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Introduction. The long-term use of benzodiazepines (BZD) and z-drugs in older populations is associated with a variety of sociodemographic and health-related factors. Recent studies reported that long-term BZD and z-drugs use is associated with increased age, female sex, and severe negative psychological (e.g., depression) and somatic (e.g., chronic disease) factors. The current study explores the sociodemographic and health-related factors associated with long-term BZD and z-drugs use in the elderly. Methods. We conducted a cross-sectional survey among randomly selected patients of one health insurance plan (“AOK North-West”) with BZD and z-drugs prescriptions in the past 12 months. The sample was stratified by appropriate German prescription guidelines (yes vs. no) and age (50–65 vs. >65 years). To examine the association of selected sociodemographic and psychological variables (e.g., sex, employment status, quality of life, depression) with long-term use, a binary logistic regression analysis was conducted. Results. In total, data from 340 patients were analyzed. The mean age was 72.1 (SD = 14.5) years, and the most commonly used substances were zopiclon (38.1%), oxazepam (18.1%), and lorazepam (13.8%). The mean defined daily dose (DDD) was 0.73 (SD = 0.47). Insomnia was the main reason for prescribing BZD and z-drugs. The long-term use of BZD and z-drugs was significantly associated with unemployment (OR = 2.9, 95% CI [1.2–7.1]) and generally problematic medication use (OR = 0.5, 95% CI [0.2–1.0]). Discussion. Unemployment status and problematic medication use had a significant association with the patient-reported, long-term use of BZD and z-drugs. Divergent prescription patterns might suggest problematic patterns of BZD and z-drugs use. The causal connection between the identified factors and problematic BZD and z-drugs prescription is not discussed in this paper. Nevertheless, employment status and possible evidence of general problematic drug use may be a warning signal to the prescribers of BZD and z-drugs. [ABSTRACT FROM AUTHOR]

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Study Aim: Opioid substitution treatment (OST) is the most effective drug treatment for opioid dependence worldwide. This form of therapy is also well established in Germany. Nevertheless, there are gaps in the provision of care, especially in rural areas and some states, due to a decreasing number of physicians involved in implementing the substitution programs. The 3 rd revision of the Narcotic Drugs Prescription Ordinance (NDPO), which came into force in 2017, transferred medical therapeutic tasks of OST to the policy-making power of the German Medical Association. This comprehensive reform of the general conditions for OST led to greater legal certainty for this form of treatment. The present study aimed to analyze the effects of the 3 rd revision of the Narcotic Drugs Prescription Ordinance from the providers' perspective., Methods: Between August and December 2019, a questionnaire on individual experiences with the changes implemented in 3 rd revision of the Narcotic Drugs Prescription Ordinance was sent by the Federal Opium Agency and the Associations of Statutory Health Insurance Physicians of the chosen federal states to 2,503 physicians implementing the substitution program in Germany as well as 563 physicians in Hamburg, Bavaria, North Rhine-Westphalia and Saxony who were not or no longer involved in this field of medical practice.The evaluation distinguished between physicians with and without further training in addiction medicine and between urban and rural districts., Results: The response rate of physicians was 34.1%. The average age was 57.9 (±8.7) years, and 64.5% were male. The most relevant changes of the NDPO revision were found to be no time limit for achieving opioid abstinence (85.3%), new assessment and treatment using additional psychotropic substances (71.0%), extending take-home regulation to a maximum of 30 days (70.0%) and greater legal certainty (66.2%). Widening of consultative care up to 10 patients met with little approval (14.8%); 36.7% did not believe that care of substituted patients was assured either now or in the future., Conclusions: The NDPO revisions were considered to be relevant in terms of increased legal certainty and treatment liberties. Information was needed in rural areas, among physicians who carried out substitution therapy without advanced training in addiction medicine and physicians no longer involved in substitution therapy., Competing Interests: KL erhielt eine Reisekostenerstattung sowie eine Kostenübernahme von Teilnahmegebühren und Übernachtungskosten von pcm scientific sowie die Übernahme von Konferenzteilnahmegebühren von Sanofi-Aventis. SK hat keine Interessenkonflikte. BS hat von CAMURUS Fördermittel sowie Reisekosten erhalten. H-GM-T ist Redakteur des Internetforums Substitutionspraxis. Er erhält dafür von den auf der Homepage ausgewiesenen Firmen keine Zuwendungen. UV erhielt innerhalb der letzten 3 Jahre Vortrags-, Beratungshonorar und Reisekostenerstattungen von Mundipharma GmbH sowie finanzielle Projektförderung und Reisekostenerstattungen von CAMURUS GmbH., (The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).)

Background: Long-term use of benzodiazepines (BZD) and Z-drugs is associated with the risk of developing dependency. Many older patients use these drugs for long durations, which is often associated with low-dose dependency without an increase in dose., Aim: The aim of this study is to investigate the reasons, symptoms, and side effects, as well as the prescription conditions among older patients who were prescribed BZD or Z-drugs within the last 12 months., Methods: A 9-page questionnaire was sent to 4,000 patients of the AOK-NordWest, stratified according to age group (50-56 years;>65 years) and intake behavior (long-term use/ guideline incompatible; short-term use/ guideline compatible). Patients provided demographic data and indicated on a comprehensive list of BZD and Z-drugs, which substances they had used or were currently using. In addition, patients were asked about the reasons and underlying symptoms for taking these medications, possible side effects, and previous attempts to discontinue the medications., Results: A total of 466 patients returned completed questionnaires (11.7%). A further 43 privately insured patients were recruited through pharmacies. 169 patients, mainly from the group with guideline-compatible prescriptions, indicated that they had never taken these medications. The remaining 340 patients were 68.5% female and the average age was 72.1 years. Compared to patients with guideline-compatible prescriptions, a greater proportion of patients with guideline-incompatible prescriptions were taking Z-drugs. The average daily dose (DDD) consumed was significantly higher than in those with guideline-compatible prescriptions, although on average both patient groups took low doses (<1 DDD) of the medication. In both groups, the main reason for taking BZD and Z-drugs was sleeping problems., Conclusions: Considering the recommendation that BZD and Z-drugs are to be taken only short-term for sleeping problems, the extent of insomnia indications is high. The low doses suggest a careful and controlled prescription behavior in both groups, with the majority of long-term consumers likely to have developed low-dose dependency. This is associated with only a limited need for intervention, since only few medication-dependent people underwent addiction treatment., Competing Interests: Uwe Verthein erhielt innerhalb der letzten 3 Jahre Vortrags- und Beratungshonorar sowie Reisekostenerstattungen von Mundipharma GmbH. Jens Reimer erhielt innerhalb der letzten 3 Jahre Vortrags-, Autoren- und Beratungshonorar, Reisekostenerstattungen sowie Forschungsunterstützung von Indivior, Camurus und Mundipharma GmbH. Die anderen Autoren hatten keine Verbindungen i.o.g. Sinne., (© Georg Thieme Verlag KG Stuttgart · New York.)

Whilst internationally benzodiazepines are first choice for treatment of alcohol withdrawal syndrome, Germany has a long tradition with clomethiazole. This study explores effectiveness of clomethiazole versus oxazepam in the treatment of alcohol withdrawal syndrome within an observational, stratified, non-inferiority study in routine care. Main outcome criterion was severity of the alcohol withdrawal syndrome (Alcohol Withdrawal Syndrome [AWS]) Scale in the first five days. Additionally, the association between the detoxification protocol (five vs. ten days) and AWS-Score was examined. 453 patients (74.2 % male, average age 47.1 years [± 9.2]) took part; 249 received oxazepam (55.0 %) and 204 clomethiazole (45.0 %). The average duration of inpatient treatment was 14.0 days (± 6.3) in both groups. The average AWS-score was lower in the oxazepam group compared to the clomethiazole group (50.0 [± 26.5] vs. 56.2 [± 31.5]; p < .05; effect size d = - .25). Patients with a shorter detoxification protocol had a lower AWS sum score compared to patients with a longer protocol (p < .001; d = - .46). In treatment of alcohol withdrawal syndrome in routine care oxazepam yields at least comparable results to clomethiazole., Competing Interests: Diese Studie wurde von Asklepios proresearch finanziell unterstützt. Uwe Verthein erhielt innerhalb der letzten 3 Jahre Vortrags- und Beratungshonorar sowie Reisekostenerstattungen von Mundipharma GmbH. Jens Reimer erhielt innerhalb der letzten 3 Jahre Vortrags-, Autoren- und Beratungshonorar, Reisekostenerstattungen sowie Forschungsunterstützung von Molteni Farmaceutici, Reckitt-Benckiser, Undivor, Sanofi-Aventis und Mundipharma GmbH. Die anderen Autoren hatten keine Verbindungen im oben genannten Sinne., (© Georg Thieme Verlag KG Stuttgart · New York.)