1
|
Curado DF, de Barros VV, Noto AR, Opaleye ES. Dependence on hypnotics: a comparative study between chronic users of benzodiazepines and Z-drugs. BRAZILIAN JOURNAL OF PSYCHIATRY 2021; 44:248-256. [PMID: 34133689 PMCID: PMC9169466 DOI: 10.1590/1516-4446-2020-1651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 04/04/2021] [Indexed: 01/16/2023]
Abstract
Objective: To evaluate dependence among chronic benzodiazepine and Z-drug users in Brazil. Methods: Chronic users of benzodiazepines (n=94), Z-drugs (n=74), or both (n=11) were recruited from the community, underwent a psychiatric evaluation and completed self-report instruments on hypnotic dependence, insomnia, anxiety, and depression. Users of benzodiazepines and Z-drugs were compared using t-tests, and logistic regression models were employed to explore significant predictors of a dependence diagnosis. Results: There was no difference in the prevalence of dependence among benzodiazepine (77.2%) and Z-drug (69.4%) users. Benzodiazepine users reported increased psychosocial aspects of dependence, anxiety, and depression. Preoccupation with the availability of medication (prevalence ratio [PR] = 2.39 [1.15-5.20]) and insomnia (PR = 1.10 [1.02-1.19]) were associated with a diagnosis of dependence (n=175). Conclusion: The prevalence of dependence was similar among both drug classes. The increased self-reported dependence, anxiety, and depression among benzodiazepine users may be due to behavioral rather than pharmacological aspects of medication use. Behaviors related to hypnotic use were important predictors of dependence.
Collapse
Affiliation(s)
- Daniela F Curado
- Núcleo de Pesquisa em Saúde e Uso de Substâncias (NEPSIS), Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Viviam V de Barros
- Núcleo de Pesquisa em Saúde e Uso de Substâncias (NEPSIS), Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Ana R Noto
- Núcleo de Pesquisa em Saúde e Uso de Substâncias (NEPSIS), Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| | - Emérita S Opaleye
- Núcleo de Pesquisa em Saúde e Uso de Substâncias (NEPSIS), Departamento de Psicobiologia, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil
| |
Collapse
|
2
|
The interplay of context factors in hypnotic and sedative prescription in primary and secondary care-a qualitative study. Eur J Clin Pharmacol 2018; 75:87-97. [PMID: 30215101 PMCID: PMC6326988 DOI: 10.1007/s00228-018-2555-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 09/03/2018] [Indexed: 11/18/2022]
Abstract
Purpose Non-medical or contextual factors strongly influence physicians’ prescribing behavior and may explain why drugs, such as benzodiazepines and Z-drugs, are still frequently prescribed in spite of well-known adverse effects. This study aimed to explore which contextual factors influence the prescription of hypnotics and sedatives and to compare their role in primary and secondary care. Methods Understanding medical practices as games with specific rules and strategies and performed in a largely habitual, not fully conscious manner, we asked a maximum variation sample of 12 hospital doctors and 12 general practitioners (GPs) about their use of hypnotics and sedatives. The interviews were analyzed by qualitative content analysis. Results Hospital doctors’ and GPs’ use of hypnotics and sedatives was influenced by a variety of contextual factors, such as the demand of different patient groups, aims of management, time resources, or the role of nurses and peers. Negotiating patient demands, complying with administrative regulations, and finding acceptable solutions for patients were the main challenges, which characterized the game of drug use in primary care. Maintaining the workflow in the hospital and finding a way to satisfy both nurses and patients were the main challenges in secondary care. Conclusions Even if doctors try to act rationally, they cannot escape the interplay of contextual factors such as handling patient needs, complying with administrative regulations, and managing time resources. Doctors should balance these factors as if they were challenges in a complex game and reflect upon their own practices. Electronic supplementary material The online version of this article (10.1007/s00228-018-2555-9) contains supplementary material, which is available to authorized users.
Collapse
|
3
|
Gentile G, Jego M, Spadari M, Griffiths K, Jouanjus E, Micallef J. Identification and tracking of Addictovigilance signals in general practice: which interactions between the general practitioners and the French Addictovigilance Network? Fundam Clin Pharmacol 2018; 32:643-651. [PMID: 30003596 DOI: 10.1111/fcp.12401] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 06/30/2018] [Accepted: 07/10/2018] [Indexed: 11/29/2022]
Abstract
Addictovigilance is a health vigilance dedicated to the survey of medicinal or illicit psychoactive substance use disorders (SUDs). France is the only European country to have a vigilance system specifically dedicated to substances with an abuse/addiction potential. The French Addictovigilance system is organized in a network of regional tertiary centres (called Abuse and Dependence Monitoring Centres, CEIP-Addictovigilance) and works in close collaboration with Regional and National health authorities. Because of the essential and unavoidable nature of their practice in the French Healthcare system, general practitioners (GPs) are key actors to identify and track Addictovigilance signals. They have been involved in several of the pharmacoepidemiological surveys implemented by the French Addictovigilance Network (FAN). Now, they increasingly participate in clinical research projects and studies. In this article, interactions between GPs and the FAN are illustrated with two examples: patients on opioid substitution treatment and patients on opioid analgesics. Collaborations between GPs and the FAN could be further potentiated. In particular, more effective communication on psychoactive SUDs including abuse/addiction is necessary to optimize the implementation of preventive measures for patients on psychoactive substances medications, and to improve the attitudes of GPs and more widely health professionals in the management of any psychoactive user suffering from SUDs. In addition, both adapted training and improved collaborative research could contribute to the optimization (safety, quality) of professional practices.
Collapse
Affiliation(s)
- Gaétan Gentile
- Département Universitaire de Médecine Générale, Faculté de Médecine, Aix Marseille Université, 27 boulevard Jean Moulin, Marseille, 13385, France.,Institut des Neurosciences des Systèmes, INSERM 1106, Aix Marseille Université, INSERM, INS, Inst Neurosci Syst, Faculté Médecine Timone, 27 Bd Jean Moulin, 133855, Marseille, France
| | - Maeva Jego
- Département Universitaire de Médecine Générale, Faculté de Médecine, Aix Marseille Université, 27 boulevard Jean Moulin, Marseille, 13385, France.,EA 3279 Research Unit-Public Health, Chronic Diseases and Quality of Life, Aix-Marseille University, CERESS, EA3279, 27 Bd Jean Moulin, Marseille, 13385, France
| | - Michel Spadari
- Institut des Neurosciences des Systèmes, INSERM 1106, Aix Marseille Université, INSERM, INS, Inst Neurosci Syst, Faculté Médecine Timone, 27 Bd Jean Moulin, 133855, Marseille, France.,CEIP-Addictovigilance PACA Corse, Service de Pharmacologie Clinique et Pharmacovigilance, AP-HM, Marseille, 13385, France
| | - Karolina Griffiths
- Département Universitaire de Médecine Générale, Faculté de Médecine, Aix Marseille Université, 27 boulevard Jean Moulin, Marseille, 13385, France
| | - Emilie Jouanjus
- Equipe de Pharmacoépidémiologie, INSERM UMR 1027, Université Toulouse III - Paul Sabatier, 37 Allées Jules Guesde, Toulouse, 31000, France.,CEIP-Addictovigilance, Service de Pharmacologie Médicale et Clinique, Centre Hospitalier Universitaire de Toulouse, 37 Allées Jules Guesde, Toulouse, 31000, France
| | - Joëlle Micallef
- Institut des Neurosciences des Systèmes, INSERM 1106, Aix Marseille Université, INSERM, INS, Inst Neurosci Syst, Faculté Médecine Timone, 27 Bd Jean Moulin, 133855, Marseille, France.,CEIP-Addictovigilance PACA Corse, Service de Pharmacologie Clinique et Pharmacovigilance, AP-HM, Marseille, 13385, France
| |
Collapse
|
4
|
Sundseth AC, Gjelstad S, Straand J, Rosvold EO. General practitioners' prescriptions of benzodiazepines, Z-hypnotics and opioid analgesics for elderly patients during direct and indirect contacts. A cross-sectional, observational study. Scand J Prim Health Care 2018; 36:115-122. [PMID: 29656692 PMCID: PMC6066290 DOI: 10.1080/02813432.2018.1459164] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To describe Norwegian general practitioners' (GPs') prescription patterns of benzodiazepines, Z-hypnotics and opioid analgesics (BZO-drugs) to elderly (≥70 years) patients. DESIGN, SUBJECTS AND SETTING Cross sectional, observational study. Contact- and prescription data from 148 Norwegian GPs, issued for elderly patients during eight months in 2008. GP-patient contacts were categorized as direct contacts (DC: face-to-face consultations) or indirect contacts (IC: via third party, phone or mail). Explanatory variables were characteristics linked to the GPs, patients, and practices. During analyses, GPs' number of listed patients, share of which for elderly patients, and total number of patient consultations during the period (proxy for practice activity), were categorized in quintiles (Q1-5) by number of GPs. MAIN OUTCOME MEASURES Number of BZO-drug prescriptions and quantities issued during direct- and indirect GP-patient contacts. RESULTS In total, 62% of BZO-prescriptions were issued during ICs. Of all prescriptions, 66% were large quantum packages (50 tablets or more), 62% out of which were prescribed during ICs. During the study period, 50% of the patients received repeat prescriptions. Prescribing during ICs was associated with low over all practice activity (Q1) and many (Q5) older patients on the GP's lists. CONCLUSION GPs' BZO-drug prescribing to elderly occur more frequently during ICs than within DCs, and are more commonly issued as large quantity packages. This indicates that regular- or long-term use among elderly is common, contrasting with previous and current national guidelines, which recommend regular clinical assessments and short time or intermittent use of BZO-drugs. Key Points GPs frequently prescribe benzodiazepines, Z-hypnotics and opioid (BZO) drugs for elderly people. BZO-drugs are frequently issued during indirect GP-patient contacts and in relatively large quantities, indicating regular or long-term use. GPs' BZO-drug prescribing patterns contrast with national guidelines recommending clinical assessment and short time or intermittent use of BZO-drugs.
Collapse
Affiliation(s)
- Anne Cathrine Sundseth
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway;
- CONTACT Anne Cathrine SundsethDepartment of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Svein Gjelstad
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway;
| | - Jorund Straand
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway;
- General Practice Research Unit, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Elin O. Rosvold
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway;
| |
Collapse
|
5
|
Kurko T, Saastamoinen LK, Tuulio-Henriksson A, Taiminen T, Tiihonen J, Airaksinen M, Hietala J. Trends in the long-term use of benzodiazepine anxiolytics and hypnotics: A national register study for 2006 to 2014. Pharmacoepidemiol Drug Saf 2018; 27:674-682. [PMID: 29726630 DOI: 10.1002/pds.4551] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 03/20/2018] [Accepted: 04/06/2018] [Indexed: 11/06/2022]
Abstract
PURPOSE Long-term benzodiazepine (BZD) treatment continues to be a debated topic. Because individual BZDs have different clinical profiles, we assessed the nationwide trends of long-term BZD use at active substance level during years 2006 to 2014. METHODS This study covered all reimbursed BZD purchases (n = 408 572-521 823 annually) for adults recorded in the Finnish Prescription Register. We assessed long-term use (annual cumulative purchase of ≥180 defined daily doses) in general, and at active substance level with the most commonly used BZD anxiolytics (oxazepam, diazepam, alprazolam, and clonazepam for nonepilepsy indications) and hypnotics (zopiclone, zolpidem, and temazepam) included. The persistence rates for each substance were assessed separately. RESULTS The prevalence of long-term BZD use among Finnish adults declined significantly from 5.3% to 3.6%, during years 2006 to 2014. Despite this decline, there was a significant increase in the long-term use of clonazepam for nonepilepsy indications and zolpidem (28.0% and 17.5%, respectively). Long-term use was common in the aged population, as well as among the users of hypnotics or clonazepam. Persistent use of 9 consecutive calendar years varied between 7.5% for incident alprazolam users and 21.0% for incident clonazepam users. CONCLUSIONS We found a declining trend in long-term BZD use, but the decline was not uniform between the substances-the long-term use of clonazepam and zolpidem even increased. Follow-up research is needed to assess whether the decline in BZD use is accompanied by an increased use of other types of anxiolytic or hypnotic drugs or other forms of treatment.
Collapse
Affiliation(s)
- Terhi Kurko
- Research Unit, The Social Insurance Institution, Helsinki, Finland.,Department of Psychiatry, Turku University Hospital, Turku, Finland
| | | | - Annamari Tuulio-Henriksson
- Research Unit, The Social Insurance Institution, Helsinki, Finland.,Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Tero Taiminen
- Department of Psychiatry, Turku University Hospital, Turku, Finland
| | - Jari Tiihonen
- Department of Clinical Neuroscience, Karolinska Institutet, Karolinska Universitetssjukhuset Solna, Stockholm, Sweden.,Department of Forensic Psychiatry, Niuvanniemi Hospital, University of Eastern Finland, Kuopio, Finland
| | - Marja Airaksinen
- Clinical Pharmacy Group, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Jarmo Hietala
- Department of Psychiatry, Turku University Hospital, Turku, Finland
| |
Collapse
|
6
|
Long-term use of benzodiazepines: Definitions, prevalence and usage patterns – a systematic review of register-based studies. Eur Psychiatry 2015; 30:1037-47. [DOI: 10.1016/j.eurpsy.2015.09.003] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 09/02/2015] [Accepted: 09/05/2015] [Indexed: 01/10/2023] Open
Abstract
AbstractBackgroundNumerous treatment guidelines recommend that long-term use of benzodiazepines (BZD) should be avoided primarily due to development of tolerance and a risk for BZD dependence. Despite this, long-term BZD use remains a controversial subject in clinical patient care with “for and against” debates. However, there is no explicit understanding of what is meant by long-term BZD use in real world. The aim of this study was to assess different definitions, usage patterns, prevalence and other characteristics of long-term BZD use based on published register-based studies. Synthesis of these characteristics is essential to derive a meaningful definition of long-term BZD.MethodsSystematic review of register-based studies on long-term BZD use published in 1994–2014.ResultsFourty-one studies met our predetermined inclusion criteria. The length of BZD use defined as “long-term” varied in these studies ranging from one month to several years. The most common definition was six months or longer during a year. The prevalence of long-term BZD use in the general population was estimated to be about 3%. The relative proportion of long-term BZD users (all definitions) in adult BZD users ranged from 6% to 76% (mean 24%; 95% CL 13–36%). The estimates were higher in studies only on the elderly (47%; 95% CL 31–64%). Long-term use involved typically steady treatment with low BZD doses. However, in elderly patients long-term BZD use and exceeding recommended doses was relatively common. Several characteristics associated with long-term use were found.ConclusionsLong-term BZD use is common and a clinical reality. Uniform definitions for “long-term”, which is in line with population-based evidence, is needed to have more comparable results between studies. Our systematic review suggests that duration of BZD treatment over six months, the most common definition for long-term BZD use in the included studies. As also recommended previously, it is a useful starting point for further analyses on disadvantages but also potential advantages associated with long-term BZD use.
Collapse
|
7
|
Rat C, Penhouet G, Gaultier A, Chaslerie A, Pivette J, Nguyen JM, Victorri-Vigneau C. Did the new French pay-for-performance system modify benzodiazepine prescribing practices? BMC Health Serv Res 2014; 14:301. [PMID: 25011548 PMCID: PMC4105521 DOI: 10.1186/1472-6963-14-301] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Accepted: 07/09/2014] [Indexed: 11/23/2022] Open
Abstract
Background French general practitioners (GPs) were enrolled in a new payment system in January 2012. As part of a national agreement with the French National Ministry of Health, GPs were asked to decrease the proportion of patients who continued their benzodiazepine treatment 12 weeks after its initiation and to decrease the proportion of patients older than 65 who were prescribed long half-life benzodiazepines. In return, GPs could expect an extra payment of up to 490 euros per year. This study reports the evolution of the corresponding prescribing practices of French GPs during that period regarding patients who were prescribed a benzodiazepine for the first time. Methods The national healthcare system's administrative database was used to report the longitudinal follow-up of two historical cohorts of French patients from the Pays de la Loire area. Study patients: The “2011” and “2012” cohorts included all patients who initiated benzodiazepine regimens from April 1 to June 30 in 2011 and 2012, respectively. The primary outcomes were the proportion of those study patients who continued benzodiazepine treatment after 12 weeks and the proportion of study patients >65 years who were prescribed long half-life benzodiazepines. Analyses were performed using a multi-level regression. Results In total, 41,436 and 42,042 patients initiated benzodiazepine treatment in 2011 and 2012, respectively. A total of 18.97% of patients continued treatment for more than 12 weeks in 2012, compared with 18.18% in 2011. In all, 27.43% and 28.06% of patients >65 years continued treatment beyond 12 weeks in 2011 and 2012, respectively. The proportion of patients >65 years who were prescribed long half-life benzodiazepines decreased from 53.5% to 48.8% (p < 0.005) due to an increase in short half-life benzodiazepine prescriptions. Patients >65 years who were prescribed short half-life benzodiazepines were more likely to continue treatment after 12 weeks (p < 0.005). Conclusions Despite the pay-for-performance strategy, the number of short half-life benzodiazepine prescriptions increased between 2011 and 2012, and the number of long half-life benzodiazepine initiations remained unchanged. Reducing the proportion of long half-life benzodiazepine prescriptions might be counterproductive because prescribing short half-life benzodiazepines was associated with higher rates of continuation beyond the recommended duration.
Collapse
Affiliation(s)
- Cédric Rat
- Department of General Practice, Faculty of Medicine, 1 rue Gaston Veil, 44035 Nantes, France.
| | | | | | | | | | | | | |
Collapse
|