Abstract
Benzodiazepines (BZDs) are widely used as anxiolytic, hypnotic, and antiepileptic drugs. They have a fast pharmacodynamic tolerance to hypnotic and anxiolytic effects and long-term prescribing of them is ineffective and potentially dangerous because of the induced dependence. Numerous studies have outlined the high level of their use in Europe, with a particular high level of use in France. The risk of death is not negligible in any patient population,1 and can be a result of long-term exposure, acute exposure, or sudden dosage increase. This article reviews the determinants of BZD prescription by GPs and existing measures to reduce it. A synthesis narrative review of recent published or unpublished international literature on BZD prescription in general practice has been used. ### France’s position in BZD consumption France is second to Spain in the use of anxiolytic BZDs and Sweden and Norway have the highest level of use of hypnotic BZDs, with France in third place. A moderate decrease in BZD use has been observed in France over the past 3 years, but the number of French people consuming BZDs is still too high and many campaigns in France to reduce BZD use have been unsuccessful. In most European countries included in the Agence National de Securite du Medicament et des Produits de Sante (ANSM) report,2 long-term BZD use is stable over time even though short-term use decreases.3 ### BZDs consumption and the public health problem In France, BZDs and related Z drugs (such as zolpidem and zopiclone) are actively monitored by the ANSM ‘addictovigilance’ network, through national survey databases, spontaneous reports by health professionals, and health insurance reimbursement databases.4 BZDs are legitimately obtained in pharmacies by GP prescriptions, but are also obtained through ‘doctor shopping’ and through illegal means.5,6 The benefit–risk ratio of a long-term treatment is unfavourable. After a few weeks, there is an increased risk of …
Highlights
Benzodiazepines (BZDs) are widely used as anxiolytic, hypnotic, and antiepileptic drugs
In most European countries included in the Agence National de Sécurité du Médicament et des Produits de Santé (ANSM) report,[2] long-term BZD use is stable over time even though short-term use decreases.[3]
The main principles of good use of BZDs and their deprescribing rarely come from general practice, and the applicability of these principles to the GP–patient relationship is a significant challenge
Summary
Benzodiazepines (BZDs) are widely used as anxiolytic, hypnotic, and antiepileptic drugs. They have a fast pharmacodynamic tolerance to hypnotic and anxiolytic effects and long-term prescribing of them is ineffective and potentially dangerous because of the induced dependence. The risk of death is not negligible in any patient population,[1] and can be a result of long-term exposure, acute exposure, or sudden dosage increase. This article reviews the determinants of BZD prescription by GPs and existing measures to reduce it. A synthesis narrative review of recent published or unpublished international literature on BZD prescription in general practice has been used. Competing interest: The authors declare that no competing interests exist. Author Keywords: Prescribing benzodiazepine, General practice, Drug and substance abuse
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