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Kosto A, Lev D, Reiss N, Meged-Book T, Press Y. Discontinuation of benzodiazepines and Z-drugs in hospitalised population at the age of 60 and above. An open-label randomized controlled trial. Int J Geriatr Psychiatry 2023; 38:e6012. [PMID: 37807766 DOI: 10.1002/gps.6012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 09/25/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Treating insomnia with hypnotic drugs in elderly patients has many adverse effects. This study aims to assess the effect of two discontinuation methods of hypnotic drugs during acute hospitalization. METHODS We conducted an open-label randomized controlled trial that included participants aged 60 and above taking benzodiazepines or Z-Drugs for at least 3 months as a treatment for insomnia and were admitted to the hospital. In the prospective arm, patients were randomly assigned into two intervention groups. In the Minimal Intervention (MI) group, patients received an explanation of the dangers of long-term treatment and a recommendation to stop the treatment. In the Tapering Down Intervention (TDI) group, in addition to the explanation, patients received a tapering down table. In the retrospective arm (control group), we examined the use of hypnotic drugs among hospitalized patients 3 months after hospitalization, similar to the patients in the prospective arm. RESULTS 46 patients were enrolled in the MI group, 55 patients in the TDI group, and 114 patients in the control group. The mean age in the three groups was 75.0 ± 8.2, 75.9 ± 9.0, and 75.0 ± 7.9 years respectively (p = 0.85). After 3 months, seven (15.2%) of the patients in the MI group, 15 (27.3%) in the TD group, and 2 (1.8%) in the control group (p = 0.00003) were weaned from the hypnotic drugs treatment, without a significant difference between the intervention groups (p = 0.221). CONCLUSIONS A short intervention during hospitalization results in a significant decrease in hypnotic drug use.
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Affiliation(s)
- Amit Kosto
- Department of Internal Medicine, Soroka Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Danielle Lev
- Department of Internal Medicine, Soroka Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Nadav Reiss
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Psychiatry, Soroka Medical Center, Beer-Sheva, Israel
| | - Tehilah Meged-Book
- Department of Internal Medicine, Soroka Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Yan Press
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Department of Geriatrics, Soroka Medical Center, Beer-Sheva, Israel
- Siaal Research Center for Family Medicine and Primary Care, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer- Sheva, Israel
- Unit for Community Geriatrics, Division of Health in the Community, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Center for Multidisciplinary Research in Aging, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Silvernail CM, Wright SL. Surviving Benzodiazepines: A Patient's and Clinician's Perspectives. Adv Ther 2022; 39:1871-1880. [PMID: 35239167 PMCID: PMC9056465 DOI: 10.1007/s12325-022-02055-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/20/2022] [Indexed: 12/01/2022]
Abstract
Although benzodiazepines have been used for 6 decades, many questions remain unanswered by research. The lived experiences of those adversely affected long term can provide insights into how these agents might be more thoughtfully prescribed. Here, perspectives of one such experience encompassing benzodiazepine initiation, ongoing use with adverse consequences and difficult discontinuation are presented through the eyes of an affected individual and a clinician. This experience highlights the importance of limited initiation and duration of use (2–4 weeks) as well as a supported, slow tapering process led by patients. Because researched evidence about deprescribing benzodiazepines is insufficient and because individual experiences vary so widely, it is the patient’s expertise—that of her or his lived experience—that should assume a primary role in determining the course and pace of discontinuing these medications.
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Affiliation(s)
- Carrie M Silvernail
- Alliance for Benzodiazepine Best Practices, 3221 NE 30th Ave, Portland, OR, 97212, USA
| | - Steven L Wright
- Alliance for Benzodiazepine Best Practices, 3221 NE 30th Ave, Portland, OR, 97212, USA.
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3
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Cognitive Behavioral Therapy and Acceptance and Commitment Therapy for the Discontinuation of Long-Term Benzodiazepine Use in Insomnia and Anxiety Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910222. [PMID: 34639523 PMCID: PMC8508349 DOI: 10.3390/ijerph181910222] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/15/2021] [Accepted: 09/23/2021] [Indexed: 01/23/2023]
Abstract
Benzodiazepines have proven to be highly effective for treating insomnia and anxiety. Although considered safe when taken for a short period of time, a major risk–benefit dilemma arises in the context of long-term use, relating to addiction, withdrawal symptoms, and potential side effects. For these reasons, benzodiazepines are not recommended for treating chronic sleep disorders, anxiety disorders, nor for people over the age of 65, and withdrawal among long-term users is a public health issue. Indeed, only 5% of patients manage to discontinue using these drugs on their own. Even with the help of a general practitioner, this rate does not exceed 25 to 30% of patients, of which approximately 7% manage to remain drug-free in the long term. Cognitive Behavioral Therapies (CBT) offer a crucial solution to this problem, having been shown to increase abstinence success to 70–80%. This article examines traditional and novel CBT techniques in this regard, such as Acceptance and Commitment Therapy, which address both the underlying condition (insomnia/anxiety) and the substance-related disorder. The theoretical framework and evidence supporting the use of these approaches are reviewed. Finally, current research gaps are discussed, and key research perspectives are proposed.
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Carrier H, Cortaredona S, Philipps V, Jacqmin-Gadda H, Tournier M, Verdoux H, Verger P. Long-term risk of hip or forearm fractures in older occasional users of benzodiazepines. Br J Clin Pharmacol 2020; 86:2155-2164. [PMID: 32285959 DOI: 10.1111/bcp.14307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 03/21/2020] [Accepted: 03/24/2020] [Indexed: 01/14/2023] Open
Abstract
AIMS This article sought to study the association between patterns of benzodiazepine (BZD) use and the risk of hip and forearm fractures in people aged 50 and 75 years or more. METHODS In a representative cohort of the French National Health Insurance Fund of individuals aged 50 years or older (n = 106 437), we followed up BZD dispensing (reflecting their patterns of use) and the most frequent fall-related fractures (hip and forearm) for 8 years. We used joint latent class models to simultaneously identify BZD dispensing trajectories and the risk of fractures in the entire cohort and in those 75 years or older). We used a survival model to estimate the adjusted hazard ratios (aHRs) between these trajectories and the risk of fractures. RESULTS In the entire cohort, we identified 5 BZD trajectories: non-users (76.7% of the cohort); occasional users (15.2%); decreasing users (2.6%); late increasing users (3.0%); and early increasing users (2.4%). Compared with non-users, fracture risk was not increased in either occasional users (aHR = 0.99, 95% confidence interval [CI] 0.99-1.00) or in decreasing users (aHR = 0.90, 95% CI 0.74-1.08). It was significantly higher in early increasing users (aHR = 1.86, 95% CI 1.62-2.14) and in late increasing users (aHR = 1.39, 95% CI 1.15-1.60). We observed similar trajectories and risk levels in the people older than 75 years. CONCLUSION Occasional BZD use, which is compatible with current recommendations, was not associated with an excess risk of the most frequent fall-related fractures in people older than 50 or 75 years.
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Affiliation(s)
- Hélène Carrier
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France.,IHU-Méditerranée Infection, Marseille, France.,Department of General Practice, Aix-Marseille University, Marseille, France.,ORS Paca, Regional Health Observatory, Provence-Alpes-Côte d'Azur, Marseille, France
| | - Sébastien Cortaredona
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France.,IHU-Méditerranée Infection, Marseille, France
| | - Viviane Philipps
- Univ. Bordeaux, Inserm, Bordeaux Population Health, UMR 1219, ISPED, Bordeaux, France
| | - Hélène Jacqmin-Gadda
- Univ. Bordeaux, Inserm, Bordeaux Population Health, UMR 1219, ISPED, Bordeaux, France
| | - Marie Tournier
- Univ. Bordeaux, Inserm, Bordeaux Population Health, UMR 1219, ISPED, Bordeaux, France.,Centre Hospitalier Charles Perrens, Bordeaux, France
| | - Hélène Verdoux
- Univ. Bordeaux, Inserm, Bordeaux Population Health, UMR 1219, ISPED, Bordeaux, France.,Centre Hospitalier Charles Perrens, Bordeaux, France
| | - Pierre Verger
- Aix Marseille Univ, IRD, AP-HM, SSA, VITROME, Marseille, France.,IHU-Méditerranée Infection, Marseille, France.,ORS Paca, Regional Health Observatory, Provence-Alpes-Côte d'Azur, Marseille, France
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Sake F, Wong K, Bartlett DJ, Saini B. Benzodiazepine usage and patient preference for alternative therapies: A descriptive study. Health Sci Rep 2019; 2:e116. [PMID: 31139756 PMCID: PMC6529930 DOI: 10.1002/hsr2.116] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 01/26/2019] [Accepted: 01/28/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND AIMS The prevalence of chronic benzodiazepine use in primary care settings remains high despite clear evidence of adverse health outcomes resulting from long-term use and the availability of effective alternative behavioural therapies. Eliciting factors influencing past or current usage experience of benzodiazepine users and their future behavioural intention regarding discontinuation or alternative behavioural therapy adoption could be useful in developing informed strategies facilitating successful benzodiazepine withdrawal in long-term users. The aim of this study was to identify patient factors influencing their current long-term benzodiazepine use, past withdrawal attempt, and future intention to trial safer alternative behavioural therapies. Additionally, the study also aimed to explore patients' preference for information sources on behavioural therapies. METHODS Point of purchase surveys were conducted with patients obtaining benzodiazepines from selected pharmacies across New South Wales (NSW), Australia. Survey items included the Beliefs about Medicines Questionnaire (BMQ-specific), questions about patient's sociodemographic characteristics, as well as their views about long-term benzodiazepine use and behavioural therapies. RESULTS Seventy-five patients were recruited from 12 pharmacies across New South Wales (NSW). The surveys were conducted from November 2016 to July 2017. The mean (±SD) age of the participants was 54.3 (±16.7) with a range of 23 to 86 years, and 67% of the participants had been using the benzodiazepine for at least 1 year. Lower-education levels, stronger beliefs about the necessity of use, and lower concerns about ongoing benzodiazepine use were significantly associated with prolonged use. Sixty-four percent of the participants were not interested in behavioural therapies, and there was a significant relationship between the participants' future preference for behavioural therapies and their concerns about the potential adverse effects of benzodiazepines. A majority of the participants rated general practitioners (GPs) as their first choice and pharmacists as the second choice for discussing behavioural therapies. CONCLUSIONS Specific individual sociodemographic characteristics of benzodiazepine users and their medication-related beliefs influence their current benzodiazepine usage and future intention to trial behavioural therapies as an alternative to their benzodiazepines. Based on the reported preferences of benzodiazepine users in this study, developing and evaluating GP-pharmacist collaborative services to improve the uptake of behavioural therapies as an alternative to benzodiazepines can be recommended.
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Affiliation(s)
- Fatema‐Tun‐Naher Sake
- The School of Pharmacy, Faculty of Medicine and HealthUniversity of SydneySydneyAustralia
| | - Keith Wong
- Faculty of Medicine and HealthThe University of SydneySydneyAustralia
- Woolcock Institute of Medical ResearchThe University of SydneySydneyAustralia
- Department of Respiratory and Sleep MedicineRoyal Prince Alfred HospitalCamperdownAustralia
| | - Delwyn J. Bartlett
- Faculty of Medicine and HealthThe University of SydneySydneyAustralia
- Woolcock Institute of Medical ResearchThe University of SydneySydneyAustralia
| | - Bandana Saini
- The School of Pharmacy, Faculty of Medicine and HealthUniversity of SydneySydneyAustralia
- Woolcock Institute of Medical ResearchThe University of SydneySydneyAustralia
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Fritsch MA, Shelton PS. Geriatric Polypharmacy: Pharmacist as Key Facilitator in Assessing for Falls Risk: 2019 Update. Clin Geriatr Med 2019; 35:185-204. [PMID: 30929882 DOI: 10.1016/j.cger.2019.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This article highlights the significant health impact of falls among older adults. An emphasis is placed on the vital role of the pharmacist, regardless of practice setting, in assessing and reducing falls risk for this growing population. In addition, the importance of a stepwise comprehensive approach to falls assessment by pharmacists in collaboration with other clinicians is elucidated.
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Affiliation(s)
| | - Penny S Shelton
- North Carolina Association of Pharmacists, 1101 Slater Road, Suite 110, Durham, NC 27703, USA
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Fritsch MA, Shelton PS. Geriatric Polypharmacy: Pharmacist as Key Facilitator in Assessing for Falls Risk. Clin Geriatr Med 2017; 33:205-223. [PMID: 28364992 DOI: 10.1016/j.cger.2017.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This article highlights the significant health impact of falls among older adults. An emphasis is placed on the vital role of the pharmacist, regardless of practice setting, in assessing and reducing falls risk for this growing population. In addition, the importance of a stepwise comprehensive approach to falls assessment by pharmacists in collaboration with other clinicians is elucidated.
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Affiliation(s)
| | - Penny S Shelton
- North Carolina Association of Pharmacists, 1101 Slater Road, Suite 110, Durham, NC 27703, USA
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