Ireland: Report of the Benzodiazepine Committee 2002

This is an impressive document from Ireland that outlines the range of issues surrounding the legal and illegal use of benzodiazepines in Ireland in 2002, with the goal of improving prescribing practices. I'm not sure how many of the recommendations were followed after this document was created, but the "Good Practice Guidelines" that are suggested on page 26 of the document are excellent. I'll link the full document here, and below that, I'll copy and paste an excerpt from the section entitled "Good Practice Guidelines" so you can have a quick look.

 

http://health.gov.ie/wp-content/uploads/2014/04/Report-of-the-Benzodiazepine-Committee.pdf

 

 

3.2 Summary of Recommendations of Good Practice Guidelines for Clinicians

The main recommendations for practitioners contemplating the prescribing of benzodiazepines are as follows:-

Before initiating prescribing

Take a full history, including an alcohol and licit and illicit drug history ;

inform the patient of the side-effect profile of benzodiazepines and offer an information leaflet;

consider and treat, if possible, any underlying causes of the condition for which benzodiazepines may be prescribed;

consider referral to other services;

consider alternative therapies;

consider delaying prescribing until a subsequent visit.

When prescribing for the first time

Initiate with the lowest recommended dose but this may need to be adjusted depending on

patient’s response;

do not prescribe for longer than 4 weeks;

use phased dispensing where possible;

ensure that agreements between doctor and patient are documented;

record all details of medication prescribed and duration of treatment;

ensure that clear, effective and speedy communication concerning benzodiazepine usage takes

place between prescribing professionals both within and between services.

 

 

For patients dependent upon benzodiazepines or patients in receipt of continuing prescribing

Issue small quantities at a time (usually not more than one week);

review regularly (usually monthly);

use a long acting benzodiazepine in dosages no higher than diazepam 5 mg three times daily

or equivalent;

ensure that all patients are made aware of the risks of long term benzodiazepine use and

document this communication;

use signed consent forms where appropriate;

encourage all patients with dependency to withdraw and offer them a detoxification

programme at regular intervals (at least annually) and document all communication;

seek specialist advice before prescribing to patients who have become dependent as a result

of substance abuse.

 

The guidelines also contain recommendations for withdrawal from benzodiazepines. Specific

advice is also given in relation to the prescribing of benzodiazepines to special patient groups

such as: substance misusers, elderly patients, patients who are in hospitals or institutions, and

pregnant and breastfeeding women.

 

A number of submissions recommended that alternative therapies should be considered

rather than the prescribing of benzodiazepines. The sub-committee fully endorsed this view

and recommended that where possible practitioners should consider this option. Appendix

1 of the Guidelines outlines types of alternative therapies that may be offered.

The Committee recommends that these Good Practice Guidelines on Benzodiazepines for

Clinicians are disseminated to all practitioners, including hospital practitioners and

implemented in full.

 

It is recognised that the time required for the full implementation of these guidelines might be

lengthy.

 

The Irish College of General Practitioners is supportive of the Guidelines but point to the lack

of supports such as psychologists, nurses, counsellors etc. as being a barrier to their full

implementation. The Committee acknowledges these concerns.

 

The Primary Health Care Strategy which was published by the Minister for Health and

Children in November 2001 recognises the need for the appointment of a range of

community based support services e.g. counsellors, nurses etc. to support primary care

practitioners. However, it will take time for these supports to come on stream. It is expected

however that the implementation of the recommendations contained in this strategy will have

a positive effect in the overall implementation of the Good Practice Guidelines.

 

Ireland is way ahead in understanding benzo addiction. I lived there and I was fully warned.

 

Love buddy

I was SO impressed by this document! And it's great to hear from someone who has experienced it, so thanks for your comments, Buddy42! It seems like a model for the rest of the world to follow, if indeed it has rolled out as suggested.

Some surgeries make a principal of not prescribing it at all. The thing about Ireland is patient's pay a substantial amount of the drugs, therefore more expensive drugs are given. The cheaper options don't have to be pushed.

What's also notable from the recommendations is the idea that non-drug or alternative therapies could be offered instead of medication. Also, there's a mention of treating the underlying issue, which is brilliant! Why isn't this always done? If pain is causing anxiety or insomnia, then treat that. If it's stress related to job or family, then those things could be addressed in other ways. It just seems that medications are offered because it's easy to do so. But it's not necessarily right.

Wow! I wish my doctor had read that

 

Thanks

13 YEARS of this stuff and nothing, NOT A WORD to me about this? 

 

An impressive document, for sure.  You hear NOTHING about this in the USA.

 

Big crackdown on prescription Opioids, but nothing on benzos.

I forgot to say Thank You, Lapis.

Hey, you're welcome, Pooks!

 

Just reading your signature, and it looks like you've got the dizzies too. For me, it was the benzos 1000%, and if it's the same for you, the best thing you can do is withdraw (taper) slowly. They're "vestibular suppressants"!

Lapis,

I am Irish and living in Ireland at present and benzos are not prescribed presently on a long term basis except to those of us who have been on them for a lifetime. Most people are prescribed SSRI's or some a/d for anxiety disorder instead of benzos so there is an over prescribing of a/ds now but I guess it is better in a way. My doctor is a good one and I am seeing a psychiatrist at present to get off my V. She has a holistic approach to medicine.

 

We are a tiny country here but we are progressive. Thank you for all the wonderful posts with articles of great interest to me. We are the land of saints and scholars. I still love to read and learn about everything that affects me but I am not religious at all, no saint here but soulful and into good karma  .

 

Moya x

Moya, it's great to hear from you! I'm so glad to hear what's happening there, and in your situation in particular. It's not the "Luck of the Irish," it's the "Brains of the Irish"! I've got one more reason to admire your country!

Lapis,

Maybe a bit of both although I have never been lucky really and not brainy either LOL. Just me as I am and getting better at being just who I am

 

Hope you continue to do well Please keep posting what you find, it is great to read anything in the news on this subject.

 

Love Moya x

Hi Moya,

I bet you're brainy and lucky, but perhaps not so good at admitting it! But thanks for the encouragement, and yes, I'll certainly post anything else I find/have. I went through an intense period of researching the topic at hand, and I found so many fascinating articles. Now that I'm on BB, I can share them and discuss them with others. It's been quite rewarding, and I hope, helpful for others. I think sharing info is a huge part of what BB does so well.

 

I hope you're doing well too, Moya!

Take care,

Lapis

Lapis,

I am doing great at the moment, feel better than I ever felt on benzos, such a blessing and hope this window stays open.

 

Moya x

Fantastic news, Moya! I hope it continues for you and things just keep getting better and better.

 

I'm still very dizzy, so I guess I could use some Irish Luck, or Canadian Luck or whatever luck I could get my hands on! 

 

Lapis

 

 

Thanks Moya.

 

Here in the U.S. I consider the suppression of side effects of benzo a scandal, but it has received no major media attention.  I suspect drug companies tend to downplay this and doctors, like mine, kind of use it as a hook to keep you coming back.  I think my neuro now is spooked by my case, after 13 years, and is going to help me withdraw.  He is expecting to lower the dose in April but we are holding at 1.0 per day for now.  I have found it's better for me to split the two tabs into four doses per day.  I also am at fault for, in the past, occasionaly popping an extra pill in stressful situations.  Little did I know the consequences that lay ahead.  Dr. says he doesn't like to give more than 1.0 Xanax per day, and I do take Halcion for sleep.  Some Norco too, but also trying to cut down on that.  As I have stated before, at age 68, is it really worth tapering and withdrawal if side effects cause problems?