The Royal Australian College of General Practitioners (RACGP) has created a new guide on prescribing benzodiazepines, focusing on patient-centred care, accountable prescribing and harm reduction.
A class of drugs most commonly used to treat anxiety and insomnia, every year in Australia nearly 7 million prescriptions for benzodiazepines are issued, with Valium and temazepam among the most common.
RACGP President Dr Frank R Jones said although benzodiazepines had been associated with both benefits and harms for patients, their use had led to growing concern about the harms associated with both the authorised and unauthorised use of the drugs.
“It is vital GPs are aware of the issues benzodiazepines have created at a broad society level and among individual patients,” Dr Jones said.
“There is significant debate in the medical community about the appropriate role and use of these drugs and this has been exacerbated by a lack of clinical guidelines in the area. The RACGP’s new guide, Prescribing drugs of dependence in general practice, Part B: Benzodiazepines is the first in Australia to comprehensively address these issues.
“Prescription of benzodiazepines, as with any treatment, should be based on a comprehensive medical assessment, a diagnosis, an examination of risks and benefits and a management plan.
“It is also important for patients to understand that medication is only part of the answer to managing complex mental health issues and non-drug therapies should also be explored,” Dr Jones said.
The guide explains that benzodiazepines should not be the first line of treatment and are generally regarded as a short-term therapeutic option. Long-term use, beyond four weeks, should be uncommon, made with caution and based on thoughtful consideration of the likely risks and benefits, accompanied with continued monitoring.
Dr Jones said while problems associated with the use of benzodiazepines were rare in patients who took low doses for recommended periods, some patients may be more vulnerable to harms.
“As GPs we need to be vigilant in identifying patients who may be misusing or abusing benzodiazepines because this can become a long-term and distressing problem.
“Patients who have a substance use disorder may ‘doctor shop’ to gain prescriptions and increase their use and dosage. When taken in combination with other substances such as opioid medications, illicit drugs and alcohol, this can result in death.”
Dr Jones said GPs could help patients recognise they have a problem, set goals for recovery and ensure they received the right treatment.
The guide should help reduce patient harm associated with benzodiazepine misuse however, broader issues beyond the control of the RACGP also need to be addressed.
“There needs to be an immediate rollout of a real-time prescription drug database, something the RACGP has long called for. There is also the need for consistency across states when it comes to laws and definitions regarding drugs of dependence because current variations complicate and confuse health professionals,” Dr Jones said.