Developing primary care services for high-dose benzodiazepine-dependent patients: A consultation survey

Abstract

Aim: To survey healthcare workers and high-dose benzodiazepine-dependent patients and obtain views on service improvement for managing high-dose benzodiazepine dependency. Methods: Two focus groups were conducted-one consisting of drug workers and highdose benzodiazepine users and one of drug workers and general practitioners. Groups discussed gaps in service provision for benzodiazepine dependency. Based on a thematic analysis of the discussion, a pilot questionnaire was developed. The final version was sent to all GPs and drug workers in one inner-London borough. Findings: Five themes emerged from the focus groups: definition, impact on society, fear of withdrawal, attitudes and future service developments. The questionnaire was sent to 210 GPs and 21 drug workers. Response rate: 105 (50%) and 13 (62%), respectively. GP respondents had seen 482 high-dose benzodiazepine dependent patients in the preceding month; drug workers had seen 90. Benzodiazepines were considered an important cause of social and physical problems (69% and 75%, respectively). Just 9% of GPs thought that users wanted to withdraw, 23% were not encouraging them to withdraw and only 45% felt confident in carrying out withdrawal. The Department of Health, 'Orange Guidelines', had only been read by 53% of GPs. Three service priorities were identified: specialist benzodiazepine drug workers (preferably based in general practices), educational support (including up-to-date guidelines) and clinical psychologist input.

A Systematic Review and Meta-Synthesis of Patients’ Experiences and Perceptions of Seeking and Using Benzodiazepines and Z-Drugs: Towards Safer Prescribing

“…The nine included studies were published between 2003 and 2015 and were from four countries (Australia, Belgium, UK, USA) [12,13,9,[14][15][16][17][18][19]. Participants in these studies were mainly older adults that were frequent users of BZDs.…”

“…Finally, discussion of what patients wanted from services also included the idea of establishing specialised withdrawal services: "Some service users wanted a specialized benzodiazepine service: They should maybe have a place where they just…deal in benzos and nothing else…like the same as a methadone place" [18] …”

Innocent parties or devious drug users: the views of primary healthcare practitioners with respect to those who misuse prescription drugs

“…Whilst much has been written about practitioners' attitudes towards drug misusers per se, and their treatment within primary care settings [ 12 - 15 ], we have found little which has examined this issue within the context of patients involved in misuse of prescription medicines, specifically. A small-scale study undertaken in the UK which explored views of high-dose benzodiazepine-dependent patients also identified that these individuals were not considered a uniform group, with distinctions made between housewives "with anxiety problems" and polydrug users [ 16 ].…”

Interventions for benzodiazepine withdrawal: Perceptions of benzodiazepine counsellors

“…Nevertheless, research shows minimal interventions such as a tailored GP letter or consultation (Darker et al., 2015) can assist patients to withdraw. However, GPs report difficulty addressing the needs of patients with complex psychological issues and prescription drug misuse (Anthierens et al., 2007; Kapadia et al., 2007; Porath‐Waller et al., 2015). There is now compelling evidence that psychosocial support contributes to the effectiveness of BZD withdrawal, and it has been found that combining a medically supervised taper with psychological counselling is superior to tapering alone (Parr et al., 2009; Reeve et al., 2017).…”