2. Benzodiazepine Prescribing in Primary Care Jeff Rudman Benzodiazepine Prescribing in Primary Care Newton Rigg Jan 2008 Jeff Rudman Cumbria PCT GP Prescribing Lead

5. prescribing influences medicine management other pressures cumbrian position background

6. background background

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

8. Barbiturates

9. benzodiazepines ZZZZZZZZ drugs

10. Benzodiazepines temazepam diazepam nitrazepam lorazepam loprazolam

11. Z drugs zopliclone zolpidem zaleplon

13. Effects Relieve tension worry anxiety Promote calm and relaxation Induce sleep

14. Side Effects Aggression hostility Excitement Antisocial behaviour Anxiety Insomnia Altered perception

15. Addictive Tolerance 3-14 d Abuse + alcohol Withdrawal Syndrome: Insomnia Anxiety Tremor Loss of appetite Confusion

16. Sudden Withdrawal convulsions psychoses

17. 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

18. position position

19. anxiety grief panic insomnia

20. patients head ?

21. 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

22. influences influences

23. doctors head ?

24. unhappy stressed pressured pill for every ill !

25. doctors head ? alarms bells ringing??

26. benzo s can seriously damage your health WARNING ??????

28. time listen understand patients perspective empathise partnership realism

29. modification of help seeking behaviour

30. empower the patient preserve the doctor patient relationship

31. RAPEDRAPED

32. Reassure Advice Prescribe Educate Direct

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

36. medicine management

38. Morecambe Bay award

40. interventions withdrawal PILs background use comparative data websites

41. team work

42. Interface

43. incentivesinterventions

44. www.benzo.org.uk www.prodigy.nhs.uk / benzodiazepine & z drug withdrawal www.bcnc.org.uk

45. other pressures

46. so much else to do time consuming hard work resource implications not cost saving

47. The desire to take medicine is perhaps the greatest feature which distinguishes man from animals Sir William Osler Sir William Osler

48. One of the first duties of the physician is to educate the masses not to take medicine Sir William Osler

49. its not benzos……