Patients’ experiences and perceptions of seeking and using benzodiazepines and z-drugs: a systematic review and meta-synthesis

Introduction: Benzodiazepines and z-drugs can be used to manage insomnia, anxiety and pain. Despite only being recommended for short-term use, they are often prescribed long-term with potential for harm such as falls, accidents and dependence. We aimed to synthesise findings from qualitative studies of patients’ experiences and perceptions of seeking or receiving benzodiazepines and z-drugs in order to explore factors that perpetuate use of these drugs, and to identify possible strategies for achieving safer prescribing. Methods: We conducted a systematic review, searching literature in MEDLINE, CINAHL, Social Science Citation Index, Science Citation Index, PsycINFO, and AMED, for relevant qualitative studies published in a European language between January 2000 and April 2014. To be included in the review, studies needed to have been conducted in Europe, the United States, Australia or New Zealand. We also searched the reference lists of included studies. We assessed study quality using the Critical Appraisal Skills Programme qualitative checklist, and synthesised findings using thematic synthesis. Results: We created seven analytical themes from the nine papers that were included in the review. These were 1) patients’ negative perceptions of insomnia and its impact, 2) failed self-care strategies, 3) triggers to medical help-seeking, 4) attitudes towards treatment options and service provision, 5) varying patterns of use, 6) withdrawal, 7) reasons for initial or ongoing use. Conclusion: From a patient perspective, prescribing of benzodiazepines and z-drugs is perpetuated by patients feeling psychologically dependent on them, perceiving there to be an absence of support to withdraw or use alternatives, and denying or being unaware of side-effects. Possible strategies for achieving safer prescribing are: education for patients and healthcare professionals using online resources, increasing the availability of alternatives, and extending the dialogue between patients and healthcare professionals