Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

RCSI research highlights long-term prescription drug use

04 April 2018

New research led by Dr Cathal Cadogan at RCSI’s School of Pharmacy and Professor Kathleen Bennett at RCSI’s Population Health Sciences Division, has highlighted that approximately one-third of medical card patients dispensed prescriptions for benzodiazepines and Z-drugs in Ireland are receiving these medications on a long-term basis.

The study, 'Benzodiazepine and Z-drug prescribing in Ireland: analysis of national prescribing trends from 2005-2015', has been published in the British Journal of Clinical Pharmacology.

This repeated cross-sectional analysis reveals that while benzodiazepine prescribing decreased significantly by 26.5% from 2005 to 2015, the proportion of individuals receiving Z-drug prescriptions increased significantly by 14.4%. Benzodiazepine and Z-drug prescribing rates were highest for older women (≥65 years) throughout the study period.

Prescribing guidelines specify that the upper limit of duration for the use of these medications is two to four weeks. However, the research has found that a third of patients dispensed these medications were receiving prescriptions for more than three months. Long-term use of these medications can cause various problems, such as cognitive and psychomotor impairment.

Cathal Cadogan

Ireland’s national Benzodiazepine Committee was established in June 2000 in order to examine current prescribing practices and to address concerns about long-term prescribing and inappropriate use of these medications. The study findings suggest that progress in reducing national benzodiazepine prescribing levels has, to date, been slow and offset by increased Z-drug prescribing, despite reports highlighting problems with both drug classes, such as falls. Furthermore, prescribing rates for both drug classes have stabilised in recent years, indicating that any progress may have stalled and that scope exists for further intervention.

Dr Cathal Cadogan, Lecturer in Pharmacy Practice at RCSI and lead author on the paper, said: "Z-drugs were originally promoted as favourable alternatives to benzodiazepines for the treatment of insomnia. However, there is a lack of evidence of any clinically useful differences, in terms of effectiveness, and potential for adverse effects, dependence or abuse.

"Our study recommends that targeted interventions are needed to reduce potentially inappropriate long-term prescribing and use of these medications in Ireland. However, additional investment is likely to be needed in appropriate non-pharmacological supports for patients, such as counselling services, in order to implement and sustain necessary changes in prescribing practices," Dr Cadogan concluded.

The paper, 'Benzodiazepine and Z-drug prescribing in Ireland: analysis of national prescribing trends from 2005-2015', is published in the British Journal of Clinical Pharmacology and can be read here.