Presentation on theme: "Benzodiazepine Prescribing in Primary Care Jeff Rudman Benzodiazepine Prescribing in Primary Care Newton Rigg Jan 2008 Jeff Rudman Cumbria PCT GP Prescribing."— Presentation transcript:
Benzodiazepine Prescribing in Primary Care Jeff Rudman Benzodiazepine Prescribing in Primary Care Newton Rigg Jan 2008 Jeff Rudman Cumbria PCT GP Prescribing Lead
prescribing influences medicine management other pressures cumbrian position background
alcohol ? alcohol barbiturates 1864 barbiturates bayer 1911 phenobarbitone 1950 s addiction benzodiazepines 1950 s benzodiazepines chlordiazepoxide ‘librium’ diazepam ‘valium’ 2000 s flunitrazepam ‘rohypnol’
Addictive Tolerance 3-14 d Abuse + alcohol Withdrawal Syndrome: Insomnia Anxiety Tremor Loss of appetite Confusion
Sudden Withdrawal convulsions psychoses
CSM advice short term relief (2-4 weeks)anxiety only when severe, disabling or causing extreme distressinsomnia only when severe, disabling or causing extreme distress short term mild anxiety use is inappropriate and unsuitable
anxiety grief panic insomnia
patients head ?
Background information How many people take Benzo and Z Drugs? It is estimated that between 500,000 and 1 million people in the UK receive repeat prescriptions for therapeutic doses of a benzodiazepine Over 80% of prescriptions for benzodiazepines are issued to people over the age of 65 years, and these are the people who are most vulnerable to their adverse effects. It is estimated that 200,000 people in the UK use benzodiazepines illicitly, usually in association with other drugs and to help with insomnia and agitation when coming off stimulants The reduction in prescribing of hypnotic benzodiazepines (sleeping tablets) in recent years has been matched by an increase in prescribing of z drugs
doctors head ?
unhappy stressed pressured pill for every ill !
doctors head ? alarms bells ringing??
benzo s can seriously damage your health WARNING ??????
time listen understand patients perspective empathise partnership realism
modification of help seeking behaviour
empower the patient preserve the doctor patient relationship
Reassure Advice Prescribe Educate Direct
doctors head ? hands ? soft touch? does it have to be like this?
Morecambe Bay award
interventions withdrawal PILs background use comparative data websites
/ benzodiazepine & z drug withdrawal
so much else to do time consuming hard work resource implications not cost saving
The desire to take medicine is perhaps the greatest feature which distinguishes man from animals Sir William Osler Sir William Osler
One of the first duties of the physician is to educate the masses not to take medicine Sir William Osler