Morecambe Bay PCT (Primary Care Trust) through Andrea Loudon, Head of Pharmacy and medicine Management, and her team of Prescribing Support Pharmacists under the Project Leadership of Simon Butterworth, are in the process of developing an innovative approach to both benzodiazepine control and reduction in prescription medication. They are working on a "whole system" approach which involves prescribing, dispensing and the patient.
BCNC (Benzodiazepine Co-operation not Confrontation) as a group would recommend this approach as being a step in the right direction in the battle to eliminate the problems caused by this type of medication. We would suggest that their approach be followed by other PCTs who should take advice from MBPCT.
The following paperwork has been reproduced , by approval, from works produced by MBPCT Medicines Management Team for which we thank them.
Page 1 of 22
Page 2 of 22
MBPCT Medicines Management
Page 3 of 22
MBPCT Medicines Management
Old problem; chlordiazepoxide
We feel justified in suggesting that the drug should be used with circumspection and scepticism until the results of controlled trials are available
Letter to the Editor, Lancet October 1960
Page 4 of 22
MBPCT Medicines Management
Old problem
“If large doses of chlordiazepoxide are used,the drug should not be abruptly discontinued”.
Psychopharmacologia (1961)
Page 5 of 22
MBPCT Medicines Management
Old problems
Committee on Review of Medicines Report
(BMJ 1980)CSM Current Problems January 1988
CMO Newsletter January 2004
Page 6 of 22
MBPCT Medicines Management
CSM Advice on use of benzodiazepines
1. Benzodiazepines are indicated for the short-term relief of anxiety that is severe, disabling or subjecting the individual to unacceptable distress, occurring alone or in association with insomnia or short term psychosomatic, organic or psychotic illness.
2. The use of benzodiazepines to treat short-term “mild” anxiety is inappropriate and unsuitable.
3. Benzodiazepines should be used to treat insomnia only where it is severe, disabling, or subjecting the individual to extreme distress.
Page 7 of 22
MBPCT Medicines Management
Page 8 of 22
MBPCT Medicines Management
Morecambe Bay – Estimates of Use
Hypnotics
8430 people prescribed hypnotics in 1 year
Est 7000-8000 current users
Anxiolytics
5709 people prescribed anxiolytics in 1 year
Est 3000-4000 current users
10,000 – 12,000 people currently using benzos
Page 9 of 22
MBPCT Medicines Management
Benzodiazepine Users
1. Short term acute use2. Long term use (no perceived problems)
3. Long term use (recognised problems)
4. Recreational users (misusers) of benzodiazepines
. Occasional
. Persistent
Page 10 of 22
MBPCT Medicines Management
Management Strategy
1. Educate health care professionals in effective interventions
2. Stop short term acute use becoming long term dependant use
3. Engage and inform long term users of benzodiazepines
4. Direct benzodiazepine users to most appropriate method of reduction
Page 11 of 22
MBPCT Medicines Management
Aims – managing acute use
. Information on risk of dependency at point of prescribing and dispensing. Maximum of 2 weeks use
. Prevent short term users becoming long term users
Page 12 of 22
MBPCT Medicines Management
Aims – long term use (groups 2&3)
1. Raise awareness – information at point of prescribing and dispensing2. Provide information and support for all users
3. Information for prescribers in discontinuation techniques
Page 13 of 22
MBPCT Medicines Management
Recreational users (group 4)
1. Support may be available via
Drug and Alcohol team
Psychology Services
Psychiatrist
2. ?Referral mechanism
Page 14 of 22
MBPCT Medicines Management
Implementation – GP Practices
1. Continue with information for GP practices
2. Provision of leaflets / posters
3. Identify high use patients
4. Target practices with increasing use
5. Practice policies
6. ?any additional pressure
Page 15 of 22
MBPCT Medicines Management
Implementation – community pharmacy
Utilise community pharmacy contract
Include benzodiazepine users in MUR priorities
PCT determined audit for 2007 on benzodiazepine use
A theme through the public health campaigns
This CPPE workshops – Anxiety and Insomnia (25th April)
Page 16 of 22
MBPCT Medicines Management
Audit Standards for Community Pharmacy Standard 1
100% patients receiving new prescriptions for benzodiazepines (including Z’ drugs) receive information on safe use. This should be documented for all patients.
Page 17 of 22
MBPCT Medicines Management
Audit Standards for Community Pharmacy
Standard 2
Patients who have received long term / repeat prescriptions for benzodiazepines (including Z’ drugs) will receive written information to help them make an informed choice about continuing use.
This will be documented for at least 80% of those patients.
Page 18 of 22
MBPCT Medicines Management
Audit Standards for Community Pharmacy
Standard 3x% of patients prescribed a benzodiazepine long term will be offered a Medicines Use Review by December 2007
Page 19 of 22
MBPCT Medicines Management
Audit Standards for Community Pharmacy
Standard 4
. Staff in the pharmacy maintain a list of other benzodiazepine management services in their area, and know what referral mechanisms are in place for those providers
Page 20 of 22
MBPCT Medicines Management
Audit Standards for Community Pharmacy
Standard 5
A record is made of referrals to other services for benzodiazepine management / reduction.
Page 21 of 22
MBPCT Medicines Management
Audit Standards for Community Pharmacy
Standard 6
The pharmacy will have written patient information available on benzodiazepine use, on sleep, and on anxiety. Use of these will be documented.
Page 22 of 22
Copyright © 2006 bcnc.org.uk Organisation
Forum Disclaimer SiteMap Home Contact us The Ashton Manual