Decision aid to guide discussions on sleeping pill prescriptions
A patient decision aid on medicines associated with dependence or withdrawal symptoms has been published
People who have been prescribed sleeping medications benzodiazepines and Z-drugs (zolpidem or zopiclone) could benefit from a new patient decision aid designed to help them make an informed choice about their treatment in discussion with their GP or pharmacist.
NICE has today (Thursday, 15 June) published a patient decision aid and a one-page summary, the latest additions to its medicines associated with dependence or withdrawal symptoms: safe prescribing and withdrawal management for adults guideline, first published last year.
It aims to provide clear and easy-to-use advice and information to support people taking benzodiazepines or z-drugs to help them understand the benefits and risks of staying on their current dose, reducing their dose, or stopping taking the drugs altogether.
The decision aid has been created by an expert group of professionals and people with lived experience, including members of the Royal College of Psychiatrists, the National Mental Health Clinical Advisor, representatives from Recovery Experience Sleeping Pills and Tranquilisers (REST) and other organisations.
The aid has been developed as part of work linked to NHS England’s framework for local health and care providers, launched in April this year, which aims to further reduce the number of prescriptions for medicines associated with withdrawal or dependence. This includes high-strength painkillers and other addiction-causing medicines, like opioids and benzodiazepines, where they may no longer be the most clinically appropriate treatment – and in some cases, potentially harmful.
Clinicians are encouraged to discuss and offer people alternatives, including psychotherapy, sleep clinics and social activities or clubs before prescribing.
As part of the NHS England framework, GPs and clinical pharmacists are being asked to provide patients with a personalised review of their medicines so they can make an informed, shared decision about whether a change in treatment is appropriate. The NICE patient decision aid will help facilitate this and help people make an informed decision about their treatment.
The changes to reduce prescriptions are already having an impact. 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.
This is a useful and usable interactive guide for both clinicians and patients and has been developed with the involvement of both.
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.
As with many other medications, we need to balance the potential benefits and risks of harm from starting, continuing and stopping benzodiazepines and z-drugs. This guide will help individuals have discussions with their clinicians about potential risks and benefits of these medications.