Experiences of long-term benzodiazepine use and addiction amid changes in guidelines for the prescription of narcotic drugs: a qualitative study

Abstract

Background: Addiction to sedative, hypnotic, and anxiolytic drugs (collectively referred to as benzodiazepines), medications commonly used to treat anxiety and sleeping problems, has been described as a hidden epidemic. Growing concerns about addiction and other negative outcomes associated with use of these narcotics have resulted in their regulation and recommendations for more restrictive prescription. However, there are few studies on experiences of long-term benzodiazepine use from the user perspective, and even fewer focusing on people with addiction, who may be the most affected by changing regulations. The aim of this study was to explore experiences of people with long-term use and addiction to benzodiazepines during a time of major changes in guidelines for the prescription of narcotic drugs.

Methods: This qualitative study included nineteen individual interviews with adults (> 18 years) diagnosed with addiction to benzodiazepines who were undergoing treatment at an urban outpatient clinic in Sweden. The in-depth interviews were pseudonymized, transcribed verbatim, and analyzed using reflexive thematic analysis.

Results: Two themes highlight the effect of changing prescription guidelines on long-term benzodiazepine users. The first theme, benzodiazepines were not always seen as problematic, but neither were the risks discussed, underscores the absence of psychiatric assessments and conversations about risks at the time of first prescription and highlights the need for clearer communication. The second theme, entangled in continued benzodiazepine use and increasing restrictions on prescribing, illustrates how addiction developed over time and describes how limited contact with prescribers facilitated long-term use, which often persisted until the participants were faced with deprescription.

Conclusions: This study describes the experiences of individuals with long-term use and addiction to benzodiazepines during a time of shifting attitudes towards prescribing. The results highlight areas for improvement in care for this vulnerable group of patients, including the need for proactive and regular communication about risks of addiction and additional support during deprescription.

Keywords: Addiction; Benzodiazepines; Drug use; Patient experiences; Qualitative; Substance-related disorders.