Abstract
The College has recently updated and endorsed its professional practice guideline ‘Guidance for the use of benzodiazepines in psychiatric practice’. The College is committed to advancing the profession of psychiatry and meeting the needs and expectations of our members by providing high quality, up-to-date practice and policy documents. The Practice, Policy and Partnerships Committee (PPPC) guides this process, and in updating the guidance on benzodiazepines, was led by the Committee for Therapeutic Interventions and Evidence Based Practice (CTIEBP). The Faculty of Addiction Psychiatry, the Anxiety Disorders Clinical Practice Guidelines (CPG) Working Group, and other expert members were also engaged in this process.
We are pleased to now be able to make public the results of this work, in the form of a clear, evidence-based document, which we hope will be of high value in clinical practice. This document has particular significance in the context of the November 2015 release of the Australian Commission for Safety and Quality in Health Care’s (ACSQHC) Australian Atlas of Healthcare Variation (the Atlas). The ACSQHC has undertaken this important body of work in order to identify areas of unwarranted healthcare variation in Australia, and to develop recommendations for how this can be addressed.
Chapter 5 of the Atlas focusses on variations in the dispensing of opioid medications, with findings showing that there are tenfold variations in the dispensing of opioid medications between regions of Australia. We support the ACSQHC’s recommendations for addressing unwarranted variation, including via the dissemination of up-to-date information on prescribing guidelines. We are particularly pleased to be able to contribute to this via the timely release of our benzodiazepines guidance. Resources such as these will form part of a holistic approach to continuing to ensure that Australians have access to healthcare of the highest level of safety and quality.
The updated guidance emphasises that, as with all pharmacological treatments, benzodiazepines offer a range of beneficial therapeutic effects, and also some potentially disadvantageous effects. It sets out recommendations for the use of benzodiazepines in psychiatric practice that is mindful of the particular problems associated with dependence and risk of overdose with this medication. Key recommendations include:
Benzodiazepines should be prescribed based on a comprehensive assessment, including specific diagnostic reasons or target symptoms for which good evidence of efficacy exists.
A substance use history should be taken prior to prescribing benzodiazepines. For consumers with a history of drug or alcohol misuse, particular caution should be exercised.
A plan for ceasing the medication should be documented.
Consumers should be informed of the potential for both tolerance and dependence, the risk of withdrawal symptoms, and the full range of possible side effects. When considering long term prescription, the consumer’s informed, formal consent should be documented.
Benzodiazepines should be prescribed at the lowest effective dose.
Particular care should be taken with consumers for whom the sedative side effects of benzodiazepines pose particular risk, such as sedentary and older people.
Caution should be exercised in prescribing when any conditions with respiratory depression are present.
Universal precautions should be applied, including having one prescriber, dose limits, controlled scripting and undertaking a clinical review of repeat prescriptions.
The updated guidance can be accessed in full in the ‘Guideline and resources for practice’ section of the College website (www.ranzcp.org). The Australian Atlas of Healthcare Variation, including Chapter 5 on the dispensing of opioids, and an accompanying statement from the College, can be accessed via the ACSQHC website.