Deprescribing long-term use of benzodiazepines in primary care practice: where to next?

Globally, insomnia management guidelines now mandate that benzodiazepine (BDZ)/benzodiazepine receptor agonist (BZRA) use is limited to short-term periods (up to four weeks) [1]. Patients are provided evidence-based non-pharmacological behavioral treatments such as cognitive behavioral treatment for insomnia (CBTi), and when prescribing occurs, plans are put in place to deimplement, deprescribe, or discontinue use after the recommended period using recommended tapering guidelines. Clinicians are increasingly turning to initiate BDZ/BZRA prescriptions with caution, in a phenomenon referred to as “reluctant pharmaceuticalization,” [2] but often use this resort in the face of the patient, practice, or systemic barriers.