An unknown quantity
According to Professor Colin Bradley, professor of general practice at University College Cork, GPs are aware of the dangers of the drugs, but may not be quite aware of the prevalence of the problems they cause. Speaking ahead of last year’s “Benzodiazepines: An Integrated Response” conference, Prof Bradley told Irish Medical Times the low level of risk perception was perpetuated because some GPs had some patients on benzodiazepines for some time without it seemingly doing them any great harm. It was also difficult for GPs to identify the minority for whom the drug might be doing harm, he said.
A member of the Commission on Benzodiazepine Prescribing that produced guidelines for GPs in 2001, Prof Bradley notes some 10% of GMS patients were on benzodiazepines in 2001, and ten years on this figure is largely unchanged.
GPs must seek specialist advice before prescribing to patients who have become dependent as a result of substance abuse
While this could be interpreted as a failure to implement the guidelines in general practice, it could also be due to the paucity of support services in the form of clinical psychology and cognitive behavioural therapy. But it must also be acknowledged that the simple act of writing to patients on long-term benzodiazepines, inviting them to participate in a withdrawal programme, leads to up to 10% of patients successfully coming off the drug.
Studies by the Health Research Board using the National Drug Treatment Reporting System and the National Drugs Related Deaths Index indicate a rising incidence of problems related to benzodiazepine use. And with most prescriptions for hypnotics and anxiolytics being written in primary care, GPs have a big responsibility to modify their prescribing.