Davies and colleagues highlight the issue of inappropriate long-term benzodiazepine and Z-drug (BZD) prescribing1 but their conclusions and recommendations are flawed.
First, they suggest that prescribing should be reduced by ensuring adherence to existing guidelines for prescribing and withdrawal, or developing new guidelines where needed.
Guidelines have failed to reduce benzodiazepine and Z-drug prescribing: clinicians do not adhere to recommendations to use hypnotics and anxiolytics short term and only after trying psychological therapies.2 The reasons for this are multifaceted and complex. Second, they advocate more research into the harms associated with long-term BZD use. Many studies have investigated harms from long-term benzodiazepine use, including risks of cognitive impairment, falls, hip fractures, and road traffic collisions. Finally, the authors recommend mandatory national drug withdrawal services and a helpline and website for prescribed drug dependence. These recommendations are arguably the most concerning because they lack evidence to support them. There is already evidence for benzodiazepine withdrawal, ideally combining discontinuation with psychological therapy for the underlying disorder.3 Setting up new services without considering the likely workforce and resource needs, effectiveness, costs, or unintended consequences ignores the evidence that points to multifaceted rather than simplistic solutions to address the complex problem of BZD prescribing.
- © British Journal of General Practice 2017
