Australia’s National Drug Strategy
Beyond 2009 Consultation
Submission
From: Gwenda Cannard, CEO, Reconnexion
24/2/2010
Background to Reconnexion
Reconnexion (formerly TRANX) is a not for profit organisation providing services
related to benzodiazepine and analgesic dependency, anxiety disorders and
depression. Part funding is received for the Benzodiazepine Program from the
Department of Health (Vic).
Counselling
Reconnexion provides a small counselling service for benzodiazepine and analgesic
dependence. Counselling for anxiety disorders and depression for all ages is provided
by contract psychologists from three sites (Glen Iris, Northcote & Melton) and a range
of group programs is provided. Secondary consultation is provided
Education activities
Education & training on safe use principles of benzodiazepines and withdrawal
support is provided to health and welfare practitioners. Training is also provided in
CBT for anxiety, depression and dual diagnosis. A national Anxiety & Depression
Conference is held each year.
Community information sessions have focussed on women from culturally diverse
backgrounds, seniors (including from culturally diverse backgrounds) and general
sessions on anxiety and sleep management.
Resources
A number of resources have been produced for practitioners and clients, including
treatment manuals, relaxation CD, booklets and information sheets.
Emerging issues - Pharmaceutical Misuse
Benzodiazepines
Nature, extent and culture of use of benzodiazepines
Benzodiazepines continue to be overprescribed and inappropriately prescribed and
used. The benzodiazepines have demonstrated efficacy in the short term only. Long
term use diminishes efficacy and has the potential to cause dependency and other
significant harms. Prescribing (according to the Quality Use of Medicines principle of
“judicious, safe and appropriate”) should therefore be short term and limited to
essential situations only to avoid the potential for long term use and dependence.
Benzodiazepine dependency can be difficult to manage, and withdrawal is frequently
a painful and protracted experience.
The causal pathways to use are varied and responses will need to be tailored to
address the varying populations who use these drugs.
Use of benzodiazepines tends to be in the following categories:
(i)
Inappropriate prescribing for long periods – long term low dose users.
Affecting older people (over 65’s) prescribed benzodiazepines
predominantly for sleep; culturally diverse migrant populations; people
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(ii)
(iii)
(iv)
with anxiety disorders and women (2:1 ration to men). This is also related
to (ii).
Prescribing as an inadequate response to the problem. Affecting people
with abuse issues e.g. sexual abuse and family violence. Reliance on
benzodiazepines and potential dependency becomes a barrier to more
effective support or treatment.
Substitution or enhancement of illicit drugs. Many users obtain their
supply from GP’s – either using strategies to convince or intimidate GP’s,
or finding an irresponsible GP who overprescribes routinely and has
developed a reputation. Some of the drugs may then be sold.
Prescribing for young people or older drug using patients ostensibly to
support their withdrawal from illicit drugs. This well meaning prescribing
almost invariably leads to a dual addiction.
Use of analgesics tends to be in the following categories:
(i)
Prescribing for people with an acute or chronic injury or condition
requiring opioid analgesics who subsequently develop an addiction to the
drugs
(ii)
Prescribed or over the counter use by people who commence using these
drugs for a psychological effect (or sleep) and develop tolerance and
dependency on the drugs
(iii)
Substitution or enhancement of illicit drugs. Many users obtain their
supply from GP’s – either using strategies to convince or intimidate GP’s,
or finding an irresponsible GP who overprescribes routinely and has
developed a reputation. Some of the drugs may then be sold.
The impact of long term benzodiazepine use for people taking prescribed doses for
long periods of time is often overlooked; however it can be argued that these people
suffer as much if not more from the effects of these drugs as do their counterparts
taking much higher amounts.
Extent of benzodiazepine and analgesic use
The overall use of benzodiazepines has decreased significantly since the peak
prescribing of the 1980’s. From the early 1990’s, however, the extent of use seems to
have reached a plateau rather than a continued decline, and use appears to be
increasing. Comparisons between the National Health Survey of 2004/5 and that of
2007/8 show an increase in all medications taken by adults who identified as having a
mental health problem. 27% (72%) reported using antidepressants, 23%(27%)
sleeping pills and 10%(23%) for anxiety and nerves. (Figures in brackets are 2007/8)
Prescriptions for morphine based analgesics have doubled from 1995 to 2003.
Harms related to benzodiazepine and analgesic use
These have been well documented and include:
 Dependence and withdrawal effects
 Relationship to criminal activity
 Suicide attempts
 Drug overdose
 Cognitive effects for long term users
 Health risks associated with injecting
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
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Health risks to the stomach, liver and kidneys (analgesics)
Increased risk of falls and other health problems(older people)
Increased anxiety and insomnia
Increased depression
Effects on GP’s – morale and reputation re prescribing –particularly opioid
analgesics to addicted users
Poorly managed chronic pain.
Responses to the issue
Development of a National Benzodiazepine (and Analgesic)/Pharmaceuticals
Strategy which would incorporate the following:
1. Community education initiatives. Community understanding of drug use needs
to be ‘broadened’ to include benzodiazepines and analgesics – currently
people do not conceptualise these as ‘drugs’ and do not associate their overuse
with ‘drug addiction’.
2. Community education activities to include culturally and linguistically diverse
and indigenous people.
3. Community education and support for family and friends of dependent users
of benzodiazepines and analgesics (and all drugs).
4. Research – benzodiazepine withdrawal strategies. Current research trials into
the efficacy of Flumazenil (a benzodiazepine antagonist) should be extended
dependent on outcomes.
5. Research – extent of use. The National Drug Strategy household survey to
include drugs used for anxiety, sleep or pain – not described as ‘non medical’
use. Other surveys on length of time of benzodiazepine use.
6. Research – on line treatment approaches – similar to Anxiety Online for
people dependent on benzodiazepines and analgesics (and other drugs or
alcohol).
7. Research into the barriers for GPs relating to alternatives to benzodiazepine
prescribing.
8. GP education initiatives – appropriate prescribing, risks and safe use principles
for use of benzodiazepines (and other hypnotics)and “How to say No to doctor
shoppers” strategies.
9. GP education and support materials for insomnia – particularly in older
people.
10. GP education and support for reducing benzodiazepines and withdrawal
support.
11. GP education and support for the management of pain.
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12. Significant and timely ramifications for GP’s identified as prescribing large
amounts of benzodiazepines and/or analgesics routinely.
13. Education initiatives for residential aged care staff on alternatives to
benzodiazepines and antipsychotics for patient management and sleep
14. Increased number of specialist pain management clinics
15. Continued support for the Alcohol & Drug sector and practitioners to build on
the dual diagnosis capacity of services (currently provided through the
Department of Health & Ageing, Improved Services Capacity Building
Grant); to include sexual abuse capacity.
16. Initiatives or policies to ensure consistency of approach (evidence based) with
Alcohol & Drug residential withdrawal support treatment for people
withdrawing from benzodiazepines. Similarly for residential rehabilitation
services. Department of Health funding to allow for longer treatment.
17. Training and education opportunities for psychologists in drug and alcohol and
dual diagnosis issues. Psychologists are moving into private practice in
increasing numbers, due largely to the Better Access MBS initiative – they
often have little knowledge relating to medications and substance use.
18. Increased resources to allow improved follow up practices to be routinely
undertaken for patients leaving hospital in pain and with prescriptions for
analgesics.
19. Discharge policy for hospitals ensuring patients are not discharged with a
benzodiazepine script.
For a comprehensive article on the issues of benzodiazepine and analgesic use and
prevention strategies, see Neilsen S. and Thompson N. Prevention of Pharmaceutical
Misuse, DrugInfo, Australian Drug Foundation.
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