Why is reviewing B-Z use important?
Benzodiazepines and z-drugs: Quality prescribing - a guide for improvement
B-Z use is associated with tolerance, possible dependence and avoidable drug-related harms. These harms include but are not limited to:
- cognitive dysfunction (confusion, impaired concentration, memory impairment, impaired ability to drive and increased accidents)
- falls and associated increased risk of hip fractures
- depressive symptoms
- paradoxical effects i.e. disinhibition, anxiety and impulsivity12,16
More recently studies have reported increased mortality associated with B-Z use in a range of populations.17,19
B-Z prescribing has reduced over the years in Scotland (see Chart 1, below)). Chart 2 shows less than 6% of adults receiving B-Z in 2023/24. Long-term (≥8 weeks) use remains common with over 40% of adults receiving B-Z remaining on treatment long-term (Chart 3 Jan-March 2024). This is outwith medicine licensing and runs contrary to current guidelines and prescribing advice.5,13,15
Current NICE guidance advises that prescribers ‘do not offer a benzodiazepine for the treatment of Generalised Anxiety Disorder (GAD) in primary or secondary care, except as a short-term measure during crises’.15 However, where their use is considered appropriate for the short-term treatment of insomnia or anxiety disorders their use should be limited to, for example, less than two weeks on an ‘as required’ basis.14,15
Proactively reviewing B-Z prescribing and their use creates an opportunity to reduce and stop inappropriate medicines and has been shown to be effective.34-38 The use of such proactive reviews across Scotland has helped practices and health boards reduce inappropriate B-Z use, see Charts 2 and 3.
Chart 1: NHS board benzodiazepine and z-drug prescribing by defined daily dose (DDD*) per 1000 list size per day
Chart 2: Proportion of adults prescribed a benzodiazepine or z-drug (B-Z) for 8 weeks or less, or longer than 8 weeks, by NHS board, Scotland 2023/24
Chart 3: Adults prescribed a benzodiazepine or z-drug (B-Z) long-term (>8 weeks) as a proportion of adults prescribed a B-Z
