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Withering on benzodiazepines

Withering on benzodiazepines

Last month, the Journal of the American Medical Association published the results of a randomised controlled trial in which community pharmacists helped older patients to come off benzodiazepines.

Patients had to be long-term users of benzodiazepines and aged between 65 and 95. The pharmacists provided an educational intervention, followed by further support with a step-wise drug tapering protocol. Patients in the control group received usual care. The results were impressive. Of over 300 patients entering the study, only 14 per cent dropped out.

After six months, over a quarter of patients who received help from their pharmacists had stopped benzodiazepines completely (compared with 5 per cent in the control group) and a further 11 per cent had reduced their doses. This study provides strong evidence of benefits from an intervention by pharmacists. Is this something we should introduce in the UK? Of course it is.

We have been aware for many years of the intractable problem of long-term benzodiazepine use. New prescriptions for benzodiazepines may be in decline, but for people who have been on these medicines for long periods there is no real support available. It is not appropriate to refer these patients to drug and alcohol services, which are, in any case, already swamped with their current caseloads.

So there is a need, and there is an evidence-based solution; but is there is any appetite to engage community pharmacists to develop and provide such a service?

It might be argued that, in the current financial climate, there are higher priorities, and I have some sympathy with that point of view. But what about the counter argument that says these patients became dependent on benzodiazepines not because of any drug misuse or lifestyle choice, but because of failings in the NHS? Doesn't the NHS bear a particular responsibility to these patients? Now that there is evidence of an intervention that is effective, isn't it incumbent on the NHS to respond?

The intervention is remarkably effective and, compared with other interventions, it would be comparatively inexpensive. Our representative organisations should take note and develop proposals as to how such a service might work. If we delay it's likely to be forgotten and we will have lost another opportunity.

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