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Clinical Pharmacy News Summary

Role for pharmacists in reducing the problem
of benzodiazepine addiction

The Pharmaceutical Journal
Vol 266 No 7148 p668-670

May 19, 2001

Pharmacists have a role to play in assisting patients addicted to benzodiazepines, according to Sheena Macgregor, prescribing adviser for Borders Primary Care NHS Trust, Roxburghshire, Scotland.

Ms Macgregor told The Journal on May 16 that, despite increased medical and public awareness of the long-term effects of benzodiazepines, many patients still requested sleeping tablets, or "something to help them cope" with a difficult life event.

Ms Macgregor's comments follow a BBC Panorama programme that highlighted the degree to which benzodiazepines are being prescribed in the United Kingdom. The programme's presenter claimed that more than one million adults in Britain were addicted to tranquillisers prescribed by their general practitioners. This was despite guidance that was issued in 1988 by the Committee on Safety of Medicines, which stated that benzodiazepines should not be prescribed for more than four weeks at a time.

Speaking on the programme, which was broadcast on May 13, Professor Louis Appleby, the National Director for Mental Health at the Department of Health, said: "There are seven million prescriptions each year for these drugs but our data does not tell us how many people are on them long-term." He added that changing prescribing practice required more than just guidelines, and that practice changed slowly.

Commenting on what pharmacists could do to help alleviate the problem, Ms Macgregor said that prescribing advisers should recommend that benzodiazepines are not added to computer repeat prescription records. This would avoid patients accessing further supplies without their GP reviewing the prescription. "Patients need to be advised that the prescription is for a few weeks only and should be informed of the alternative options that are available." She added that, in some areas, alternative resources could be an option, for example, sleep clinics, community psychiatric nursing or clinical psychology support.

Ms Macgregor added that prescribing advisers could encourage GPs to review benzodiazepine prescribing and assist them with developing withdrawal strategies. Practice-based and community pharmacists could also provide support for motivated patients to discontinue their medication gradually.

Professor Martin Kendall, chairman of the Joint Formulary Committee of the British National Formulary, told The Journal on May 16: "In the right context, benzodiazepines have an important place in therapeutics, but, despite clear guidance on how they should be prescribed, there are still some concerns about inappropriate use.

"The Joint Formulary Committee recognises that doctors still see individuals who have become dependent on benzodiazepines. This is why the BNF not only describes the effects of benzodiazepine dependence and sudden withdrawal but it continues to offer advice on how patients are best weaned off the drug."

BNF guidance

The guidance, which is summarised in the British National Formulary (No 4.1, p166), states:

• Benzodiazepines are indicated for the short-term relief (two to four weeks only) of anxiety that is severe, disabling or subjecting the individual to unacceptable distress, occurring alone or in association with insomnia or short-term psychosomatic, organic or psychotic illness.

• The use of benzodiazepines to treat short-term "mild" anxiety is inappropriate and unsuitable.

• Benzodiazepines should be used to treat insomnia only when it is severe, disabling, or subjecting the individual to extreme distress.

The BNF also provides guidance on withdrawal of benzodiazepines. It states that a benzodiazepine can be withdrawn in steps of about one-eighth of the daily dose every fortnight. It also suggests a protocol for patients who have difficulty withdrawing from the drugs.

From: The Pharmaceutical Journal, May 19, 2001

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