Benzodiazepines Co-operation Not Confrontation (BCNC)
The full version of this document, including proposals for each stage, can be seen at www.bcnc.org.uk/way-ahead.html
Benzodiazepines, such as Diazepam, Ativan, Librium, Tranxene, Mogadon, to name a few, are among the most commonly prescribed of all drugs. They are primarily indicated for anxiety and insomnia but are also used for many other conditions. This document looks at the way ahead if problems associated with benzodiazepines are to be solved.
(1) The Problems:-
Psychological and physical dependency, the state when people feel they can no longer function correctly without benzodiazepine, can develop within weeks and medical evidence suggests that benzodiazepines are no longer effective after a few weeks. The committee on Safety of Medicines concludes that they should, in general, only be prescribed for short term usage of between 2 /4 weeks. The vast majority of people who become dependent do so via prescription supplied benzodiazepines
Withdrawal symptoms include depression, anxiety, insomnia, nightmares, agoraphobia, fatigue, poor memory and concentration and can take many months and even years before they subside completely.
(c) Street Use
Recreational usage is a growing problem and the availability is becoming easier via street suppliers and the Internet. They are often used to increase the effects of illicit drugs.
(2) Steps to be Taken
(a) New Patients
(1) There are many different reasons for prescribing benzodiazepines, including anxiety, bereavement, pain relief, menopause, muscle relaxant etc. In the cases which are anxiety related, the first line treatment should be psychological therapy but there is a great shortage of clinical psychologists which create long waiting lists. The London school of Economics and Political Science have recently issued the “The Depression Report. A New Deal for Depression and Anxiety Disorders” in which they propose that 10,000 new therapists in the next seven years, 5000 should be clinical psychologists and 5000 should be psychological therapists.
(2) It is vital that an education program is put in place to ensure that all GPs understand the results that their prescribing can have on their patients, if they prescribe for longer than the recommended time scales laid down by the BNF, i.e. 2-4 weeks.
(3) Patients should be given enough information such that they can make an educated decision as to whether or not to undertake such treatment. A leaflet outlining what benzodiazepines are, what they are used for, how they work, is already available to GPs, and all medical staff, via Patients UK or on their website www.prodigy.nhs.uk which was updated June 2006 and is Prodigy validated.
(b) Patients Dependent on Prescription Supplied Benzodiazepines
(1) Under the new system, due to come into effect from October 2006, there will be some 152 PCTs and it is vital, especially with the re-organisation that is taking place, that each of these PCTs carries out an audit to determine the number of patients who are, within their domain, dependent on prescription benzodiazepines.
(2) It should be highlighted, to all professionals, that successful withdrawal can only be achieved by working with people who are willing to withdraw and the withdrawal must always be at the patients’ rate of reduction. It is both time wasting and expensive in terms of human effort to force people to withdraw and is only counter productive.
(3) Structure needs to be added to the “blue print”, for withdrawal from benzodiazepine, has been produced by the Prodigy Guidance in their document Benzodiazepine and Z Drug Withdrawal, which is available on their website www.prodigy.nhs.uk.
(4) Each PCT should have a person, a focal point, who would oversee all aspects of benzodiazepine usage within the PCT.
(5) Each GP surgery should have a suitably trained, in benzodiazepines, surgery nurse or pharmacist, who would work with the GP, and would be responsible for educating all patients, who are treated by that surgery, about the problems associated with benzodiazepines.
(6) A better working partnership should be established between the doctors and organisations in the voluntary sector who deal with and are familiar with benzodiazepine withdrawal.
(c) Street Benzodiazepines
People, who have fallen into the benzodiazepine trap via street drugs, should be treated in exactly the same way as those who have become dependent through prescription supplied benzodiazepines. These people are usually handled by the drug and alcohol teams. It is therefore vital that the staff who run this service are included in the overall training of staff on benzodiazepines.
1. A member of the D and A team should be made responsible for the overview of street benzodiazepine dependency, and should liaise with the person with overall responsibility for the PCT.
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