Benzodiazepine and ‘Z’ Drug Prescribing Policy

At St Clements Surgery we recognize that benzodiazepines and other sedative drugs are highly addictive, even in short courses and are increasingly being associated with increased risk of dementia and early death.  They are highly fatal in overdose.

They have a high street value and are often sold on by patients (including the elderly) to supplement income.

When used in conjunction with other medications, for example opioids the effects (and therefore the risks) are magnified by up to a factor of 8.

Definitions:

Benzodiazepine: class of drugs which are sedating. Can be used in short courses to treat acute anxiety, seizures, insomnia, alcohol withdrawal and muscle spasm. Examples: diazepam, clonazepam, lorazepam, temazepam, chlordiazepoxide

‘Z’ Drugs: A class of drugs which are commonly used as sleep aids. Examples: zopiclone, zolpidem

Our practice policy will be to use these medications only when they are strictly necessary and in the shortest possible courses at the lowest possible doses.

Your GP MIGHT prescribe a short course of these medications in the following circumstances:

  1. Insomnia
  2. But only after all other avenues have been explored (for eg over the counter treatments, online CBT, sleep hygiene etc)
  3. Muscle spasm in back pain (but only if this has been helpful previously)
  4. Acute bereavement reaction (though has been shown to make your bereavement harder in the long run)

These will only be after discussion with the GP and for very short courses (a few days) and will not be repeated. They will not be added to your repeat prescriptions.

In the following circumstances we DO NOT prescribe these medications:

  1. Fear of flying  (fear of flying courses are available – for example- https://flyingwithconfidence.com/ – which quotes a 98% success rate)
  2. Dental procedures (your Dentist can prescribe if needed)
  3. Hospital procedures or investigations such as MRI (the requesting physician is responsible for prescribing this)
  4. Acute anxiety of any other cause
  5. Alcohol detox

Current long term prescriptions:

If you have a current long term prescription of any of these medications it is highly likely that you are addicted to them. We recognize that this means it can be very difficult to come off them and we are here to support you with this. We are aiming as a practice to reduce these prescriptions and help you come off them if possible.

For your safety we have decided to make the following rules for these prescriptions:

All patients on long term benzos and Z drugs-

  • we will aim as a practice to review and reduce these prescriptions.
  • All patients on repeat prescriptions for these medications will be reviewed annually and risks clearly documented.
  • No more than 1 month’s worth will be prescribed and early script requests will be declined.
  • No urgent prescription requests- all requests must go through patients named GP to reduce the risk of errors and to improve continuity
  • ‘lost or stolen’ prescriptions- will be issued once with the provision of a police number but this will not be repeated.
  • Patients who lose/have stolen their prescription once will be asked to sign a patient contract to agree that they will not be issued with further scripts in these circumstances, and this will be added as an alert to their notes.
  • New patients to the practice who are on these medications will be informed as soon as they register of this practice policy.
  • Current patients will be informed by the practice of this new policy and offered support if they wish to reduce and stop their medications.

Here are some websites with further information :

https://patient.info/mental-health/insomnia-poor-sleep/benzodiazepines-and-z-drugs

https://www.talktofrank.com/drug/benzodiazepines

https://www.mind.org.uk/information-support/drugs-and-treatments/sleeping-pills-and-minor-tranquillisers/about-sleeping-pills-and-minor-tranquillisers/

If you have any questions with regards to this policy please do not hesitate to book a routine appointment with your GP or one of our practice pharmacists.