Reducing diazepam prescribing for illicit drug users: a randomised control study.
Illicit drug users undergoing mandatory reductions in prescribed diazepam were randomly allocated to one of two methods of delivering psychological support to help reduce their prescription: a) an enhanced intervention consisting of skills training and reinforcement, and b) a limited intervention where patients initially received skills training and thereafter only advice. Outcome measures at baseline and six-months consisted of daily diazepam dose; reported illicit drug use; Severity of Dependence Scale; Hospital Anxiety and Depression Scale (HADS); Pittsburgh Sleep Quality Index. Fifty-three of 119 eligible patients agreed to be randomly allocated to the interventions. Those in the enhanced intervention reduced their daily dose of prescribed diazepam from a mean of 27.8 mgs to 19.9 mgs at six months (5.3% per month) compared with 29.8 mgs to 17.6 mgs at six months (7.5%) among those in the limited intervention group. However, there was no statistically significant difference in the reduction rate between the intervention groups. Approximately 75% of patients in each group suspended their reduction programme. The enhanced intervention group reported a statistically and clinically greater reduction in the mean HADS depression score (10.6 at baseline and 7.7 at follow-up), compared with a rise from 8.9 to 11.2 in the limited intervention group. In conclusion, it is possible to reduce prescribed diazepam among illicit drug users but not at the rate of 10% per month set by the study. The difficulties of working with this population necessitate a flexible and possibly long-term approach to reducing prescribed benzodiazepines.
Elliott
Lawrie
L
School of Nursing and Midwifery, University of Dundee, UK. l.elliott@snm.dundee.ac.uk
Glenday
John
J
Freeman
Laura
L
Ajeda
Dina
D
Johnston
Brian
B
Christie
Morag
M
Ogston
Simon
S
D000328:Adult; D000927:Anticonvulsants / Q000627:therapeutic use; D001007:Anxiety / Q000188:drug therapy; D003863:Depression / Q000188:drug therapy; D003975:Diazepam / Q000627:therapeutic use; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005500:Follow-Up Studies; D006801:Humans; D013287:Illicit Drugs; D019966:Substance-Related Disorders / Q000517:prevention & control*
D000927:Anticonvulsants; D013287:Illicit Drugs; D003975:Diazepam