Since 1 February 2023, a withdrawal programme can be provided for outpatients taking benzodiazepines or Z-drugs. This programme is based on the magistral preparation of capsules following a doctor's prescription. The project, which was initially due to run for one year, has been extended until 31 December 2024.
Long-term use of benzodiazepines and Z-drugs is reaching alarming levels in Belgium. Among other things, its use can lead to nervous system disorders (drowsiness, anterograde amnesia, etc.), psychiatric disorders (abnormal behaviour, hallucinations, sleepwalking, etc.) and an increased risk of falls in the elderly. To reverse this trend, the NIHDI and the Minister of Public Health are allocating a budget for a withdrawal programme. The multidisciplinary programme, involving the patient, the prescriber and the pharmacist, enables a gradual stop to be made in 50 to 360 days, or stabilisation at the lowest possible dose.
The project seems to be successful: since the project started, more than 2,000 Belgian pharmacists have already monitored more than 5,500 patients. Figures from the Belgian Pharmaceutical Association (Association pharmaceutique belge - APB) also show that 105 new withdrawal programmes are initiated in pharmacies every week. This number remains more or less stable.
Patients wishing to take part must meet the following conditions:
• be at least 18 years old;
• have given informed consent to share their health data (via eHealth);
• follow the programme in an outpatient setting (i.e. outside nursing homes, care homes or other healthcare institutions), at the same pharmacy (at the patient's choice) for the entire duration of the programme;
• chronic use (≥3 months) of a single benzodiazepine or related drug (Z-drug) taken once a day and not exceeding three times the DDD (Defined Daily Dose);
• the patient is only entitled to reimbursement for one withdrawal programme per year*.
*Withdrawal is not entirely free for the patient. Patients still have to pay for medical consultations, as well as for the packaging of the speciality used to make the magistral preparation.
Further information on practical aspects for prescribers and pharmacists is available in the February 2023 issue of Folia Pharmacotherapeutica.
The CBIP is also planning an e-learning course on benzodiazepine withdrawal for doctors and pharmacists.
For useful, reliable and scientifically-based information on psychotropic drugs, please consult the website www.usagepsychotropes.be.