Multiagency Working Group publishes report and recommendations to address overprescribing of benzodiazepines, z-drugs, and gabapentinoids in Ireland

• “Examining the Overprescribing of Benzodiazepines, Z Drugs and Gabapentinoids in Ireland” was written and produced by a multiagency Working Group, led by the Medical Council.
• The report aims to highlight patient safety issues regarding the prescribing patterns of benzodiazepines, z-drugs and gabapentinoids in Ireland, and makes recommendations.
• The Working Group has identified the need for a detailed analysis concerning different practice settings and patient cohorts in order to recommend comprehensive, targeted solutions. 

Tuesday, 25th February 2025: A multiagency working group has today published a report “Examining the Overprescribing of Benzodiazepines, Z Drugs and Gabapentinoids in Ireland”.

The report was written and produced by a Working Group established by the Medical Council with representatives from across the health sector. It outlines the key issues identified and recommendations of the Working Group, which was established to review and address overprescribing by doctors of benzodiazepines, z-drugs, and gabapentinoids in Ireland.

The recommendations within the report aim to reduce the initiation and inappropriate prescribing of these medicines in the interests of patient and doctor safety, and to support prescribers.

Key Recommendations of the Working Group:

1. Improved Service Delivery: Increase resources for Primary Care counselling supports and addiction services to reduce the number of people requiring prescriptions for benzodiazepines, z-drugs and gabapentinoids. Additionally, provision of appropriate resourcing of all prescribers to support patients to reduce their consumption of these drugs.

2. Education: Further educational initiatives should be developed for doctors, pharmacists, and the public to increase awareness of the risks associated with benzodiazepine, z-drug and gabapentinoid use. Training and awareness around overprescribing matters should be a focus of pre-registration education and training of all prescribers.

3. Advancing Transparency in Prescribing Practices: The Working Group proposes that a central repository for data, which would be accessible to prescribers, should be established. The purpose of this is to enhance visibility of private prescribing of controlled drugs, to achieve greater accountability and improve prescribing practices, while ensuring data protection obligations are adhered to.

4. Consideration given to including Pregablin and Gabapentin in the Controlled Drugs List: The Working Group supports the idea of consideration being given to including pregabalin and gabapentin on the controlled drugs list, as has been done in other countries, such as the UK. However, it acknowledges that this this alone may not be enough. Additional improved service delivery (Recommendation 1) is also crucial to ensuring this reclassification has the desired impact on prescription rates and adverse impacts of these drugs.

5. Implementation of Recommendations of the Working Group: The successful implementation of these recommendations will require considerable stakeholder involvement across the Irish healthcare system to be effective. The Working Group recommends the establishment of an implementation group to assess progress on the implementation of the recommendations within this Report.

Commenting on the report, Dr Margaret O’Riordan, Chair of the Working Group and member of the Medical Council said, “The publication of this report and its recommendations is a result of over four years’ work involving multiple healthcare stakeholders in Ireland. It is an excellent example of utilising insights gained from a regulatory process, and working with partners to enhance public protection and patient safety.

“While benzodiazepines may have a role in the treatment of a patient on a time-limited basis, caution and strict monitoring are required when they are prescribed, the overprescribing of benzodiazepines, z-drugs, and gabapentinoids is an issue that affects patient safety and has significant implications for public health. Our report highlights the importance of tailored approaches, the significance of services like pain clinics, mental health, and addiction services, as well as the necessity of medicines reconciliation and review in primary and secondary care settings and during care transitions.

“By exploring various practice settings such as hospitals, primary care, and residential care, as well as dissecting patient cohorts (including older individuals, those with drug dependencies, and new patients with anxiety or pain) targeted solutions can be identified.

“It is important to acknowledge that addressing these issues demands a significant time commitment, especially in General Practice. Limited access to counselling and addiction services further strains both patients and health professionals' efforts to address these needs.

“Doctors have a very clear ethical responsibility regarding the safe prescribing of these drugs, as set out in the Medical Council’s Guide to Professional Conduct and Ethics for Registered Medical Practitioners. If any prescriber is facing challenges in prescribing these medications, we would strongly encourage them to engage with the HSE Addiction Services for support and guidance.

“This working group was established following an increase in serious complaints relating to the overprescribing of benzodiazepines and the publication of this report and its recommendations is an excellent example of utilising insights gained from a regulatory process to work with partners to enhance public protection and patient safety,” concluded Dr O’Riordan.

Professor Eamon Keenan, National Clinical Lead, Addiction Services, HSE said, “The HSE and HSE Addiction Services welcome the publication of this report.

“We see first-hand the impact the inappropriate use of these medicines can have on public health. From a treatment perspective, benzodiazepines were the fourth most common drug causing presentations to Addiction services in 2023, accounting for 1,477 cases.

“These drugs are also implicated in drug related deaths as recorded on our National Drug Related Deaths Index (NDRDI). Over the years 2012 to 2021, there has been a 45% increase in the number of deaths where benzodiazepines have been implicated and deaths where pregabalin has been implicated have risen from 14 in 2013 to 83 in 2021.

“The recommendation in relation to resourcing services is timely and HSE Addiction Services looks forward to working with stakeholders to implement all recommendations set out in the report,” concluded Professor Keenan.

The Working Group included representatives from the Medical Council, Health Services Executive (HSE) (Addiction Services, Primary Care, Primary Care Reimbursement Service (PCRS), Medicine Management Programme (MMP), Nurse and Midwife Medicinal Product Prescribing), Department of Health (DoH) (Medicines, Controlled Drugs & Pharmacy Legislation Unit, National Patient Safety Office & Mental Health Unit), the Pharmaceutical Society of Ireland (PSI), Irish College of General Practitioners (ICGP), Nursing and Midwifery Board of Ireland (NMBI), Health Products Regulatory Authority (HPRA), and College of Psychiatrists of Ireland (CPI).