Takamine Linda, Krein Sarah L, Ratliff Erika, Strominger Julie, Virk Amarra, Maust Donovan T
VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Mail Stop 152, Ann Arbor, MI, USA.
Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
J Gen Intern Med. 2024 Feb;39(2):247-254. doi: 10.1007/s11606-023-08385-z. Epub 2023 Aug 31.
Little is known about patients' experiences with benzodiazepine (BZD) discontinuation, which is thought to be challenging given the physiological and psychological dependence and accompanying potential for significant withdrawal symptoms. The marked decline in BZD prescribing over the past decade in the US Department of Veterans Affairs healthcare system presents an important opportunity to examine the experience of BZD discontinuation among long-term users.
Examine the experience of BZD discontinuation among individuals prescribed long-term BZD treatment to identify factors that contributed to successful discontinuation.
Descriptive qualitative analysis of semi-structured interviews conducted between April and December of 2020.
A total of 21 Veterans who had been prescribed long-term BZD pharmacotherapy (i.e., > 120 days of exposure in a 12-month period) and had their BZD discontinued.
We conducted semi-structured interviews with Veteran participants to learn about their BZD use and the process of discontinuation, with interviews recorded and transcribed verbatim. Data were deductively and inductively coded and coded text entered into a matrix to identify factors that contributed to successful BZD discontinuation.
The mean age of interview participants was 63.0 years (standard deviation 3.9); 94.2% were male and 76.2% were white. Of 21 participants, only 1 had resumed BZD treatment (prescribed by a non-VA clinician). Three main factors influenced success with discontinuation: (1) participants' attitudes toward BZDs (e.g., risks of long-term use, perceived lack of efficacy, potential for dependence); (2) limited withdrawal symptoms; and (3) effective alternatives, either from their clinician (e.g., medication, psychotherapy) or identified by participants.
BZD discontinuation after long-term use is relatively well tolerated, and participants appreciated reducing their medication exposure, particularly to one associated with physical dependence. These findings may help reduce both patient and clinician anxiety related to BZD discontinuation.
关于患者停用苯二氮䓬类药物（BZD）的经历，我们知之甚少。鉴于生理和心理依赖以及随之而来的严重戒断症状的可能性，人们认为停用BZD具有挑战性。过去十年中，美国退伍军人事务部医疗系统中BZD处方量显著下降，这为研究长期使用者停用BZD的经历提供了一个重要契机。
研究长期接受BZD治疗的个体停用BZD的经历，以确定有助于成功停药的因素。
对2020年4月至12月期间进行的半结构化访谈进行描述性定性分析。
共有21名退伍军人，他们曾接受长期BZD药物治疗（即12个月内暴露超过120天）且已停用BZD。
我们对退伍军人参与者进行了半结构化访谈，以了解他们使用BZD的情况和停药过程，访谈进行录音并逐字转录。数据进行了演绎和归纳编码，并将编码后的文本输入矩阵，以确定有助于成功停用BZD的因素。
访谈参与者的平均年龄为63.0岁（标准差3.9）；94.2%为男性，76.2%为白人。在21名参与者中，只有1人恢复了BZD治疗（由非退伍军人事务部的临床医生开处方）。影响停药成功的三个主要因素：（1）参与者对BZD的态度（例如，长期使用的风险、认为缺乏疗效、依赖的可能性）；（2）有限的戒断症状；（3）有效的替代方法，要么来自他们的临床医生（例如，药物、心理治疗），要么由参与者自行确定。
长期使用BZD后停药的耐受性相对较好，参与者对减少药物暴露表示满意，尤其是减少与身体依赖相关的药物暴露。这些发现可能有助于减轻患者和临床医生与停用BZD相关的焦虑。
