The intended and unintended consequences of benzodiazepine monitoring programmes: a review of the literature.

WHAT IS KNOWN AND OBJECTIVE

Concern has been expressed regarding the potential over-prescription of benzodiazepines (BZDs) and their potential for misuse and abuse. Patterns of BZD use can be tracked by prescription monitoring programmes (PMPs). This study reviews the literature examining the impact of PMPs on the use of BZDs.

METHODS

Studies published in English from January 1980 to April 2009 were identified though PubMed, EMBASE, IPA, CINHL and Web of Science using MeSH terms: 'Benzodiazepines' OR 'Benzodiazepines/supply and distribution' AND ('Social Control, Formal/legislation, jurisprudence'); Emtree terms: 'drug control'/exp AND 'benzodiazepine derivative'/exp/mj. A broad search strategy was also used: benzodiazepines; triplicate prescription program; prescription monitoring program; triplicate prescribing; and triplicate prescription policy.

RESULTS AND DISCUSSION

This search identified 32 relevant articles that addressed the impact of implementation of a PMP for BZDs in New York State in 1989. Overall, BZD prescribing declined following implementation, but the decline was not consistent across population groups. In particular, marginalized and vulnerable populations, such as persons with chronic mental health disorders, may be disproportionately affected.

WHAT IS NEW AND CONCLUSION

We provide a critical review of the impact of PMPs on the use of BZDs. PM decreases overall use of BZDs, but may have unintended consequences that differentially impact certain populations. Furthermore, research is warranted to understand better the long-term costs and benefits.