In 2003,
the Danish Minister for the Interior and Health instructed general
practitioners to reduce prescriptions of benzodiazepines (BZD)
and cyclopyrrolones (CP) by 50%. However, no effective methods
were specified. In Denmark, it is estimated that there are approximately
100,000 BZD-dependent patients, constituting approximately 2%
of the population.
Objective: This article describes the implementation of a successful,
simple and voluntary intervention to reduce the use of dependence-inducing
drugs, while at the same time challenging practitioners' ingrained
habits and prejudices in this field.
Methods: The rules implemented were essentially in accordance
with the official Danish rules, such that a prescription for BZD
and CP could only be issued for one month at a time, and only
following consultation. Use was monitored using the Danish registration
system, Ordiprax, which monitors sales of prescription medicine.
Two Danish general practices, comprising a patient base of approximately
2300 were studied. With the exception of the severely physically
or mentally ill, all users of BZD and CP were included.
Results: After 2½ years, the use of BZD and CP was reduced
by 75% and 90%, respectively. The reorganization of prescription
patterns was seen to be significantly easier than physicians had
expected. During the first three months, only four to five additional
visits per week per 1000 patients were required. Subsequently,
this number was stabilized at one to two additional visits. The
usual collaborative partners, such as psychiatrists, homecare
services, hospitals and substance abuse units were essentially
not deployed. No serious withdrawal effects arose.
Conclusion: The implementation of the aforementioned simple procedures
is to be recommended for the prescription of BZD and CP drugs,
as the effect is immediate and easily attainable, with a reasonable
work input required on the part of general practitioners.
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