Impact of changes in controlled drugs legislation on benzodiazepine receptor agonist prescribing in Ireland: a repeated cross-sectional study

Abstract

Purpose To examine the impact of new controlled drugs legislation introduced in May 2017 on benzodiazepine receptor agonist (BZRA) prescribing in Ireland. Methods A repeated cross-sectional analysis was conducted using publically available monthly pharmacy claims data from the General Medical Services (GMS) database. The study population comprised all GMS-eligible individuals aged ≥ 16 years from January 2016 to September 2019. Monthly prevalence rates of individuals receiving BZRA prescriptions per 10,000 eligible population were calculated and trends examined over time. Segmented linear regression of prevalence rates was used to examine changes before and after introduction of the legislation stratified by gender and age groups. Regression coefficients (β) and 95% confidence intervals (CIs) for monthly change were calculated. Results Pre-legislation (January 2016 to April 2017), there was a significant monthly decline in benzodiazepine prevalence rate (β = − 1.18; 95% CI − 1.84, − 0.51; p < 0.001) but no significant change in Z-drug prescribing. Post-legislation (May 2017 to September 2019), increases in prevalence rates were observed for benzodiazepines (β = 1.04; 95% CI 0.17, 1.92; p = 0.021) and Z-drugs (β = 1.04; 95% CI 0.26, 1.83; p = 0.010). Post-legislation trends showed increases in BZRA prevalence rates among the youngest subgroup (16–44 years), with variable changes in the middle-aged subgroup (45–64 years) and no changes in the oldest subgroup (≥ 65 years). Conclusions This study indicates that introduction of new legislation had limited impact on BZRA prescribing on the main public health scheme in Ireland. Interventions targeting specific population subgroups may be required to achieve sustained reductions in prescribing.

Trends in prescribing pattern of opioid and benzodiazepine substitutes among Medicare part D beneficiaries from 2013 to 2018: a retrospective study

“…The outcomes were prescriptions for opioids, benzodiazepines or Z-drugs, gabapentinoids or SSRIs/SNRIs during the calendar year. Consistent with past research, 28 29 we chose to combine Z-drugs and benzodiazepines because of their shared actions as benzodiazepine receptor agonists, [28][29][30] with overlapping side effect profiles. While we recognise that some pharmacodynamic/kinetic differences exist among the constituent drugs comprising benzodiazepine receptor agonist drug group (eg, chlordiazepoxide vs alprazolam; zolpidem vs zaleplon) and the SSRIs/SNRIs drug group (fluoxetine vs paroxetine vs duloxetine), benzodiazepines and Z-drugs are henceforth referred to as benzos/Z-drugs while the serotonergic agents are referred to as SSRIs/SNRIs, a reflection of shared mechanisms and toxicity profile by drugs in each group.…”

Supporting safe and gradual reduction of long‐term benzodiazepine receptor agonist use: Development of the SAFEGUARDING‐BZRAs toolkit using a codesign approach

“…9 To address the issue of long-term BZRA use, various interventions have been evaluated including brief intervention-based approaches (e.g., short consultations with healthcare professionals recommending BZRA discontinuation), cognitive behavioural therapy and pharmacological treatments (e.g., antidepressants, anticonvulsants). [10][11][12][13] However, translating effective interventions into clinical practice remains problematic due to deficits in their development and reporting. Furthermore, previous studies have tended to focus on reducing prescribing of benzodiazepines by prescribers rather than on how to support service users discontinue their use of benzodiazepines.…”

‘I just thought that it was such an impossible thing’: A qualitative study of barriers and facilitators to discontinuing long‐term use of benzodiazepine receptor agonists using the Theoretical Domains Framework

“…3 Interventions targeting long-term BZRA use have shown varying effects. [11][12][13][14] For example, cognitive behavioural therapy (CBT) combined with gradual dosage reduction has proven effective in the short term (up to 3 months postintervention) in reducing BZRA use. 12 However, the precision with which CBT-based interventions have been described varies and effects have not been sustained over longer periods.…”

“…Interventions targeting long‐term BZRA use have shown varying effects 11–14 . For example, cognitive behavioural therapy (CBT) combined with gradual dosage reduction has proven effective in the short term (up to 3 months postintervention) in reducing BZRA use 12 .…”