Benzodiazepine and z-drugs
Practice policy on the prescribing of benzodiazepine and z-drugs
At Robin Lane Health and Wellbeing Centre we recognize that benzodiazepines and other sedative drugs are highly addictive, even in short courses, and are increasingly being associated with increased risk of dementia and early death. They are highly fatal in overdose.
They have a high street value and are often sold on by patients (including the elderly) to supplement income.
When used in conjunction with other medications, for example opioids, the effects (and therefore the risks) are magnified by up to a factor of 8.
Definitions:
Benzodiazepine: class of drugs which are sedating. Can be used in short courses to treat acute anxiety, seizures, insomnia, alcohol withdrawal and muscle spasm. Examples: diazepam, clonazepam, lorazepam, temazepam, chlordiazepoxide
‘Z’ Drugs: A class of drugs which are commonly used as sleep aids. Examples: zopiclone, zolpidem
These are all classified as controlled drugs.
What is a controlled drug?
The Misuse of Drugs Act 1971 defines controlled drugs (CDs) as drugs which are ‘dangerous or otherwise harmful’ and have the potential for abuse or misuse. To protect patients and the public, stringent safeguards are put in place to control the availability of these drugs.
Controlled medicines need to be used and looked after more carefully than other medicines.
Policy decision
Our practice policy will be to use these medications only when they are strictly necessary and in the shortest possible courses at the lowest possible doses.
Your GP MIGHT prescribe a short course of these medications in the following circumstances:
- Insomnia – But only after all other avenues have been explored (for eg over the counter treatments, online CBT, sleep hygiene etc)
- Muscle spasm in back pain (but only if this has been helpful previously)
- Acute bereavement reaction (though has been shown to make your bereavement harder in the long run)
This will only be after discussion with the GP and for very short courses (a few days) and will not be repeated. They will not be added to your repeat prescriptions.
In the following circumstances we DO NOT prescribe these medications:
- Fear of flying (fear of flying courses are available – for example- https://flyingwithconfidence.com/ – which quotes a 98% success rate)
- Dental procedures (your Dentist can prescribe if needed)
- Hospital procedures or investigations such as MRI (the requesting physician is responsible for prescribing this)
- Acute anxiety of any other cause
- Alcohol detox
Current long term prescriptions:
If you have a current long term prescription of any of these medications it is highly likely that you are addicted to them.
We recognize that this means it can be very difficult to come off them and we are here to support you with this. We are aiming as a practice to reduce these prescriptions and help you come off them if possible.
For your safety we have decided to make the following rules for these prescriptions:
We will aim as a practice to review and reduce these prescriptions.
All patients on repeat prescriptions for these medications will be reviewed annually and risks clearly documented. You will be offered help with reducing / stopping these medications.
No more than 1 month’s worth will be prescribed and early script requests will be declined.
No urgent prescription requests – all requests for acute issues must be through an appointment or econsult / patchs request to reduce the risk of errors and to improve continuity
Lost or stolen prescriptions will be issued once with the provision of a police number. This will not be repeated (See Practice Policy for lost / stolen Controlled Drug Prescriptions)
New patients to the practice who are on these medications will be informed as soon as they register of this practice policy.
Current patients will be informed by the practice of this new policy and offered support if they wish to reduce and stop their medications.
Here are some websites with further information :
https://patient.info/mental-health/insomnia-poor-sleep/benzodiazepines-and-z-drugs
https://www.talktofrank.com/drug/benzodiazepines
If you have any questions with regards to this policy please do not hesitate to book a routine appointment with your GP or one of our practice pharmacists.