An electronic intervention may increase chances of benzodiazepine cessation

1. An electronic intervention promoting self-management of benzodiazepine cessation significantly increased the chances of benzodiazepine cessation compared to placebo.

Evidence Rating Level: 1 (Excellent)

Long-term benzodiazepine use can increase the risk of cognitive decline, falls, and motor vehicle accidents, and increase dependence on benzodiazepines and/or other illicit or nonillicit medications. The Eliminating Medications Through Patient Ownership of End Results (EMPOWER) trial demonstrated an 8-fold increase in benzodiazepine cessation among patients in the treatment group. However, many subsequent trials have not replicated these results. Furthermore, although this study used printed materials, electronically delivered interventions have become more dominant given their cost and scalability advantages. This randomized clinical trial, EMPOWER-electronically delivered (EMPOWER-ED), sought to replicate EMPOWER’s findings after converting the intervention to an electronic format. 161 patients (mean [SD] age, 61.9 [13.7] years; 16.8% female) with an active benzodiazepine prescription for at least 3 months were included. Patients in the intervention group received access to the EMPOWER-ED website, which included self-assessment of risks associated with long-term benzodiazepine use, information on possible drug-related harms, vignettes of peers who had successfully stopped using benzodiazepines, and therapeutic alternatives for managing sleep difficulties and/or anxiety. They also received a personalized tapering schedule. Patients in the control group were recommended to follow their clinician’s recommendations. After 6 months, patients in the intervention group were significantly more likely to complete benzodiazepine cessation (10 of 82 [12.2%] vs 2 of 79 [2.5]; unadjusted OR, 5.35 [95% CI, 1.13-25.24]). More patients in the intervention group reported a benzodiazepine dose reduction of 25% or greater, although this difference was not significant (14 of 82 [17.1%] vs 6 of 79 [7.6]; unadjusted OR, 2.50 [95% CI, 0.91-6.90]). There was no significant difference in Veterans RAND 12-Item Health Survey (VR-12) physical score (p = 0.92), VR-12 mental score (p = 0.73), anxiety (p = 0.37), or sleep (p = 0.90). Overall, electronic interventions are effective at empowering individuals with long-term benzodiazepine use to complete cessation. Further studies are required to establish this finding in a larger study population.

Click here to read this study in JAMA Network Open

Image: PD

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