Reduction In Benzodiazepine Use Research Articles

Use of benzodiazepines and z-drugs not compliant with guidelines and associated factors: a population-based study.

Benzodiazepines and z-drugs are primarily indicated for the treatment of sleep disorders and anxiety symptoms. Their frequent long-term use contrasts with the international guidelines that limit treatment duration to a maximum of 4 weeks. The objective of this study was to assess the frequency of their use that was not in accordance with guidelines in the French general population between 2007 and 2012 and associated characteristics. A cohort of 67,550 benzodiazepine new users was set up in an exhaustive database for health-care reimbursements and representative of the French population. Benzodiazepine use not in accordance with guidelines was defined as the concomitant dispensation of several benzodiazepines, the dispensation of treatment over a period longer than recommended, or a new dispensing within the 2months following the end of a previous treatment of maximum recommended duration, considering that French recommendations distinguish between hypnotic (4 weeks) and anxiolytic benzodiazepines (12 weeks). Benzodiazepine use not in accordance with guidelines was high, in about 30% of new hypnotic users and 20% of new anxiolytic users. Its frequency was stable over the study period. Associated characteristics were similar for new hypnotic or anxiolytic users, i.e.. older age, treatment initiation by a psychiatrist, presence of a chronic disease, hospitalization, or another psychotropic treatment. These findings provide a solid basis for establishing a public health policy to reduce benzodiazepine use not compliant with guidelines. They should be further explored in patients most at risk in the present study, e.g., patients treated by a psychiatrist.

De l’intérêt d’évaluer l’anxiété : impact de l’utilisation d’une EVA sur la consommation de benzodiazépines

BackgroundThe optimal management of psychiatric symptoms requires constant adaptation of therapeutic strategy to clinic evolution. If benzodiazepines are a treatment of choice for acute anxiety states in hospitals, their excessive consumption is a concern, revealing a preference of chemical anxiolysis to non-drug alternatives, yet effective for episodes of low or moderate intensities. Faced with an acute anxiety, choice of various therapeutic options requires evaluating its intensity in order to establish an appropriate therapeutic response. To enable systematic and accurate evaluation of an anxious state, Visual Analogue Scale (VAS) seems to be the most suitable tool. The application of VAS to measure anxiety is widely validated by previous research on the subject. We assume that the self-assessment of anxiety is likely to lead to a reduction in benzodiazepine use. ObjectiveThis study aims to determine the impact of systematic evaluation of acute anxious state by VAS, on consumption of benzodiazepines, by proposing a therapeutic strategy adapted to the anxiety level. MethodsThis is a comparative, prospective, multicentric study. Both studied samples came from a population of patients hospitalized in psychiatric crisis service, and recruited sequentially over a period of three months each. For the first group, our practices did not change; for the second group, we introduced VAS as a systematic tool for evaluating each acute episode. Have been included all patients over a period of six months, for which was provided a conditional anxiolytic treatment by benzodiazepine, regardless of their pathology. Then we have compared individual and overall consumption of benzodiazepines (inmg diazepam-equivalent per day of hospitalization) of the two samples. Finally, we compared the consumption of the service during the inclusion period with the consumption of the previous years at the same time of the year. ResultsOur study did not reveal the impact of the introduction of EVA on the consumption of benzodiazepines (P=0.44). However, we observed a decrease in overall average consumption during the same period in the previous year. DiscussionThe evaluation of a symptom, subjective by nature, by an outside observer, is undeniably biased. The benefit of self-evaluation has been proven in the treatment of other acute symptoms such as pain. With VAS, the objective is to better know the intensity of a symptom, to offer the patient a matched care. Its use as an investigative tool of acute anxious states in hospitals appeared to be a promising lead, especially concerning the implementation of non-pharmacological anxiolytic strategies, as an alternative to over-consumption of benzodiazepines. Unfortunately, its use to evaluate acute anxious states didn’t permit to reduce benzodiazepines’ consumption. Our results are compared with data from the actual scientific literature. ConclusionThe adaptation of the therapeutic anxiolytic strategy by self-assessment of the intensity of an anxiety state appears unfortunately inappropriate, both on an individual level, and as a public health point of view. We have to try to find other ways, which would allow preferring non-drug strategies and reducing the consumption of benzodiazepines.

Introduction of a primary care formulary to a nursing home

Objectives/aims : Prescribing is the most common intervention General Practitioners do and accounts for the second highest area of HSE expenditure. Currently there is no Primary Care Prescribing Formulary in Ireland. As part of the HSE service plan 2016 there is a targeted 110 million reduction in prescribing and drug costs. Formularies improve quality of prescribing by decreasing the range of drugs used. The Medicines Management Programme has a single ‘preferred drug’ within a therapeutic drug class. These six medications are also recommended 1st line in the Glasgow Primary Care Prescribing Formulary. Method : The prescriptions for the 48 patients in Heather House nursing home were surveyed. The medications prescribed were compared to the Glasgow Primary Care formulary. A meeting was held between the pharmacist supplying the medications, the General Practitioners and the nursing staff of Heather House. Agreed changes were implemented in the following months prescriptions. Results : There was 118 total changes to medications made averaging at 2.5 changes per patient and 1.4 discontinuations over a 3 month period per patient (66 medications were discontinued). There was 18 benzodiazepine conversions to diazepam (with a 20% total reduction in benzodiazepine use).€30.15 per patient per month was saved leading to €361.83 per patient per year. Calculating the number of nursing home beds in Ireland this leads to a cost saving of 8 million per year. Conclusion : A formulary provides good evidence based prescribing that is both logical and provides value for money

Effect of mirtazapine versus selective serotonin reuptake inhibitors on benzodiazepine use in patients with major depressive disorder: a pragmatic, multicenter, open-label, randomized, active-controlled, 24-week trial

BackgroundThis study aimed to evaluate whether selecting mirtazapine as the first choice for current depressive episode instead of selective serotonin reuptake inhibitors (SSRIs) reduces benzodiazepine use in patients with major depressive disorder (MDD). We concurrently examined the relationship between clinical responses and serum mature brain-derived neurotrophic factor (BDNF) and its precursor, proBDNF.MethodsWe conducted an open-label randomized trial in routine psychiatric practice settings. Seventy-seven MDD outpatients were randomly assigned to the mirtazapine or predetermined SSRIs groups, and investigators arbitrarily selected sertraline or paroxetine. The primary outcome was the proportion of benzodiazepine users at weeks 6, 12, and 24 between the groups. We defined patients showing a ≥50 % reduction in Hamilton depression rating scale (HDRS) scores from baseline as responders. Blood samples were collected at baseline, weeks 6, 12, and 24.ResultsSixty-five patients prescribed benzodiazepines from prescription day 1 were analyzed for the primary outcome. The percentage of benzodiazepine users was significantly lower in the mirtazapine than in the SSRIs group at weeks 6, 12, and 24 (21.4 vs. 81.8 %; 11.1 vs. 85.7 %, both P < 0.001; and 12.5 vs. 81.8 %, P = 0.0011, respectively). No between-group difference was observed in HDRS score changes. Serum proBDNF levels were significantly decreased (χ 2 = 8.5, df = 3, P = 0.036) and serum mature BDNF levels were temporarily significantly decreased (F = 3.5, df = 2.4, P = 0.027) in the responders of both groups at week 24.ConclusionThis study demonstrated mirtazapine as the first-choice antidepressant for current depressive episodes may reduce benzodiazepine use in patients with MDD. Trial registration UMIN000004144. Registered 2nd September 2010. The date of enrolment of the first participant to the trial was 24th August 2010. This study was retrospectively registered 9 days after the first participant was enrolled

Effects of a geriatric intervention aiming to improve quality care in nursing homes on benzodiazepine use and discontinuation.

Benzodiazepines and "Z drugs" are often prescribed in residents of nursing homes (NH) despite their well-known deleterious effects. We aimed to investigate if a general intervention on quality of care led to discontinuation of benzodiazepine, and to examine which NH-related factors were associated in change of benzodiazepines use. IQUARE is a quasi-experimental study, investigating the impact of an intervention based on a geriatric education with NH staff on several quality indicators of care (including appropriate prescriptions). All participating NH received an initial and 18-month audit regarding drug prescriptions and other quality of care variables. The analysis included 3973 residents, 2151 subjects (mean age: 84.6 ± 8.5 years; 74.3% women) in the control group and 1822 (mean age: 85.5 ± 8.1 years; 77.4% women) in the intervention group. Outcomes at 18 months were benzodiazepines use, long-acting benzodiazepines use, new-use of benzodiazepines, and discontinuation. The effect of the intervention was investigated using mixed-effect logistic regression models, including NH variables and residents' health status as confounders. Higher reductions in benzodiazepine use (-2.8% vs. -1.5%) and long-acting benzodiazepine (-3.7% vs. -3.5%) were observed in intervention group, but not statistically significant. None of the structural and organisational NH-related variables predicted either discontinuation or new-use of benzodiazepines; hospitalisations and initial use of meprobamate increased the likelihood of becoming a new-user of benzodiazepines. Multivariate analysis suggested that living in a particular NH could affect benzodiazepines discontinuation. A general intervention designed to improve overall NH quality indicators did not succeed in reducing benzodiazepines use. External factors interfered with the intervention. Further studies are needed to examine which NH-related aspects could impact benzodiazepines discontinuation.

Clinical effectiveness of a sedation protocol minimizing benzodiazepine infusions and favoring early dexmedetomidine: a before-after study.

IntroductionRandomized controlled trials suggest clinical outcomes may be improved with dexmedetomidine as compared with benzodiazepines; however, further study and validation are needed. The objective of this study was to determine the clinical effectiveness of a sedation protocol minimizing benzodiazepine use in favor of early dexmedetomidine.MethodsWe conducted a before-after study including adult surgical and medical intensive care unit (ICU) patients requiring mechanical ventilation and continuous sedation for at least 24 hours. The before phase included consecutive patients admitted between 1 April 2011 and 31 August 31 2011. Subsequently, the protocol was modified to minimize use of benzodiazepines in favor of early dexmedetomidine through a multidisciplinary approach, and staff education was provided. The after phase included consecutive eligible patients between 1 May 2012 and 31 October 2012.ResultsA total of 199 patients were included, with 97 patients in the before phase and 102 in the after phase. Baseline characteristics were well balanced between groups. Use of midazolam as initial sedation (58% versus 27%, P <0.0001) or at any point during the ICU stay (76% versus 48%, P <0.0001) was significantly reduced in the after phase. Dexmedetomidine use as initial sedation (2% versus 39%, P <0.0001) or at any point during the ICU stay (39% versus 82%, P <0.0001) significantly increased. Both the prevalence (81% versus 93%, P =0.013) and median percentage of days with delirium (55% (interquartile range (IQR), 18 to 83) versus 71% (IQR, 45 to 100), P =0.001) were increased in the after phase. The median duration of mechanical ventilation was significantly reduced in the after phase (110 (IQR, 59 to 192) hours versus 74.5 (IQR, 42 to 148) hours, P =0.029), and significantly fewer patients required tracheostomy (20% versus 9%, P =0.040). The median ICU length of stay was 8 (IQR, 4 to 12) days in the before phase and 6 (IQR, 3 to 11) days in the after phase (P =0.252).ConclusionsImplementing a sedation protocol that targeted light sedation and reduced benzodiazepine use led to significant improvements in the duration of mechanical ventilation and the requirement for tracheostomy, despite increases in the prevalence and duration of ICU delirium.

Effects of Prescription Drug Reduction on Quality of Life in Community-Dwelling Patients with Dementia.

Due to the use of multiple drugs and prevalence of diminished cognitive function, community-dwelling elderly individuals are more likely to have drug-related issues. We examined changes in quality of life (QOL) and activities of daily living (ADL) 3 months and 6 months after reducing drug use of dementia patients who had newly begun community-dwelling care. Prescription drug use was reduced in the intervention group, whereas the non-intervention group continued their regimen or began using additional drugs. QOL and ADL were assessed with the Japanese version of the EQ-5D and the Barthel Index, respectively. Subjects were 32 individuals aged ≥65 years who had begun community-dwelling between March and July 2014 and had received approval for long-term care insurance. On average, the intervention group (n = 19) stopped using 2.6 prescription drugs. After 6 months, the differences in the QOL and ADL scores in the intervention group were -0.03 ± 0.29 and 6.32 ± 18.6, respectively, while the differences in the QOL and ADL scores in the non-intervention group (n = 13) were -0.13 ± 0.29 and -2.69 ± 23.7, respectively. In the intervention group, ADL scores were significantly increased by 14.0 ± 11.1 6 months after reduced benzodiazepine use. QOL was maintained with reduced drug use, while ADL score was slightly increased. In addition, the reduction of benzodiazepine use significantly increased ADL. In order to reduce polypharmacy among community-dwelling elderly patients, it is necessary to create an opportunity for pharmacists to re-examine their prescriptions.

Review: Supervised withdrawal plus other interventions reduces benzodiazepine use in older persons.

Source Citation Gould RL, Coulson MC, Patel N, Highton-Williamson E, Howard RJ. Interventions for reducing benzodiazepine use in older people: meta-analysis of randomised controlled trials. Br J Ps...

Interventions for reducing benzodiazepine use in older people: meta-analysis of randomised controlled trials

The use of benzodiazepines has been advised against in older people, but prevalence rates remain high. To review the evidence for interventions aimed at reducing benzodiazepine use in older people. We conducted a systematic review, assessment of risk of bias and meta-analyses of randomised controlled trials of benzodiazepine withdrawal and prescribing interventions. Ten withdrawal and eight prescribing studies met the inclusion criteria. At post-intervention, significantly higher odds of not using benzodiazepines were found with supervised withdrawal with psychotherapy (odds ratio (OR) = 5.06, 95% CI 2.68-9.57, P<0.00001) and withdrawal with prescribing interventions (OR = 1.43, 95% CI 1.02-2.02, P = 0.04) in comparison with the control interventions treatment as usual (TAU), education placebo, withdrawal with or without drug placebo, or psychotherapy alone. Significantly higher odds of not using benzodiazepines were also found for multifaceted prescribing interventions (OR = 1.37, 95% CI 1.10-1.72, P = 0.006) in comparison with control interventions (TAU and prescribing placebo). Supervised benzodiazepine withdrawal augmented with psychotherapy should be considered in older people, although pragmatic reasons may necessitate consideration of other strategies such as medication review.

Quality Initiative to Reduce Benzodiazepine Use in a Cardiothoracic Intensive Care Unit

Delirium has been shown to increase the length of mechanical ventilation, intensive care unit (ICU) and hospital length of stay, and rates of post-discharge institutionalization and in-hospital mortality.1,2 The incidence of delirium in nonventilated patients in the ICU has been shown to be approximately 50%, and the incidence in ventilated patients is even higher at approximately 80%.3,4 Several risk factors have been associated with the development of delirium, including patient age, baseline cognitive impairment, severity of illness, history of alcoholism, elevated creatinine, hypertension, and benzodiazepine use.

Addressing the Issue of Chronic, Inappropriate Benzodiazepine Use: How Can Pharmacists Play a Role?

Prescribing guidelines do not recommend the long-term use of benzodiazepines since their effectiveness with chronic use is out-weighed by risks including dependence, memory and cognitive impairment, hip fractures and traffic accidents. Despite these guidelines, historical data points to an increasing proportion of inappropriate, repeat prescribing of benzodiazepines in Ireland and elsewhere, with up to 33% of patients who use these drugs doing so long-term. The typical long-term benzodiazepine user is an older, socio-economically disadvantaged patient who has been prescribed these medicines by their general practitioner (GP) and dispensed them by their community pharmacist. Misuse of benzodiazepines in nursing homes and psychiatric institutions is also of concern, with one Irish study indicating that almost half of all admissions to a psychiatric hospital were prescribed these drugs, usually despite a lack of clear clinical need. Discontinuation of benzodiazepines has proven to be of benefit, as it is followed by improvements in cognitive and psychomotor function, particularly in elderly patients. It is obvious that an inter-professional effort, focusing on the primary care setting, is required to address benzodiazepine misuse and to ensure appropriate pharmaceutical care. Pharmacists must be an integral part of this inter-professional effort, not least because they are uniquely positioned as the health professional with most frequent patient contact. There is already some supporting evidence that pharmacists’ involvement in interventions to reduce benzodiazepine use can have positive effects on patient outcomes. Here, this evidence is reviewed and the potential for pharmacists to play an expanded role in ensuring the appropriate use of benzodiazepines is discussed.

Treatment or “high”: Benzodiazepine use in patients on injectable heroin or oral opioids

Benzodiazepine (BZD) use is widespread among opioid-maintained patients worldwide. We conducted a cross-sectional survey to investigate motives and patterns of BZD use and psychiatric comorbidity in a convenience sample of patients (n=193) maintained on oral opioid agonists or diacetylmorphine (DAM). Prolonged BZD use and high-risk behaviors like parenteral use were common. After principal component analysis, motives were divided into those related to negative affect regulation, positive affect regulation (i.e. reward-seeking) and somato-medical problems. Negative affect regulation and somato-medical motives were associated with prolonged use. Psychiatric comorbidity was associated with several self-therapeutic motives, most importantly to lose anxiety. Patients maintained on DAM were more likely to be ex-users of BZD and report high positive affect regulation. Therefore, patients maintained on different agonists may have deviating motives for BZD use, which could be of importance when addressing this issue. Treatment of psychiatric comorbidity, in particular anxiety, depressive and sleeping disorders, may be helpful in reducing BZD use, particularly in patients maintained on oral opioids.

2692 – A study on the efectiveness of electroacupuncture in the management of sleep disorder among methadone maintenance therapy patients in kajang: a preliminary investigation

Introduction High prevalence of poor sleep quality has been reported among Methadone Maintenance Therapy (MMT) patients. In order to reduce side effects and prevent relapse, new treatment approaches should be considered and recently, electroacupuncture (EA) has believed to have a therapeutic effect in the treatment of drug addiction. Aims To investigate the effects of EA on sleep quality in patients receiving MMT. Methods A prospective, open-labelled, parallel, randomized-controlled trial was conducted among MMT patients in Kajang, Selangor, Malaysia. A total of 22 drug misusers who met DSM-IV were randomly assigned into two groups. The treatment group was given methadone plus EA stimulation at 1.1+80Hz while the control group received methadone plus Sham EA without increasing the intensity of the stimulation. Both groups received the EA treatment 30 minutes per session for 14 days. Sleep quality was assessed by validated Pittsburgh Sleep Quality Index. Results In terms of pre and post treatment comparison, we found that there were significant difference of mean sleep latency (p= 0.011), use of medication (p= 0.043) and global PSQI (p= 0.009) for the treatment group. However, only sleep efficiency (p= 0.014) showed a significant difference between pre and post treatment for the control group. In terms of group comparison, we found that there was significant difference of mean sleep latency (p= 0.004), sleep efficiency (0.004) and global PSQI (0.008) for post treatment. No significant difference was found for pre treatment. Conclusion Electroacupuncture may have adjunct effect on sleep improvement and have potential to reduce Benzodiazepine use among MMT patients.

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Introduction: Dexmedetomidine is an alpha-2 receptor agonist indicated for intensive care unit and procedural sedation. In addition to its sedative properties, dexmedetomidine has sympatholytic effects that reduce heart rate and blood pressure. Alcohol withdrawal is characterized by agitation, psychosis, and manifestations of autonomic hyperactivity. The objective of this study was to evaluate the use of adjunctive dexmedetomidine for severe alcohol withdrawal. Hypothesis: Addition of dexmedetomidine results in reduced benzodiazepine use, withdrawal symptoms, and causes minimal side effects. Methods: This retrospective study evaluated patients >18 years old with severe alcohol withdrawal treated with dexmedetomidine in conjunction with the standard of care. Patients without a Clinical Institute Withdrawal Assessment (CIWA) score of?8 or those prescribed dexmedetomidine for other indications were excluded. Patient vital signs, CIWA scores, benzodiazepine use, and dexmedetomidine doses and duration were compared pre- and post-dexmedetomidine initiation. Paired t-tests were utilized to compare continuous variables, with p<0.05 considered significant. Results: Sixteen patients were enrolled. The majority of patients were male (94%) with an average age of 44.3 ± 13.6 years. The mean APACHE II score was 16.1 ± 8.2, and mean length of stay in the ICU was 131.8 ± 65.9 hours. Average duration of dexmedetomidine was 40.4 ± 39.2 hours at a mean dose of 0.52 ± 0.23 mcg/kg/hour started 41.7 ± 20.2 hours after admission. Total benzodiazepine exposure, represented by milligrams of lorazepam equivalents, was less after initiating dexmedetomidine (39.4 ± 28 vs 18.2 ± 18; p=0.018), as was the average CIWA score (14.5 ± 4.2 vs 9.0 ± 4.6; p=0.004). Heart rate (106.8 ± 15.9 vs 82.7 ± 12.4; p=0.0001) and systolic blood pressure (135.8 ± 15.2 vs 124.6 ± 20.6; p=0.035) were reduced with the addition of dexmedetomidine. Bradycardia (HR?60) or hypotension (SBP?90) each occurred in 25% of patients and both occurred in 6% of patients. Conclusions: The addition of dexmedetomidine blunts the symptoms of autonomic hyperactivity and reduces benzodiazepine requirements; however, these beneficial effects must be weighed against the risk of bradycardia and hypotension.

Unpredictable Absorption of Oral Opioid Medications in a Quadriplegic Patient With Chronic Enterocutaneous Fistulas

ABSTRACTAlthough there is an abundance of literature on the acute management of enterocutaneous fistulas, there is a paucity of data on the chronic management of enterocutaneous fistulas. Their impact on oral pharmacotherapy, including their effect on the bioavailability of oral medications, is poorly understood. This case describes a 23-year-old quadriplegic male with a complex history of multiple abdominal surgeries presented with three persistent enterocutaneous fistulas. Diazepam and furosemide were among the patient's oral medications and had sufficient bioavailability to show efficacy on anxiety and pedal edema, respectively. Conversely, oral oxycodone and methadone were ineffective in controlling chronic pain despite high doses and aggressive titration. Due to inadequate pain control, the patient supplemented opioid medications with high doses of lorazepam and diazepam to augment psychological comfort. A trial of subcutaneous morphine successfully produced immediate analgesia, causing a marked reduction in benzodiazepine use. Enterocutaneous fistulas may reduce the bioavailability of oral medications to various degrees depending upon the medication. Further research is needed to elucidate the effect chronic enterocutaneous fistulas have on the bioavailability of oral medications. It is therefore important for clinicians to question the bioavailability of medications in the setting of enterocutaneous fistulas and poor clinical response.

Uncovering the source of new benzodiazepine prescriptions in community‐dwelling older adults’

Initiatives to reduce benzodiazepine use have been largely unsuccessful despite strong associations with adverse outcomes. Curtailing incident use of benzodizepines is an alternate strategy that has yet to be explored. This study aims to determine the source of incident benzodiazepine prescriptions by comparing the risk of receiving a new prescription upon hospital discharge versus after an ambulatory care clinic visit. Data were derived from 1189 community-dwelling adults aged 65 years naive to benzodiazepine consumption, enrolled in the Étude sur la Santé des Ainés, a prospective 3-year cohort study conducted in Québec, Canada. Health survey questionnaires were linked with provincial administrative databases of prescription and health service claims. Analysis with multivariate Poisson regression models compared the risk of incident benzodiazepine use post-hospitalization versus after an ambulatory care visit. Models were adjusted for sex, age, antidepressant use, and concomitant drugs. Sub-analyses were conducted for chronic prescriptions. Incident benzodiazepine use was 11% over a 2-year period, with 18.3% of prescriptions leading to chronic use (> 90 days). Hospitalization conferred a 2.7-fold greater risk of incident use than an outpatient visit (OR 2.66, 95% CI 1.78-3.98) and a 4.7-fold (OR 4.74, 95% CI 1.63-13.78) increased risk of chronic use, after adjusting for potential confounders. Despite the increased risk, only 13% of new prescriptions originated post-hospital discharge, with the remainder prescribed during outpatient visits. Interventions are required to curb incident benzodiazepine prescriptions at their source both in hospitals and in ambulatory care settings.

Predictors of response to brief intervention in general practice against long-term benzodiazepine use

Aims: To predict the response of mostly elderly patients to brief intervention against long-term benzodiazepine (BZD) use delivered in general medical practice from variables measured at baseline in a randomised controlled trial.Method: Logistic regression was used to identify predictors of a complete cessation of BZD intake or a ‘clinically significant reduction’ by a half or more from baseline to 6 months follow-up among 183 patients who received a brief intervention. Candidate predictor variables were: (i) stage of change (ii) level of BZD dependence (iii) whether BZDs were prescribed by the patient's usual general practitioner (GP) or by another medical practitioner; (iv) baseline BZD dosage; (v) type of BZD and (vi) gender.Results: Both cessation and reduction were predicted by who prescribed BZDs, with patients whose medication was prescribed by their usual GP more likely to show a positive response to brief intervention than those whose medication was prescribed by another medical practitioner. Stage of change was a significant predictor of a reduction in BZD use, with patients in the Contemplation stage nearly three times more likely, and those in the Action stage over eight times more likely, to achieve a clinically significant reduction than those in the Precontemplation stage.Conclusions: Patients receiving prescriptions from their usual GP are more likely to cease or reduce BZD intake than those receiving prescriptions from another medical practitioner. In managing patients with long-term use of BZDs, general medical practitioners should consider recording the patient's stage of change and tailoring their intervention on that basis.

Ten-year trends in benzodiazepine use in the Dutch population

BackgroundIn the past decades knowledge on adequate treatment of affective disorders and awareness of the negative consequences of long-term benzodiazepine use increased. Therefore, a decrease in benzodiazepine use is expected, particularly in prolonged use. The aim of this study was to assess time trends in benzodiazepine use.Methods and materialData from the Longitudinal Aging Study Amsterdam (LASA) were used to investigate trends in benzodiazepine use between 1992 and 2002 in two population-based samples aged 55–64 years. Differences between the two samples with respect to benzodiazepine use and to sociodemographic, physical health and mental health characteristics were described and tested with chi-square tests and logistic regression analyses.ResultsBenzodiazepine use remained stable over 10 years, with 7.8% in LASA-1 (n = 874) and 7.9% in LASA-2 (n = 919) (p = 0.90) with a persisting preponderance in women and in people with low education, low income, chronic physical diseases, functional limitations, cognitive impairment, depression, anxiety complaints, sleep problems and when using antidepressants. Long-term use remained high with 70% in 1992 and 80% in 2002 of total benzodiazepine use.ConclusionIn the Dutch population aged 55–64, overall benzodiazepine use remained stable from 1992 to 2002, with a high proportion of long-term users, despite the effort to reduce benzodiazepine use and the renewal of the guidelines. More effort should be made to decrease prolonged benzodiazepine use in this middle-aged group, because of the increasing risks with ageing.

Benzodiazepine use among heroin users: Baseline use, current use and clinical outcome

Benzodiazepine use is associated with elevated levels of harm. The current study aimed to ascertain the long-term nature of the relationship between benzodiazepine use and clinical profile among heroin users. Longitudinal cohort, with follow-up at 3, 12, 24 and 36 months. Participants were 615 heroin users recruited for the Australian Treatment Outcome Study. At baseline, current benzodiazepine users were more likely to be committing crime, had poorer psychological health and poorer physical health. Baseline benzodiazepine use was not associated with the likelihood across follow-up of heroin use (P = 0.44), committing crime (P = 0.17), poorer psychological health (P = 0.31) or poorer physical health (P = 0.48). Current benzodiazepine use was, however, associated with a greater likelihood of concurrent heroin use (OR 2.77), crime (OR 2.04), poorer psychological health (beta = -4.47) and poorer physical health (beta = -2.33). Clinicians should be aware that reductions in benzodiazepine use are associated with reductions in harm, and that baseline benzodiazepine status does not equate to poor long-term outcome.

Pain Assessment, Sedation, and Analgesic Administration in the Intensive Care Unit

Pain Assessment, Sedation, and Analgesic Administration in the Intensive Care Unit