Quality prescribing for Benzodiazepines and z-drugs: guide for improvement 2024 to 2027

Clinical foreword

We are delighted to present the Quality Prescribing for Benzodiazepine and z-drugs Guide for adults. This guide is welcomed as an opportunity to further improve the care of those requiring benzodiazepine and z-drugs. It promotes a holistic approach to person-centred care and review of treatment, highlighting the importance of addressing health inequalities alongside wider climate and sustainability challenges. The recommendations are aimed at supporting people receiving these medicines, healthcare professionals, general practice clusters, health boards and health and social care partnerships and are designed to support improvements in healthcare service redesign and provision of care.

Benzodiazepines and z-drugs are indicated for a variety of conditions including the short-term relief of severe insomnia and some anxiety disorders. People can quickly become tolerant to the therapeutic effects of benzodiazepines and z-drugs, rendering them ineffective. Nonetheless chronic use is common, exposing people to avoidable adverse drug effects and harms, and associated increased mortality risks with their use.

This guide is primarily intended to support healthcare professionals and others in the appropriate prescribing of benzodiazepines and z-drugs; supporting and enabling proactive person-centred reviews, and continuation, reduction and stopping of these medicines where appropriate.

An important principle in improving the care of individuals on benzodiazepine and z-drugs is to consider the role of the individual in shared decision-making and adopt a person-centred approach when discussing treatment options available. The 7-Steps medication review process allows a person-centred approach to both the initiation and review of existing treatment, centred around the needs of the individual.

This guide is not intended to supersede other prescribing advice such as NICE, British Association for Psychopharmacology (BAP), Scottish Government Polypharmacy Guidance or the principles outlined in the Realising Realistic Medicine report. It is intended to complement them and offer additional practical advice and options for tailoring care to the needs and preferences of the individual.

We are extremely grateful to all those who contributed to the working group and to the review and development of this guide.

Alastair Cook

Chair

Principal Medical Officer Psychiatric Adviser, Scottish Government

Alpana Mair

Deputy Chair

Head of Effective Prescribing & Therapeutics Division, Scottish Government

Professor Sir Gregor Smith

Chief Medical Officer for Scotland

Alison Strath

Chief Pharmaceutical Officer