NICE publishes guide for patients taking benzodiazepines or z-drugs

NICE has published a new decision aid designed to help patients who take anxiety and insomnia medication to make informed treatment decisions.

The decision aid has been created by an expert group of professionals (including members of the Royal College of Psychiatrists, the National Mental Health Clinical Advisor and representatives from Recovery Experience Sleeping Pills and Tranquilisers) as well as those with lived experience.

Benzodiazepines or z-drugs can be harmful when taken over long periods of time

The guidance is aimed at people who have been prescribed benzodiazepines or z-drugs (zolpidem or zopiclone) and provides clear information about the benefits and risks of staying on their current dose, as well as advice on how to reduce the dose or stop taking the medication altogether.

It warns patients of the risks of staying on the drugs for longer than intended (typically more than a few weeks), including brain fog, emotional numbness, concentration difficulties, anxiety and depression.

The guide advises patients struggling with these problems to slowly stop taking the drugs by gradually reducing the dose (also known as tapering), as this will prevent any major withdrawal effects.

However, it also warns that those having a mental health crisis or going through a particularly stressful or upsetting event in their lives should consider holding off reducing the dose, and advises anyone thinking of tapering to discuss this with their GP or another healthcare professional.

Professor Jonathan Benger, Chief Medical Officer at NICE, said the guide is “useful and usable” and will help patients to balance the potential benefits and risks of benzodiazepines and z-drugs.

“Benzodiazepines and Z-drugs can prove crucial in aiding sleep, but part of our ongoing work with NHS England and other partners is to ensure that people’s prescriptions are regularly reviewed to assess whether treatments remain necessary and effective,” he said.

A shift towards drug alternatives

The guide has been launched in a bid to reduce the number of prescriptions for medicines associated with withdrawal or dependence. This includes high-strength painkillers and other addiction-causing medicines, which can be harmful when taken over long periods of time.

The new guidance encourages clinicians to discuss and offer people alternatives to medicines, including psychotherapy, sleep clinics and social activities or clubs.

These changes are already having an impact, and between 2017/18 and 2020/21, the number of people prescribed a benzodiazepine fell by 20% from 1.4 million to 1.1 million. Z-drug prescribing also showed a 2.3% reduction over this three-year period.