One of my greatest achievements during my three years at the practice is the benzo clinic I stumbled upon and am running very successfully in the heart of Brighton. I say I stumbled upon it, because I had no prior experience in this area and would never have voluntarily gotten involved n this project. I was new at my surgery and the practice partners were trying to identify any needs I may be able to meet for them. On one of my first sessions with my tutor she described how bad the benzodiazepine prescribing issue was to me. Brighton is one of the areas in the country when it comes to overprescribing of benzodiazepines. And our surgery was one of the highest in Brighton! She asked if I might be willing to do some work in this area and keen to impress, I hesitated and admitted I did not have the skillset to deal with this but, keen to please, I agreed to take on the challenge. I remember my tutor saying to me’ “If you can detox one patient off this horrible addiction it could only be a good thing, we have nothing to lose.”
This is how I went about setting up my very own (highly successful) benzodiazepine clinic:
We printed off a list of all the patients – there were hundreds! I asked all the doctors to identify patients from the list who they believe would be happy to be reduced so I targeted the “easier” patients first.
Two sources really helped me: I called up the local drug addiction clinic “Pavilions”. I visited them and spent some time learning how they were able to work with patients to reduce their drug addictions. I also found that patients were missing many appointments and their main problem for the keyworkers and staff was patients’ lack of commitment and on the other hand patients were complaining there was no continuity – that they kept their keyworkers and clinicians assigned to them kept changing.
Learning about the successes and he fallbacks at the drug addiction clinic gave me a great starting point and I was able to learn from their mistakes and aimed to provide a committed streamlined oen to one service to our patients. To be able to do this, I needed to ensure I improved my knowledge in the area. I looked at many online sources and guidelines. I could not find any workshops which would help teach me what I needed to learn. I looked through the CPPE online learning pack which over the years has served me well and taught me in depth knowledge in most clinical areas. They had courses on deprescribing but not particularly on benzodiazepines.
I came across a website online benzo.org.uk. It is a learning site for benzodiazepine addiction, withdrawal and recovery. I remember staying up all night reading and learning about benzodiazepines – how they work, why patients get addicted and gaining an understanding of withdrawal symptoms, why they happen and how to best overcome them. Amongst the information on this website I found the Ashton Manual. This was the most important learning source I have used. It explains. The Ashton Manual is a protocol for the treatment of benzodiazepine withdrawal written by Professor Ashton and it contains detailed information about how to slowly reduce the medication, how to convert from one benzodiazepine to another, and lots of scenarios from Prof Asheton’s experiences which enabled me to have ammunition when I later came across many of these scenarios.
20 patients were carefully selected and I contacted them one at a tie to advise them that I could help them come off their medications which they were addicted to. I met a mixture of acceptance and denial. There was a common tone in the beginning where the patients would claim they had already tried before, they could not cope without the medication, others had tried and not succeeded; all things I was expecting to hear. Somehow, I was able to convince all 20 patients that my programme would be different and somehow, they all believed what I said and agreed to take part in the programme. I think it was due to the fact that I was so determined, I had all the facts and the entire manual clear as crystal in my head ad believed there was a solution for each of them. My belief translated into their belief. Before you know it all 20 of them were off their benzos!
Well, in fact in took quite some time, the quickest took around 5-6 months and some took almost 2 years. I phoned them all to begin with and some of them I have never met as I reduced their prescriptions weekly and reviewed them every week on the phone. Others I saw face to face. We do not have many clinic rooms available, so I used to see them in the therapy room which is cosy and comfortable. A perfect environment for our discussions.
I believe the success of this pilot project was due to my belief and commitment convincing them to have belief and commitment.
They all used to await my weekly phone call. I was so excited to hear when they said they were getting on well with their reduction and was there for them when they were going through hard times. I learned so much from each of them and I now use these real life scenarios to help new patients.
One of my first patients was keen to be helped and told me she was so pleased that I had called as everything had fallen apart for her due to the diazepam she was addicted to. Her children had been taken away from her and she could not have them back until she was off this medication. ^ months later, after completing my reduction programme, she came in to the surgery to let us know she has her children back. I went home and celebrated! I felt such an achievement that day and decided this is what I want to continue doing!
Another patient had been on 70mg diazepam every day for almost 20 years. He had become addicted to it during his college years and had made several attempts to come off the medication but had failed so many times he had lost count. Once again, I convinced him that I could help him (even though I didn’t think I would be able to this time!). He agreed to try it again. I made him realise that this could be a turning point in his life, made him make several changes to his entire lifestyle including diet and joining the local cycle scheme for exercise, enrolling onto several courses and each change made him feel steps of achievement along the way. It took just under two years of weekly reductions, with several hold ups due to times where he was unable to cope and then persuasion techniques to carry on. He is now clean and enjoying the fact that he has all his senses back, he is able to hold down a job and able to show commitment to others and not have to lock himself away in shame.
Each patient I have helped has in turn helped me to be able to provide better advice for the next.
I have started moving down my list of benzodiazepine patients and the confidence of being able to successfully reduce the first 20 has enabled me to convince more difficult patients to accept my hep. Patients have been calling the surgery asking to be put on my programme.
I have struggled with a few of the patients and I have had to give up on others, but I will continue working down the list because if I can detox one patient off this horrible addiction it could only be a good thing, we have nothing to lose.
