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A communication to all doctors
from the Chief Medical Officer
CMO's Update 37
January 2004



Doctors are being reminded that benzodiazepines should only be prescribed for short-term treatment, in light of continued reports about problems with long-term use.

Clear guidance for appropriate use was published in 1988 by the Committee on Safety in Medicines (CSM), which recommended Benzodiazepine should be prescribed for:

  • just two to four weeks for relief of severe or disabling anxiety that is subjecting the patient to unacceptable distress; and

  • severe or disabling insomnia in patients who are extremely distressed.

They should not be prescribed for the treatment of mild anxiety, according to the CSM. Although prescribing of benzodiazepines has declined substantially since the release of CSM advice in 1988, prescribing has continued for patients with insomnia and anxiety and for substance mis-users.

Department of Health data show that in 2002, 30% of prescriptions for benzodiazepines were for 56 or more tablets (see box), which suggests a high number of patients are receiving long-term treatment. Long-term use exposes patients to risks such as road traffic accidents, dependence and, in the older population, debilitating falls.

Reducing use

Echoing the CSM advice, the Mental Health National Service Framework (NSF), which was published in 1999, recommended that benzodiazepines should be used for no more than two to four weeks for severe and disabling anxiety.

The Mental Health NSF called upon health authorities to implement systems for monitoring and reviewing prescribing of benzodiazepines within local clinical audit programmes. Primary Care Trusts (PCTs) should ensure that this recommendation is still being implemented.

Experts say consistency in approach and effective communication between primary and secondary care health professionals could help reduce over-prescribing. Such communication could involve the use of shared treatment guidelines that specify duration of therapy and cessation of treatment following hospital discharge.

More attention should be paid to prescribing of benzodiazepines to older people. This could possibly be achieved during the regular medication reviews entitled to all people over 65, according to the Older People's National Service Framework.

Use of benzodiazepines in substance mis-users is still an area of concern. It is estimated that 14% of substance mis-users attending drug treatment centres report benzodiazepine use subsidiary to their main drug use.

Benzodiazepines by the numbers

  • General Practitioners in England wrote 12.7 million prescriptions at a cost of 20.9 million in 2002, compared to 15.8 million prescriptions worth 13.8 million in 1992. (Newer agents are more expensive, leading to higher costs despite a drop in prescription volume.)

  • 30% of prescriptions were for 56 or more tablets.

  • People over 65 years received 56% of prescriptions for the three most commonly prescribed benzodiazepines.
  • Source: Department of Health, 2002 data, England

The Department of Health is planning to introduce instalment dispensing of benzodiazepines to minimise access to excessive doses for addicted patients. Also, in some parts of the country, specialist clinics are available to help people with benzodiazepine dependence.

The Chief Medical Officer (CMO), Sir Liam Donaldson MSc, MD, FRCS(Ed), FRCP, FRCP(Ed), FRCGP, FFPHM, FMedSci is the UK Government's principal medical adviser and the professional head of all medical staff in England.

Original Source: Benzodiazepines warning, Chief Medical Officer's Update 37, Patient Safety, Department of Health, January 2004.

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