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Home > Report on innovative project in response to benzodiazepine use.

Bellerose, Delphine (2011) Report on innovative project in response to benzodiazepine use. Drugnet Ireland , Issue 39, Autumn 2011 , pp. 11-12.

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The GP–Community Partnership Addiction Project was set up in Ballymun in 2006 in response to concerns about the acceptance and normalisation of benzodiazepine use in the area, as highlighted in a study published by the Ballymun Youth Action Project (BYAP) in 2004.1 Benzodiazepines are among the most commonly prescribed drugs; they are used to treat conditions such as anxiety, depression or insomnia. While they are safe for short-term use, the risk of abuse and dependence as a result of inappropriate long-term use has been well documented. The Ballymun Family Practice took part in this project funded by the Ballymun Local Drugs Task Force in search of a non-pharmaceutical alternative to benzodiazepine prescribing. A report outlining the project and analysing the outcomes of its first three years was published in June 2011.2 

The project includes:
·         providing general practitioners (GPs) with training in motivational interviewing;
·         providing a free counselling service within the GP practices;
·         inviting long-term users of benzodiazepines to review and discuss their need for prescribed medication and, to some users, also offering onsite counselling service;
·         assessing, through quantitative and qualitative research, the impact of the letter and of the counselling service on reducing benzodiazepine use.
 
GPs in the four general practices that make up the Ballymun Family Practice identified 134 long-term benzodiazepine users among their patients. This sample was then divided into two groups: people in Group 1 (n=54) were sent a letter advising them to consider their current benzodiazepine use; people in Group 2 (n=80) were sent the same letter with an added paragraph offering the services of a counsellor. Prescriptions were monitored for the year before the letters were sent and for six months afterwards. In the six month, post-letter period, just over 29% of patients in Group 1 and over 38% in Group 2 reduced their benzodiazepine use. The letter resulted in lower prescription rates, and the offer of onsite counselling reinforced the positive impact of the letter.
 
Looking in more depth at the patients’ profiles, it appears that the initiative was more effective among younger benzodiazepine users who were on a methadone maintenance programme. There was a clear positive outcome for patients who used or had used multiple substances, including opiates, and who may have been more willing to address their benzodiazepine use as part of their overall addiction problem.
 
The project had less impact among older patients who had been on low doses of benzodiazepine for many years and were not receiving medical treatment for problem use of other substances. Reducing benzodiazepine use for this cohort involves tackling long-term health beliefs or a so-called ‘culture of benzodiazepine use’, a more complex undertaking that can only achieve results over a longer period.
 
The quantitative data on benzodiazepine prescription rates was complemented by qualitative research. Feedback from focus groups with GPs and in-depth interviews with two addiction counsellors emphasised the fact that having the addiction counsellors on site was a key element of the project. The nature and extent of integration of the counselling service within the GP practice was reported as very positive and complementary to both services. Counsellors were part of the team, while GPs felt more empowered and welcomed the much-needed support in treating addictions in general. In addition to the practical benefits to patients and practitioners, the service integration contributed to the effectiveness of the project, through early identification and intervention, and made referrals easier. The additional training provided to GPs was reported to be very helpful in the selection of referrals, and improvements in the referral process had in turn a positive impact on attendance levels.
Benzodiazepine use and its reduction is a complex issue. The project demonstrated positive outcomes for long-term benzodiazepine patients and it was particularly successful for patients who were battling other addictions.
 
While focusing on benzodiazepine use in Ballymun, this project provides relevant evidence-based information that can help communities respond to the issue of drug use. It is clear that the integration of addiction counselling in a primary care setting is beneficial, and that simple cost-effective interventions, such as the letter in this case, can make a difference. As said in the report (p. 40), ‘the project provided a tangible way of developing and fostering links in the community and promoted a multidisciplinary approach to the issue of drug use’.
 
Jane Carrigan, researcher and author of the report, described the project as a very challenging and interesting experience for researchers, GPs, and counsellors alike. The patients’ perspective was not included in this analysis, an element that may be included in future research. At the launch of the report by Minister of State Róisín Shortall, Andrew Montague, chair of Ballymun Local Drugs Task Force, Jacintha Harte, addiction counsellor, and Dermot King, interim director of BYAP, all emphasised the positive feedback from all practitioners and expressed hopes that such initiatives might lead the way in informing and influencing the work of primary health care teams. Minister Shortall also reiterated the importance of data reporting and research in the area of drug treatment as a stepping stone for improving policies and service planning.
 
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. www.drugsandalcohol.ie/5898
2. Carrigan J (2011) Chains of addiction & links of support: responding to benzodiazepine use in Ballymun. A GP–Community Partnership Addiction Project. Dublin: Ballymun Local Drugs Task Force and Ballymun Family Practice. www.drugsandalcohol.ie/15361

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