Every year, the statutory health insurance companies cover bills for some 230 million daily doses of benzodiazepines. Roughly the same amount again is prescribed in private prescriptions, but this figure is often not taken into consideration. The exact number of persons with benzodiazepine dependency is not known, but an estimated 128,000 to 1.6 million people in Germany are likely to be affected. Katrin Janhsen et al. show in their current review article in Deutsches Ärzteblatt International (Dtsch Arztebl Int 2015; 112: 1-7) what is behind the high prescription volume of benzodiazepines and what needs to be considered for the purposes of withdrawal treatment.
Benzodiazepines are important substances, and emergency medicine, anesthesiology, and psychiatric emergencies are as good as unimaginable without them. However, they are more commonly used as hypnotics and tranquillizers--for example, in the form of the classic drug valium. One in every two persons taking this medication takes it for insomnia and one in four for restlessness, nervousness, or states of agitation or tension. Benzodiazepines are highly effective, but they are also known to be associated with a high risk of misuse and dependency. The current Medicinal Products Directive (Arzneimittelrichtlinie) stipulates a usual prescription period of up to four weeks. The tablets actually sold, however, in many cases indicate long-term use. If it is necessary for a person with benzodiazepine dependency to undergo withdrawal treatment, the therapy will have to be long term. Persons with pronounced drug dependency will even have to be treated as inpatients, as the authors show on the basis of a flow diagram. They stress that doctors should avoid inappropriate long-term prescribing and should receive more intensive continuing medical education relating to the prevention and treatment of medication dependency.
Janhsen K, Roser P, Hoffmann K: The problems of long-term treatment with benzodiazepines and related substances--prescribing practice, epidemiology and the treatment of withdrawal. Dtsch Arztebl Int 2015; 112: 1-7.