“People should be allowed to taper at their own pace...”: A content analysis of free-text responses to a questionnaire on discontinuing long-term benzodiazepine receptor agonist use
Authors: Lynch T , Ryan C , Huff C , Foster D E , Cadogan C 
Published: April 2024

Abstract

Introduction
Interventions are needed to support discontinuation of long-term use (≥3 months) of benzodiazepine receptor agonists (BZRAs) which persists in healthcare settings worldwide.[1] A theory-based questionnaire was developed to examine mediators of behaviour change relating to discontinuing long-term BZRA use.[2]

Aim
To examine free-text responses to an online questionnaire on barriers and facilitators to discontinuing long-term BZRA use.

Methods
The questionnaire was disseminated via online BZRA support groups to community-based adults with either current or previous experience of long-term BZRA use. All respondents self-declared that they met the eligibility criteria: ≥ 18 years, current or previous experience of long-term BZRA use (≥ 3months), and living in the community (i.e. not based in inpatient treatment settings). There were no exclusion criteria based on geographical location or the use of other medications. The questionnaire included four free-text questions which elicited detailed insights into respondents’ experiences of long-term BZRA use. These free-text questions focused on: (1) barriers and (2) facilitators to discontinuing BZRA use, (3) additional supports required to discontinue BZRA use, and (4) additional comments regarding BZRA use. The total sample size was calculated based on the number of individuals that clicked on the questionnaire. This was used as an indicator of the number of individuals that saw the questionnaire and provided a baseline sample size in order to calculate the response rate from the number of completed questionnaires. Response data were analysed using content analysis. Experts by experience with previous experience of long-term BZRA use were involved in developing the questionnaire and reviewing the results.

Results
The overall response rate was 46.2% (271/587). The majority of respondents were female (77%, n=208) and the median age was 52 years (range 19-81 years). Most respondents resided in the United States (69%, n=185), Canada (8%, n=23) or United Kingdom (8%, n=21) and were first prescribed BZRAs by a general practitioner (45%, n=118) or psychiatrist (41%, n=112). Almost half of respondents (49%, n= 134) had been taking BZRAs for over 10 years and the main reported reason for their initial BZRA prescription was anxiety (52%, n=141). Most respondents (68%, n=185) had previously attempted to discontinue BZRAs and 82% (n=223) reported that they were tapering from BZRAs at the time of completing the questionnaire. The most commonly reported barrier to BZRA discontinuation related to the consequences of stopping the medication, including withdrawal symptoms and the possibility of the original symptoms returning. The most common facilitator that respondents reported would help them in discontinuing BZRA use was support, primarily from medical professionals. Many respondents reported having been harmed or negatively affected in some way because of BZRA use. Several respondents expressed regret over ever taking BZRAs and/or reported that, with the benefit of hindsight, they should never have taken BZRAs in the first instance.

Conclusion
The findings highlight the range of barriers faced by those attempting BZRA discontinuation and the importance of additional supports. Holistic and person-centred approaches are needed to support discontinuation of long-term BZRA use that considers an individual’s personal circumstances and wider social context.

References
1. Lynch T, Ryan C, Hughes CM et al. Brief interventions targeting long-term benzodiazepine and Z-drug use in primary care: a systematic review and meta-analysis. Addiction. 2020;115(9):1618-39
2. Lynch T, Ryan C, Presseau J, Foster DE, Huff C, Bennett K, Cadogan C. Development and validation of a theory-based questionnaire examining barriers and facilitators to discontinuing long-term benzodiazepine receptor agonist use. Research in Social and Administrative Pharmacy. 2024 Feb 1;20(2):163-71.