Benzodiazepine usage: cause for concern

 

Sir, – Your editorial (“Irish Times view on Benzodiazepine use: a cause for concern”, July 15th) on the high rates of benzodiazepine and Z-drug (a group of non-benzodiazepine drugs with effects similar to benzodiazepines) usage in Ireland is timely and all the more compelling because it does not take aim at hapless prescribers like myself.

Why is chronic benzo and Z-drug usage so high in the over-65s, you ask.

Probably because they were started much earlier in the patient’s life.

In an audit several years ago in my UK practice, we found one-third of patients gave some of their tranquillisers or sleeping tablets to a neighbour or relative who was having a hard time.

In my practice in Ireland, we recently did an audit of benzo and Z-drug prescribing and identified those on such prescriptions for six months and longer.

We put in supports such as an information leaflet, special consultations and a reducing dosage plan.

On review six months later, there was very little change in usage. Except there was much aggravation at reception and with the doctor from patients who really didn’t want to change.

Indeed, a small number of patients left the practice to find a more compliant prescriber. Older patients are less likely to have access to street benzos and are more dependent on their GP or psychiatrist and thus easier to measure.

If the OECD investigated benzo Z-drug usage in a younger cohort, they would find much street availability and buying on these drugs and less reliance on the medical profession. Benzo and Z-drug usage is now normalised in many areas of the country.

Some doctors take a strict line on prescribing such medications.

The net effect is that patients move on to find a practice that will prescribe for them.

The broader question is why our western society needs to consume such large quantities of psychoactive substances, be they benzos, opiates or indeed alcohol. – Yours, etc,

TOM O’DOWD MD,

General Practitioner,

Dublin 24.