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Prescribing drugs of dependence in general practice

Part B - Benzodiazepines

Appendix C. Process of development

Last revised: 11 Nov 2019

This guide was developed in response to calls for a resource for GPs and general practice teams to manage benzodiazepine prescribing. It represents a synthesis of current scientific knowledge and rational clinical practice regarding treatment with benzodiazepines. The content broadly conforms to the highest evidence-based standards according to the principles underlying the Appraisal of Guidelines Research and Evaluation (AGREE) Instrument. It strives to be as free as possible of bias toward any theoretical approach to treatment.

The RACGP convened a GP-led advisory group, comprising GP members with expertise and experience in drugs of dependence and guideline development. A literature search was conducted and key resources were identified.

A limited literature search was conducted, using key resources including PubMed, The Cochrane Library, University of York Centre for Reviews and Dissemination (CRD) databases, international health technology agencies, in addition to a focused Internet search. Filters were applied to limit retrieval to articles in English, health technology assessments, systematic reviews, meta-analyses and guidelines. In the first level of screening, titles and abstracts were reviewed and potentially relevant articles were retrieved based on:

  • national and international benzodiazepine prescribing guidelines
  • national and international guidelines of specific disease state management (eg insomnia, anxiety)
  • high-quality systematic reviews on benzodiazepine prescribing
  • high-quality publications that address key issues with benzodiazepine pharmacology, dependence, tolerance and adverse effects.

An in-depth critical analysis of the publications was not undertaken.

This guide provides recommendations based on current evidence-based guidelines, including the Scottish Intercollegiate Guidelines Network (SIGN), the British Association of Psychopharmacology, and the Health Technology Assessment Unit of the Spanish Ministry of Health and Social Policy.

In cases where guideline recommendations specific to the indication were not available, other sources, such as systematic reviews, have been used to inform the recommendations.

The advisory group did not attempt to re-evaluate the evidence behind these recommendations or convert the recommendation grades to the Australian National Health and Medical Research Council (NHMRC) grading levels. Therefore, the recommendations tables include the reference and sources of recommendations, the recommendation grade and links to further information on the evidence grade where available (refer to Appendix B). For some recommendations, an evidence grade was not available; therefore, these recommendations should be treated as expert opinion.