What is your opinion on benzodiazepines

Guide to prescribing and dispensing benzodiazepines

The guideline is a practical aid for doctors and pharmacists and gives a brief overview of the therapy and care with this group of drugs. Therapy with benzodiazepines as well as benzodiazepine analogues can lead to undesirable psychological dependence. The common goal of the two chambers of medical professions is to help doctors and pharmacists through this guide to better recognize, treat and avoid these dependencies in the future.

Benzodiazepines have been used successfully for many years as sleep aids, antispasmodics, sedatives (tranquilizers) or as agents for muscle relaxation (muscle relaxants). However, its calming, anxiety-relieving and sleep-promoting effect induces numerous patients to take it continuously, combined with rapid habituation and pronounced withdrawal symptoms when weaning. For this reason, new substances, the so-called benzodiazepine analogues ("Z-substances": zaleplon, zopiclone and zolpidem), have been developed which act in a similar way to the benzodiazepines, but should not have their side effects. However, even with these substances, prolonged use leads to dependency.

Pay attention to non-indicated permanent prescriptions

The dependence on benzodiazepines and their analogues is an increasing problem in our healthcare system. Nationwide, it is assumed that there are more than one million benzodiazepine addicts. The elderly are particularly often affected, 80% of long-term prescriptions for sleeping pills and sedatives are for patients over 55 years of age. Medical care, nursing and care for the elderly are increasingly becoming a social challenge. The long-term prescription of benzodiazepines is often little questioned.

However, continuous use is associated with numerous side effects and dangers. In addition to disturbances in concentration and mental performance, the muscle-relaxing effect causes an increased risk of falling and is a central problem, especially in older people. Despite these dangers and the widespread use, this group of patients is barely noticed and is almost ignored in the addiction aid system. The costs for treatment with benzodiazepines are low, but the health-economic importance increases due to the high number of cases and even more so due to immense follow-up costs, for example due to broken bones.

Collaborate across professional groups

Benzodiazepines are prescription drugs; prescription is the responsibility of a doctor. Pharmacists are responsible for dispensing medication to the patient and advising the patient, thereby supporting the medical task. It is therefore also part of the professional duty of pharmacists to react if they notice improper use or a non-indicated permanent prescription. A collaboration between doctor and pharmacist is particularly necessary and useful in this situation. In consultation with the attending physician, pharmacists can accompany an outpatient withdrawal with professional competence and motivating discussions.

With the guideline and the improved, cross-professional cooperation described therein, doctors and pharmacists want to contribute to the safe and sensible use of benzodiazepines and make an important contribution to improving the quality of life of many people. The intensive cooperation between the two chambers on a professional level for better patient care shows that voluntary self-administration in particular can generate excellent results for the benefit of all patients.

Dr. Ernst Pallenbach on behalf of the Addiction Working Group of the Baden-W├╝rttemberg State Chamber of Pharmacists