Reducing diazepam prescribing for illicit drug users: a randomised control study

ENGLISH :
Illicit drug users undergoing mandatory reductions in prescribed diazepam were randomly allocated to one of two methods of delivering psychological support to help reduce their prescription: a) an enhanced intervention consisting of skills training and reinforcement, and b) a limited intervention where patients initially received skills training and thereafter only advice. Outcome measures at baseline and six-months consisted of daily diazepam dose, reported illicit drug use, Severity of Dependence Scale, Hospital Anxiety and Depression Scale (HADS), Pittsburgh Sleep Quality Index. Fifty-three of 119 eligible patients agreed to be randomly allocated to the interventions. Those in the enhanced intervention reduced their daily dose of prescribed diazepam from a mean of 27,8 mg to 19,9 mg at six months (5,3 % per month) compared with 29,8 mg to 17,6 mg at six months (7,5 %) among those in the limited intervention group. However, there was no statistically significant difference in the reduction rate between the intervention groups. Approximately 75 % of patients in each group suspended their reduction programme. The enhanced intervention group reported a statistically and clinically greater reduction in the mean HADS depression score (10,6 at baseline and 7,7 at follow-up), compared with a rise from 8,9 to 11,2 in the limited intervention group. In conclusion, it is possible to reduce prescribed diazepam among illicit drug users but not at the rate of 10 % per month set by the study. The difficulties of working with this population necessitate a flexible and possibly long-term approach to reducing prescribed benzodiazepines. (Review's abstract.)