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

background background

alcohol ? alcohol barbiturates 1864 barbiturates bayer 1911 phenobarbitone 1950 s addiction benzodiazepines 1950 s benzodiazepines chlordiazepoxide ‘librium’ diazepam ‘valium’ 2000 s flunitrazepam ‘rohypnol’

Barbiturates

benzodiazepines ZZZZZZZZ drugs

Benzodiazepines temazepam diazepam nitrazepam lorazepam loprazolam

Z drugs zopliclone zolpidem zaleplon

Effects Relieve tension worry anxiety Promote calm and relaxation Induce sleep

Side Effects Aggression hostility Excitement Antisocial behaviour Anxiety Insomnia Altered perception

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

position position

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

influences influences

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

RAPEDRAPED

Reassure Advice Prescribe Educate Direct

doctors head ? hands ? soft touch? does it have to be like this?

medicine management

Morecambe Bay award

interventions withdrawal PILs background use comparative data websites

team work

Interface

incentivesinterventions

/ benzodiazepine & z drug withdrawal

other pressures

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

its not benzos……