Proposals for Consideration and Discussion
Let's look at how the problem of benzodiazepine addiction across the NHS has to be approached. There must be a two fold strategy. The first part must be to ensure that systems are put into place that will only allow the prescribing of any form of benzodiazepine or Z drug medication for short term usage and this may well require the intervention of Parliament to make it illegal to use them other than for a short term duration. It may be that benzodiazepines will need to be put into the category "A" drugs. The period of allowed prescribing has got to be less than the known, for the want of a better word, dependency integration period. Without this in place and working correctly then the removal of the problem will never come about.
The second part must be how do we help those patients who have already become dependent and what needs to be our approach to achieve some reasonable levels of success.
Part One Strategy
How are we going to stop ourselves producing even more prescribed benzodiazepines dependents? This surely must be down to education and tight regime control. The education has to be given to all Medical Practitioners working within the Community Drug teams and for all general Practitioners working in shared care in the NHS. These people have to be made fully aware of the recommendations of the various bodies on only prescribing benzodiazepines for short term usage and that period of two to four weeks should not be exceeded. In fact it may well be that the lower time period should be the one used, since recent reports coming out of Canada are talking about a seven day period usage being sufficient to create addiction.
Education alone isn't enough to ensure success. Strict controls must be put in place to ensure that the advice given is put into practice. To the layman it wouldn't seem an impossible task, in this day and age of computers and high technology to obtain records of all prescriptions, say on a daily or on a weekly basis, within each Primary Care Trust area, where the request for the supply of benzodiazepines was made. It would mean that all Pharmaceutical Chemists, who dispense the prescriptions would need to make available to some central point details of the people for whom the benzodiazepines have been prescribed, the dosage and whether or not it is a new user of that medication.
The collection of such information could be either Primary Care Trust wide or limited to existing Local Health Group areas. I'm sure that some of the type of information I am talking about is already available with the Prescribing Support Chemists within the L.H.G's. If there is a will to stop the over prescribing for new patients to benzodiazepines, then a way will be found to make this information available between the inter-acting groups. A fairly easy software programme could be introduced to make for easy analysis. The programme should be such that it would give a read out as soon as the agreed length of time for new users had been reached. It would highlight the doctors surgery involved so that a standard email or fax could be sent to the Doctor to inform him/her to cease prescribing of the particular drug for that particular patient unless special circumstances exist which must be given to the Health Authority.
If at the end of the predetermined length of time for the usage of the benzodiazepines, the patient still exhibits the same symptoms then a different approach to the patients problem must be taken. This may involve the use of a different form of medication or counselling or a mixture of both.
Part Two Strategy
How do we help people who have already become dependent? All such patients should be supplied with information on the long term effects of benzodiazepines. This could be given out in the form of a leaflet by the prescribing surgery or the supplying chemists. It should contain at least the following.
(1) Adverse effects of Benzodiazepines
(a) Over sedation, especially in the old, may contribute to confused states and may contribute to falls and fractures.
(b) It can cause forgetfulness and memory impairment.
(c) It can cause increases in irritability and argumentativeness.
(d) It can cause confusion.
(e) Long term usage can result in anxiety symptoms, panic attacks, agoraphobia, insomnia, depression and increasing physical symptoms.
(2) Therapeutic dose dependence
People who have become dependent on therapeutic doses of benzodiazepines usually have several of the following characteristics;-
(a) They have taken benzodiazepines in prescribed doses, usually low, for months or years.
(b) They have gradually come to "need" benzodiazepines to carry out normal, day to day, activities.
(c) They have difficulty in stopping the drug, or reducing dosage, because of withdrawal symptoms.
(d) They develop anxiety symptoms between doses or get cravings for the next dose.
(e) They contact their doctor regularly to obtain repeat prescriptions.
(f) They may carry their tablets around with them.
(g) They may have increased their dosage since the original prescription.
(h) They may have the symptoms given in 1 (e) above.
(3) Why should you come off Benzodiazepines?
Because of the following;-
(a) Unwanted effects given above.
(b) Increased risk of accidents-traffic, home, work.
(c) Increased risk of attempted suicide, especially in depression.
(d) Contributions to job loss, unemployment, loss of work.
(e) They are no longer effective after a certain length of time. Usually weeks or months.
(f) You will feel better in yourself after coming off the drug.