Benzodiazepine usage in the North Eastern Health Board region of the Republic of Ireland

Abstract

Introduction: Benzodiazepines are a large group of drugs used as hypnotics, anxiolytics, and tranquillisers, anti convulsants, pre-medication and for intravenous sedation. Extended use of benzodiazepines may lead to dependence and misuse. Use of benzodiazepines, for anxiety disorder and insomnia, is therefore just recommended for short-term use. Current European prescribing guidelines for usage of benzodiazepines for general anxiety is 4 weeks and 1-2 weeks for acute insomnia. Despite prescribing recommendations long-term use is widespread in medical practice, especially among elderly. For many years now concerns have been expressed over the inappropriate use of benzodiazepines in Ireland. Aim: The objective of this study was to determine the feasibility of exploiting government General Medical Services (GMS) data to provide periodic drug utilisation reports, and assess benzodiazepine and related drug usage in the North Eastern Health Board (NEHB) region during the period January 2001 to June 2003. Method: Prescription data over the GMS population, NEHB, from the GMS Payments Boards data records was interrogated by using the database program Filemaker pro 5, and the database analysis program SPSS11. Results: The results shows that the prescribing of benzodiazepines and related drugs gradually increased during the study period and was mainly due to an increasing for the benzodiazepine-related drugs zolpidem and zopiclone. The total average number of Defined Daily Doses (DDDs) per prescription items for all included drugs was for the period for 22 days supply. All the hypnotics had average number of DDDs per prescription higher than the recommend, for 14 days supply. As an example, Flunitrazepam, which is classified as a Schedule 3 controlled drug was on average prescribed for 33 days supply. In 2002 48.9% of the users had prescriptions in 3 or more consecutive months, 30.3% received prescriptions in ? 6 consecutive months and 9.7% had prescriptions in every month during 2002. Conclusion: Although this study has several limitations the results show that the prescribing of benzodiazepines and related drugs in the GMS population, NEHB during January 2001 to June 2003 are high and that many patients seems to be long-term users, which is in conflict with best clinical practice.