Reduction in the use of benzodiazepines and cyclopyrrolones in general practice

  • Viggo K. Jørgensen
  • Birgit S. Toft
Keywords: Benzodiazepines, Physician's Practice Patterns, Denmark


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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1. Srisurapanont M, Critchley J, Garner P, Maneeton B, Wongpakaran N. Interventions to reduce benzodiazepine prescribing. Cochrane Database Syst Rev. 2005 Jan 24;(1).Protocol.

2. Communication regarding the prescription of addictive drugs. Directive CIR 12 from 13/01/2003. Copenhagen; Danish National Board of Health, 2003.

3. Hansen EH, Helweg-Jørgensen S. Dependency on psycho pharmaceutics from a patient perspective [in Danish] Faculty of Pharmaceutical Sciences. Lægemiddelforskning 1999: 23.

4. Danish Medicines Agency. Institute for Rational Pharmacotherapy. Benzodiazepine in general Practice [In Danish]. 2004; Sep;(1):1-41. Available from URL: [Accessed 2008 March 22].

5. Wang PS, Bohn RL, Glynn RJ, Mogun H, Avorn J. Zolpidem use and hip fractures in older people. J Am Geriatr Soc. 2001,49:1685-1690.

6. Cumming R, Le Couteur DG. Benzodiazepines and Risk of Hip Fractures in Older People. CNS Drugs. 2003;17:825-837.

7. McGwin G, Sims RV, Pulley L, Roseman JM. Relation among chronic medical conditions, medications, and automobile crashes in the elderly: a population-based case-control study. Am J Epidemiol. 2000;152(5):424-431.

8. Vester JC, Veldhuijzen DS, Volkerts ER. Residual effects of sleep medication on driving ability. Sleep Med Rev. 2004;8(4):309-325.

9. Ashton CH. Benzodiazepines: How they work and how to withdraw. The Ashton Manual, Aug. 2002. [Online]. Available from URL: [Accessed 2008 March 22].

10. Jørgensen VRK, Toft BS, Fogh MS. Reducing the use of addictive drugs in clinical practice [in Danish] Ugeskr Laeger. 2006;168:1636-1640.

11. Jørgensen VRK, Toft BS, Fogh MS. Reducing the use of benzodiazepines and cyclopyrrolones in clinical practices. Pharmacy Practice 2006;4(2):74-78.

12. Ordiprax: a tool for doctors and regions. Fact sheet from the Danish Medicines Agency [online]. Available from URL: [Accessed 2008 March 22].

13. Danish Medicines Agency. The consumption of benzodiazepines and benzodiazepine related drugs [online]. Available from URL: [Accessed 2007 Sep 16]

14. Torper J, Steine S. Seponation of benzodiazepine- how is the experience of the users [In Norwegian] Tidsskr Nor Laegeforen. 2004;124(18):2342-2344.

15. Gyldmark M, Hansen EH. The social costs of dependency on psycho pharmaceutics [in Danish] Faculty of Pharmaceutical Sciences. Lægemiddelforskning 1997:36-37.

16. Mouland G. A letter to benzodiazepine users--an efficient way to reduce the prescription [in Norwegian]. Tidsskr Nor Laegeforen. 1997;117:3097-3100.

17. Andreasen CM, Errebo-Knudsen L, Kristensen KA. Patient information might reduce the use of benzodiazepines in general practice.[in Danish] Ugeskr Laeger. 1989;145:2968-2970.

18. Weintraub M, Singh S, Byrne L, Maharaj K, Guttmacher L. Consequences of the 1989 New York State triplicate benzodiazepine prescription regulations. JAMA.1991;266(17):2392-2397.

19. Holden JD, Hughes IM, Tree A. Benzodiazepine Prescribing and Withdrawal for 3234 Patients in 15 General Practices. Fam Pract. 1994;11:358-362.

20. Ashton H. Benzodiazepine Withdrawal: outcome in 50 patients. Br J Addiction. 1987;82:665-671.

21. Jørgensen VRK. Benzodiazepine reduction in practice [In Danish]. Månedskr Prakt Lægegern. 2006;84:333-339.
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