Community pharmacists' experiences and perceptions of substance use disorder for benzodiazepines and Z-drugs

Twelve percent of Belgians use benzodiazepines and Z-drugs (BZD/Z) in their daily lives. Although treatment should not exceed 2-4 weeks, they continue to be prescribed. Prolonged use can trigger side effects such as tolerance, physical and psychological dependence, or withdrawal symptoms and lead to substance use disorder (SUD). Community pharmacists (CP) have frequent contact with patients when fulfilling their prescriptions, which gives them a particular role in the day-to-day management of the medication. To explore CP’s experiences and perceptions of SUD to BZD/Z, semi-structured interviews were conducted with 7 randomly selected CP from rural and urban area in Liège (Belgium). Thematic content analysis was performed on the interview transcripts. CP declared having no criteria to identify a SUD. However, they are alerted by the presence of large prescriptions in the patient’s pharmaceutical file and, occasionally, unusual behaviour when collecting the medication. Most participants described feeling uncomfortable discussing the issue with patients. Furthermore, intra-professional collaboration is almost non-existent and inter-professional collaboration with general practitioners (GP) is not systematic, and dependent on the existing professional relationship. They also report that they have rarely followed a patient for de-prescribing their BZD/Z and expressed incomprehension regarding the high number of BZD/Z prescriptions and a feeling of helplessness. These findings demonstrate a lack of resources for CP to address the issue of SUD. Improving intra- and interdisciplinary collaboration (CPs - GPs - mental health professionals) may help improve care for all patients with SUD and prevent over-prescription of BZD/Z