The Ballymun Youth Action Project explored the use and misuse of benzodiazepines in Ballymun between 2003 and 2004 using a combination of qualitative and quantitative techniques.1 

The study employed three methods:

• Focus groups
• Interviews with key informants
• Retrospective survey of dispensing practices.  

A combination of community workers and the research team moderated and analysed the findings of a number of focus groups comprising:

• Adults prescribed benzodiazepines; 

• Problem drug users who may or may not use benzodiazepines;
• Treated problem drug users who no longer used benzodiazepines;
• Young drug users who may or may not use benzodiazepines;
• Members of the community and voluntary organisations that address the consequences of benzodiazepine use. 

The main findings from the focus groups and two key interviews were:

• The majority of participants first observed benzodiazepine use in their homes.
• Benzodiazepine use occurs among all age groups, from the young to the elderly.
• More women than men use benzodiazepines.
• Reasons for therapeutic use of benzodiazepines were: to treat anxiety and depression, to help sleep, and to assist people to cope with a variety of situations, including bereavement. 
• The reasons for non-therapeutic use were: to get a desired chemical effect, to enhance the effect of some drugs (such as heroin) and to reduce the effects of stimulants (such as ecstasy and cocaine).
• Benzodiazepines were commonly used in combination with other drugs.
• Benzodiazepine use was considered normal among the population of Ballymun and was recently associated with the Ballymun Regeneration Limited scheme.
• Prescribing practices of doctors contribute to the problem as many people had been receiving scripts for years.
• Large supplies of illicit benzodiazepines were available for purchase in the area, of which the majority were acquired from repeat prescriptions.
• Another source of benzodiazepines was bartering or sharing between residents.
• Benzodiazepine prescribing was linked to methadone maintenance treatment.
• The process of benzodiazepine detoxification was difficult and its success rate was very low. 
• There was a lack of factual information about the long-term effects of benzodiazepines.
• The problems associated with benzodiazepine use were dependence, impaired mental functioning, negative effects when consumed with alcohol and extreme actions that were opposite to the desired effect. 

The following are the findings from a retrospective survey of dispensing patterns in a limited number of community pharmacies in Ballymun over four separate one-week periods between December 2000 and July 2002: 

• There were 751 instances of tablet dispensing included in the study.
• Almost 90 per cent of the prescriptions were issued under the General Medical Services scheme.
• Over 40 doctors prescribed benzodiazepines during the study period, but 77 per cent of the prescriptions were written by four doctors.
• Just under 63 per cent of the prescriptions examined were for diazepam and almost 23 per cent were for flurazepam.
• Almost 66 per cent of the prescriptions were dispensed to women.
• The type of benzodiazepine prescribed was associated with gender.  A higher proportion of men received flurazepam than women, while the opposite was the case with temazepam. 
• Almost two-fifths of the population were first dispensed benzodiazepines over five years ago.  

A key informant interviewed a number of medical practitioners (either face-to-face or by phone) to explore medical perspectives of benzodiazepines and the findings reveal that:

• Addressing benzodiazepine misuse must be considered in the context of the social and economic environment and a medical approach on its own will not address the problem.
• There are different medical approaches to managing benzodiazepine use.  These are: abstinence, a short-term prescription followed by detoxification and long-term maintenance.
• The review of repeat prescribing is hampered by the immediate requirements of the local population, the potential workload, and the possible dangers associated with detoxification.
• In instances of shared care between two medical practitioners, clients may conceal the fact that they have received benzodiazepine prescriptions from the other practitioner.
• Clients may present alcohol dependence as anxiety or depression to the medical practitioner so as to obtain a benzodiazepine prescription.  

In conclusion, the authors recommend that the root social and economic causes must be addressed.  The management of benzodiazepine dependence requires a multi-faceted approach including psychological and social services rather than an approach directed by doctors only.  

1. Ballymun Youth Action Project (2004) Benzodiazepines – whose little helper? The role of benzodiazepines in the development of substance misuse problems in Ballymun. Dublin: National Advisory Committee on Drugs.