title: Deprescribing benzodiazepines and Z-drugs in community-dwelling adults: a scoping review.
abstract: BACKGROUND
  Long-term sedative use is prevalent and associated with significant morbidity, including adverse events such as falls, cognitive impairment, and sedation. The development of dependence can pose significant challenges when discontinuation is attempted as withdrawal symptoms often develop. We conducted a scoping review to map and characterize the literature and determine opportunities for future research regarding deprescribing strategies for long-term benzodiazepine and Z-drug (zopiclone, zolpidem, and zaleplon) use in community-dwelling adults.
  
  
  METHODS
  We searched PubMed, Cochrane Central Register of Controlled Trials, EMBASE, PsycINFO, CINAHL, TRIP, and JBI Ovid databases and conducted a grey literature search. Articles discussing methods for deprescribing benzodiazepines or Z-drugs in community-dwelling adults were selected.
  
  
  RESULTS
  Following removal of duplicates, 2797 articles were reviewed for eligibility. Of these, 367 were retrieved for full-text assessment and 139 were subsequently included for review. Seventy-four (53%) articles were original research, predominantly randomized controlled trials (n = 52 [37%]), whereas 58 (42%) were narrative reviews and seven (5%) were guidelines. Amongst original studies, pharmacologic strategies were the most commonly studied intervention (n = 42 [57%]). Additional deprescribing strategies included psychological therapies (n = 10 [14%]), mixed interventions (n = 12 [16%]), and others (n = 10 [14%]). Behaviour change interventions were commonly combined and included enablement (n = 56 [76%]), education (n = 36 [47%]), and training (n = 29 [39%]). Gradual dose reduction was frequently a component of studies, reviews, and guidelines, but methods varied widely.
  
  
  CONCLUSIONS
  Approaches proposed for deprescribing benzodiazepines and Z-drugs are numerous and heterogeneous. Current research in this area using methods such as randomized trials and meta-analyses may too narrowly encompass potential strategies available to target this phenomenon. Realist synthesis methods would be well suited to understand the mechanisms by which deprescribing interventions work and why they fail.
authors.affiliation: Faculty of Medicine, Dalhousie University, Mail Box #259, 5849 University Avenue, Room C-125, PO Box 15000, Halifax, NS, B3H 4R2, Canada. andre.p@dal.ca.
authors.forename: André S
authors.initials: AS
authors.lastname: Pollmann
authors.affiliation: College of Pharmacy and Department of Psychiatry, Dalhousie University, 5968 College St, PO Box 15000, Halifax, NS, B3H 4R2, Canada. andrea.murphy@dal.ca.
authors.forename: Andrea L
authors.initials: AL
authors.lastname: Murphy
authors.affiliation: College of Pharmacy and Department of Psychiatry, Dalhousie University, 5968 College St, PO Box 15000, Halifax, NS, B3H 4R2, Canada. joel.bergman@dal.ca.
authors.forename: Joel C
authors.initials: JC
authors.lastname: Bergman
authors.affiliation: Department of Psychiatry and College of Pharmacy, Dalhousie University, QEII HSC, AJLB 7517, 5909 Veterans' Memorial Lane, Halifax, NS, B3H 2E2, Canada. david.gardner@dal.ca.
authors.forename: David M
authors.initials: DM
authors.lastname: Gardner
mesh_terms: D000081:Acetamides / Q000627:therapeutic use*; D053961:Azabicyclo Compounds / Q000627:therapeutic use*; D001569:Benzodiazepines / Q000627:therapeutic use*; D000069340:Deprescriptions; D006801:Humans; D010879:Piperazines / Q000627:therapeutic use*; D011725:Pyridines / Q000627:therapeutic use*; D011743:Pyrimidines / Q000627:therapeutic use*; D000077334:Zolpidem
chemical_list: D000081:Acetamides; D053961:Azabicyclo Compounds; D010879:Piperazines; D011725:Pyridines; D011743:Pyrimidines; C515050:zopiclone; D001569:Benzodiazepines; D000077334:Zolpidem; C085665:zaleplon