One-third of medical card patients receive long-term prescriptions for drugs that can lose their effect and cause problems such as falls, according to the first detailed analysis of benzodiazepine and Z-drug prescribing in Ireland.
Cathal Cadogan, lead author of ‘Benzodiazepine and Z-drug prescribing in Ireland: An analysis of national prescribing trends from 2005-2015’, said updated prescribing guidance issued in February indicates the upper limits of duration for use of these drugs is two to four weeks. Yet a third of medical card patients were receiving benzo and Z-drug prescriptions on a consecutive basis for more than three months.
Prescription rates were highest for older women (³65 years) throughout the study period.
Dr Cadogan said their findings suggested not much progress has been made in reducing long-term use, despite the efforts of a benzodiazepine committee, set up in 2000, to address concerns about long-term prescribing and the potential for tolerance and dependence.
Dr Cadogan, a lecturer in pharmacy practice at the Royal College of Surgeons in Ireland, said evidence suggests that the committee’s prescribing guidelines, as well as subsequent prescribing criteria, have had little effect in improving benzo prescribing and use in Ireland.
In fact, inappropriate long-term use could persist “for many generations to come” unless targeted interventions are introduced.
The analysis found an overall decrease (26.5%) in benzo prescribing in Ireland over an 11-year period, from 225.92/1,000 in 2005 to 166.07/1,000 in 2015. Z-drug prescribing rates significantly increased (up 14.4%) from 95.36/1,000 to 109.11/1,000 population.
However, while the findings suggested evidence of progress in reducing benzo prescribing, “any observed progress... has, to date, been slow, and offset by increased Z-drug prescribing, despite reports highlighting problems with both drug classes, such as falls”.
The proportion of individuals receiving combinations of benzodiazepines and Z-drugs “significantly increased” from 11.9% in 2005 to 15.3% in 2015.
The five most commonly dispensed drugs between 2005-2015 were diazepam, alprazolam, temazepam, zopiclone, and zolpidem, drugs that counteract anxiety and insomnia.
The study says research has found long-term benzo use can give rise to cognitive and psychomotor impairment, particularly in older people (³65 years).
And while Z-drugs were “originally promoted as favourable alternatives to benzodiazepines for insomnia” there is “a lack of compelling evidence of any clinically useful differences... in terms of effectiveness, potential for adverse effects, dependence or abuse”.
The study, published in the British Journal of Pharmacology, highlights that guidelines recommending short-term use are often not adhered to, and warns that “new and existing prescribing practice needs to be carefully monitored, as inappropriate use of these medications and dependence has been identified among all age cohorts”.
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