The intended and unintended consequences of benzodiazepine monitoring programmes: a review of the literature

Original article by: J Fisher, C Sanyal, D Frail, I Sketris

Reference: Journal of Clinical Pharmacy and Therapeutics Feb 2012;37(1):7-21

Source: Journal of Clinical Pharmacy and Therapeutics

Keywords: Benzodiazepines; High-Risk Groups; Monitoring; Prescribing; Review;

Date published: 03/02/2012 17:40

Summary
by: Pharm-line

Objective: Concern has been expressed regarding the potential over-prescription of benzodiazepines (BZDs) and their potential for misuse and abuse.  Patterns of BZD use can be tracked by prescription monitoring programmes (PMPs).  This study reviews the literature examining the impact of PMPs on the use of BZDs.

Methods: Studies published in English from Jan 1980 to Apr 2009 were identified though PubMed, EMBASE, IPA, CINHL and Web of Science using MeSH terms: 'Benzodiazepines' OR 'Benzodiazepines/supply and distribution' AND ('Social Control, Formal/legislation, jurisprudence'); Emtree terms: 'drug control'/exp AND 'benzodiazepine derivative'/exp/mj.  A broad search strategy was also used: benzodiazepines; triplicate prescription programme; prescription monitoring programme; triplicate prescribing; and triplicate prescription policy.

Results and Discussion: This search identified 32 relevant articles that addressed the impact of implementation of a PMP for BZDs in New York State in 1989.  Overall, BZD prescribing declined following implementation, but the decline was not consistent across population groups.  In particular, marginalised and vulnerable populations, such as persons with chronic mental health disorders, may be disproportionately affected.

Conclusions: We provide a critical review of the impact of PMPs on the use of BZDs.  PM decreases overall use of BZDs, but may have unintended consequences that differentially impact certain populations.  Furthermore, research is warranted to understand better the long-term costs and benefits.

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