Prescribing benzodiazepines outside guidelines risks scrutiny

This month saw publication of findings from The All Party Parliamentary Drugs Misuse Group (APPDMG) on dependence to over-the-counter and prescription-only medicines, including painkillers and benzodiazepines.

Among the many recommendations, including restrictions on over-the-counter painkillers containing codeine, the report also called for the Department of Health to set up procedures to monitor GP prescribing of drugs such as benzodiazepines, particularly with a view to preventing prescribing outside BNF and DH guidelines.

The report states: "GPs who prescribe outside the guidelines must be required to justify their decision to the PCT. Pharmacists should be encouraged to flag up to PCTs doctors who are regularly prescribing to their patients outside these guidelines".

MDDUS has already commented on the report, stating that if there are genuine concerns that a GP is overprescribing or prescribing inappropriately, then clearly they shouldn’t be ignored – but a more practical approach would be to follow the National Patient Safety Agency's guidance on significant event audit.

"The ethos of auditing significant events and clinical governance is one of analysing the critical incident in a supportive environment without attributing fault so that the necessary lessons can be learned and shared with colleagues," said Dr George Fernie, MDDUS medico-legal adviser.

But the MDDUS does urge doctors to follow BNF (British National Formulary) and CSM (Committee on Safety of Medicines) guidelines on prescribing benzodiazepines. CSM advice states:

1. Benzodiazepines are indicated for the short-term relief (two to four weeks only) of anxiety that is severe, disabling, or subjecting the individual to unacceptable distress, occurring alone or in association with insomnia or short-term psychosomatic, organic, or psychotic illness.
2. The use of benzodiazepines to treat short-term ‘mild’ anxiety is inappropriate and unsuitable.
3. Benzodiazepines should be used to treat insomnia only when it is severe, disabling, or subjecting the individual to extreme distress.

The APPDMG report also recommended: "That, when GPs prescribe drugs that are known to have the potential to cause physical dependence or addiction, such as opiate-containing products and benzodiazepines and related classes of drugs, they should set up procedures to monitor the patient… The practice of repeat prescription without review for these drugs must end".

MDDUS agrees that monitoring repeat prescriptions is crucial and the failure to set up an adequate system presents significant risk for a practice.

ACTION: follow BNF and PCT or health board guidelines on prescribing opiate-containing products and benzodiazepines and related classes of drugs. Ensure your practice has a fail-safe method in place to monitor and review repeat prescribing of such drugs. Any errors should be flagged up and subject to significant event audit.