Prescribing benzodiazepines in general practice: a new view of an old problem

Abstract

General practitioner (GP) prescribing has been identified as an arena that has broad social and political implications, which stretch beyond individual outcomes for patients. This article revisits aspects of the controversy about prescribing benzodiazepines (or 'minor tranquillizers') through an exploration of contemporary views of GPs. In the 1980s the prescribing of these drugs was considered to be both a clinical and social problem, which brought medical decision making under public scrutiny. The legacy of this controversy for recent GPs remains a relatively under-explored topic. This article describes a qualitative study of GPs practising in the north-west of England about their views of prescribing benzodiazepines. The accounts of the respondents highlight a number of points about: blame allocation, past and present; clinical challenges about risk management; and deserving and undeserving patients. These GP views are then discussed in the wider context of psychotropic drug use. It is concluded that, while there has been a recent consensus that the benzodiazepines have been problematic, when they are placed in a longer historical context, a different picture is apparent because other psychotropic drugs have raised similar problems.

Socio-demographic factors and long-term use of benzodiazepines in patients with depression, anxiety or insomnia

“…For example, general interventions targeting all PHCCs rather than certain PHCCs might be more efficient, as the long term users were not clustered within certain PHCCs. The finding of a very low ICC at the PHCC level is in contrast to several other studies investigating variation in prescription patterns between health care centres (Fang et al, 2009;Mercuri and Gafni, 2011;Mousques et al, 2010;Rogers et al, 2007). However, those studies used other outcomes and it is possible that prescription patterns regarding longterm use of benzodiazepines are more related to individual-level factors than area-level factors.…”

“…If properly used, benzodiazepines possess sedative, hypnotic, and antianxiety properties and have therefore an obvious role in the therapeutic arsenal (Fang et al, 2009;Fassaert et al, 2007;Rogers et al, 2007) when initiating medical and/or psychotherapeutic treatment of depression, anxiety and insomnia disorders. Long-term use of benzodiazepines, however, is associated with complications such as withdrawal symptoms, therapeutic dose dependence, relapse anxiety, falls and fractures and impairment in long-term cognitive functioning (which can remain for several months after benzodiazepines have been withdrawn) (Anthierens et al, 2007;Cunningham et al, 2010;Fang et al, 2009;Fassaert et al, 2007;Rogers et al, 2007;Zandstra et al, 2002). …”

“…Former studies have shown that there is a considerable variation in prescription patterns between health care centres (Fang et al, 2009;Mercuri and Gafni, 2011;Mousques et al, 2010;Rogers et al, 2007). Such contextual factors may include the location of the health care centre (urban/rural), neighbourhood socioeconomic factors, the prescribing culture of physicians, and resources available in the health care centre.…”

General practitioners’ experiences and perceptions of benzodiazepine prescribing: systematic review and meta-synthesis

“…“While recently psychiatrists predominantly have focused on the management of psychosis, at the time of the emergence of the benzodiazepine problem they would regularly see outpatients with problems of anxiety and depression who were not, as now, managed in primary care” [26]. …”

“…I mean if the worst thing you can say about these drugs is that they have a potential for dependency, I don’t think that is a good enough reason to withdraw” [26]. …”