And they slept happily ever after: Online interpretive repertoires on the use of benzodiazepines and z-drugs

Abstract

Drawing on a critical social-psychological framework for discourse analysis, data from a popular forum for people over 50 were analysed to study how the habitual use of benzodiazepines and Z-drugs (BZD/Z) is discursively negotiated by Flemish older adults. We present five different repertoires (risk and addiction; alternative pathways; suffering; rationalisation; cessation) that illustrate how a pharmaceutical imaginary of these medications is constructed online and how posters act as reflexive users taking on a health role. Most repertoires emerge from a tacit norm on the undesirability of medication use for sleeping problems. In the alternative pathways and cessation repertoires this norm is implicitly accepted by focussing on how to either prevent or overcome chronic use with various alternative solutions or through tapering off, while the risk and addiction repertoire is used to more openly defend and discursively magnify the idea that medication has to be avoided at all cost. We discuss how this reflects a prevailing imperative of health and ethos of healthicisation of sleep. The rationalisation and suffering repertoires on the other hand challenge this norm by defending medication use. We further explore how these repertoires are used to self-position as either ‘noble non-user’, ‘deserving and/or compliant patient’ or ‘rational user’, reflecting previously found moral positions in offline settings. Our data add another position that has thus far not been discussed extensively with regard to prescription medication use, namely that of a ‘recovered user’. As such, this study shows how this particular online community is a site for contestation of health promotion and medical/pharmaceuticalised discourses on sleep by users and non-users alike and offers a unique insight into how people in the age group that is known to use most BZD/Z discursively negotiate the use of these medications in pseudonymised online interactions.

From prescribing dilemma to knowledge in practice: The ontological politics of benzodiazepines and Z-drugs

“…Furthermore, earlier work on interpretative repertoires of patients shows how the imaginary of BZRA is constructed around a tacit societal norm on the undesirability of pharmaceuticalising sleeping problems (Ceuterick et al, 2021), reflecting the moral positions (used to deal with conflicting values) of patients as either 'noble non-users', 'deserving and/or compliant patients' or 'rational users', also found in offline settings (Gabe et al, 2016). The positions of a 'responsible user' and 'deserving patient' also result from our storylines (as illustrated in the last column of Table 3), which reveals that prescribers equally draw on similar moral positionings of patients when making sense of a decision to prescribe.…”

Benzodiazepines and z-drugs - between treatment effectiveness and the risk of addiction

“…These medications may interact with other medications, including alcohol, and increase the risk of side effects and adverse reactions. Patients should inform their physician of all medications, supplements, and herbal products they use before starting benzodiazepines or Z-drugs [37].…”

Digital Ethnobiology: exploring the digisphere in search of traditional and indigenous knowledge and practices

“…On the forum, members describe personal treatments to sleep better based on their experiential knowledge. For a full list we refer to Ceuterick et al (2021). These remedies did not only include commercialized herbal preparations, but also recipes for home-made teas based on fresh and dried plant materials, decoctions and combinations of treatments, which were highly interesting from an ethnobiological point of view and provide an interesting new avenue for future research.…”