BENZODIAZEPINE SUBSTITUTION IN MEDICAL-PRACTICE - ANALYSIS OF PHARMACOEPIDEMIOLOGIC DATA-BASED ON EXPERT INTERVIEWS

Pharmacoepidemiologic data have shown a consistent reduction in benzod iazepine (BZ) prescriptions over the past decade. The question remains as to whether BZs are simply put aside or whether other medications a re used as substitutes. Expert interviews, at which a stratified sampl e of 114 psychiatrists, internists, and general practitioners were pre sented with case studies, were conducted to learn about the therapeuti c alternatives in the field of benzodiazepine-related indications admi nistered in daily practice. These results were used to analyze trends in pharmacoepidemiologic prescription data for all patients under the general health insurance plan from 1981 to 1988. The experts identifie d distinct alternatives to BZs in different clinical situations, inclu ding neuroleptics, antidepressants, phytotherapeutics, and analgesics. When these findings were transferred to pharmacoepidemiologic data, r esults revealed an increase in the prescription of alternative medicat ions that apparently compensated for reduced BZ use. Overall there was no change (or, rather, no increase) in the total of psychotropic pres criptions during the period.of reduced BZ prescriptions. Our findings indicate that reduction in benzodiazepines prescription is associated with substitution by various other psychotropic drugs. This has positi ve as well as negative consequences, and there must be discussed in de tail before sound recommendations can be given as to which type of dru g. BZs included, is the best choice in which type of illness.