Challenges in Deprescribing for Young Chronic Benzodiazepine Patients

Objective: This study sought to gain further understanding into the issues surrounding benzodiazepine prescribing and deprescribing for chronic benzodiazepine patients under 25 years of age. This was to be accomplished by interviewing 1) general practitioners (GPs) who were directly involved in prescribing decisions and 2) youth counsellors who have an awareness of benzodiazepine prescribing issues from the young person’s perspective.

Method: Semi-structured interviews with 17 GPs and youth counsellors were conducted. All except one interviewee consented to having quotes included in the study. Thematic analysis was the analytical approach chosen. Negative case analysis and peer debriefing were performed. Interviews ranged from 11 to 74 minutes.

Findings: The GPs interviewed were confident that benzodiazepine-seeking patients could be identified. Common identifiers were patients directly requesting benzodiazepines from the GP, patients persistently refusing alternative non-dependence-forming treatments, patients threatening harm to themselves or others if denied benzodiazepines. GPs were not the only source of benzodiazepines for young chronic benzodiazepine patients, however they were one of the main sources. Some patients who could not get sufficient quantities of benzodiazepines from their GP obtained supplies by other means including covertly obtaining benzodiazepines from family members and buying benzodiazepines from street dealers. A means used that was mentioned by the youth counsellors but not by GPs was doctor-shopping, where patients visited multiple GPs to obtain multiple prescriptions for benzodiazepines. This allowed the patients to circumvent constructive efforts by GPs. The GPs interviewed felt pressure to prescribe because benzodiazepines are very effective for their indicated purposes, but were conflicted knowing the dependence-forming nature of the medicine if taken for an extended period of time. GPs also saw difficulty in reducing the benzodiazepine dose in chronic users. Practitioners suggested ways to reduce benzodiazepine use; i) offering alternative therapies to treat the root cause of the psychological distress, ii) educating GPs to communicate the risks appropriately and iii) educating the public to better understand the potential for danger associated with benzodiazepines.

Conclusion: GPs face challenges in deprescribing benzodiazepines; some which they are aware of and some which they are not. GPs are also conflicted internally between the desire to help patients with their problems and to prevent long-term harm. GPs, the public and the state can and must act if unnecessary benzodiazepine use is to be minimised.