxiety use is inappropriate and unsuitable

positionposition

anxiety

grief

panic

insomnia

patients head ?

Background informationHow many people take Benzo and Z Drugs?

It is estimated that between 500,000 and 1 million people in the UK receive repeat prescriptions for therapeutic doses of a benzodiazepine

Over 80% of prescriptions for benzodiazepines are issued to people over the age of 65 years, and these are the people who are most vulnerable to their adverse effects.

It is estimated that 200,000 people in the UK use benzodiazepines illicitly, usually in association with other drugs and to help with insomnia and agitation when coming off stimulants

The reduction in prescribing of hypnotic benzodiazepines (sleeping tablets) in recent years has been matched by an increase in prescribing of z drugs

influencesinfluences

doctors head ?

unhappy

stressed

pressured

pill for every ill !

doctors head ?

alarms bells ringing??

benzos can seriously damage your health

WARNING ??????

timelisten

understandpatients perspective

empathisepartnership

realism

modification of help

seeking behaviour

empower the patientpreserve the doctor patient relationship

RAPED

ReassureAdvice

PrescribeEducateDirect

doctors head ? hands ?

soft touch? does it have to be like this?

medicine medicine managementmanagement

Morecambe Bay awardMorecambe Bay award

interventions

withdrawal PILs

background use

comparative data

websites

team workteam work

Interface

incentivesincentivesinterventionsinterventions

www.benzo.org.ukwww.benzo.org.uk

www.prodigy.nhs.ukwww.prodigy.nhs.uk / benzodiazepine & z drug withdrawal/ benzodiazepine & z drug withdrawal

www.bcnc.org.ukwww.bcnc.org.uk

other pressuresother pressures

so much else to dotime consuming

hard work resource implications

not cost saving

The desire to take medicine The desire to take medicine is perhaps the is perhaps the

greatest feature greatest feature which distinguishes which distinguishes man from animalsman from animals

Sir William Osler Sir William Osler

One of the first duties One of the first duties of the physician of the physician

is to educate the masses is to educate the masses not to take medicinenot to take medicine

Sir William OslerSir William Osler

its not benzos……