Older Patient Perspectives on Long-Term Anxiolytic Benzodiazepine Use and Discontinuation: A Qualitative Study

Abstract

OBJECTIVE:The objective of the study is to understand patient factors contributing to the chronicity of benzodiazepine use by older adults as a first step in the development of acceptable intervention strategies for taper/discontinuation or prevention of chronic use. DESIGN:The design of the study consists of qualitative semi-structured patient interviews. SETTING AND PARTICIPANTS:The participants were 50 anxiolytic benzodiazepine users, 61-95 years of age, recruited through referrals from primary care physicians who practiced in the general Philadelphia, Pennsylvania area.RESULTS: Many older chronic users have come to rely and psychologically depend on benzodiazepines for their unique soothing properties, attributing to these medications characteristics that extend beyond an ordinary medication, i.e., affording control over daily stress, bringing tranquility, and even prolonging life. Most of the patients denied or minimized side effects and expressed resistance to taper or discontinuation, ranging from subtle reluctance to outright refusal and fear of being left suffering without these medications. CONCLUSIONS:The reluctance of older chronic benzodiazepine users to taper or discontinue use highlights the importance of prevention and early intervention strategies to avoid the development of chronic use. Suggestions for curbing chronic use are presented.

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

“…With the exception of one paper [15] where the majority of patients were reported to be taking their medication as prescribed, they encompassed a continuum from patients who tried to minimise their usage either through taking a smaller dose than prescribed or by taking them only as needed, through to patients who took more than they were prescribed: "Many said, 'they do not like to take sleeping tablets, and so only used them when needed'" [16] "Respondents said they used only small doses, they consumed less medication than prescribed, and they took it only when necessary" [13] "'…he said one spoonful and 2 hours later I took another and another. The next night I drank two-thirds of the bottle'" [17] Patients' own awareness and fear of the dangers of addiction to BZDs contributed to a desire to take only the minimum dosage of BZDs by some patients:…”

“…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.…”

“…Several papers (particularly [14,15,19]) contained information on withdrawal strategies and enablers and barriers to withdrawal. Strategies for withdrawal included taking an individually tailored approach and focussing on alternative strategies for coping:…”

“…Are you gonna tell him [the physician] not to prescribe it anymore? Please don't tell him not to give it to me'" [15] "With minimal probing, patients' seeming willingness to consider tapering or substitution of alternative medications shifted to an admission that this would be an unacceptable option. Patients' responses ranged from the more simply expressed reluctance, "I need it" or "I don't want to change," to more sophisticated explanations, i.e., anticipation that the taper process would be negative" [15] Links between feelings and beliefs about dependence on medication and the ongoing use of medication were seen in two papers:…”

“…[14] "'…too many other competing demands to address the benzodiazepine: I always have like some other issue other than, you know, that one pill'" [15] In addition to barriers internal to the patient, barriers that were external to the patient were also discussed, such as lack of support from GPs, a need for specialist withdrawal services, and absence of an appropriate support network:…”