Benzodiazepine and Z Drug Policy
Dr Andrew Peetamsingh
Introduction
Policy statement
The purpose of this document is to ensure all personnel fully understand the recommendations for Benzodiazepine and ‘Z Drug’ Prescribing thereby ensuring that patient safety is not compromised.
Policy
Definitions
A controlled substance is generally a drug or chemical whose manufacture, possession, or use is regulated by the government because of the potential for abuse or addiction. Such drugs include those classified as narcotics, stimulants, depressants, hallucinogens, and cannabis.
A list of the most encountered controlled drugs can be found at:
https://www.gov.uk/government/publications/controlled-drugs-list–2
Some patients require strong, potentially addictive medication to help manage their condition(s). Of particular concern are ‘drugs of dependence’ (e.g. benzodiazepines and Z-drugs), particularly when these are prescribed on an on-going basis.
Benzodiazepine: class of drugs which are sedating. Can be used in short courses to treat acute anxiety, seizures, insomnia, alcohol withdrawal and muscle spasm. Examples: diazepam, clonazepam, lorazepam, temazepam, chlordiazepoxide
‘Z’ Drugs: A class of drugs which are commonly used as sleep aids. Examples: zopiclone, zolpidem
Royal Docks Medical Practice has established a policy to ensure adequate treatment, while reducing the risk of longer-term problems with drug prescriptions.
Fear of Flying
Royal Docks Medical Practice has a practice policy that we do not issue sedative prescriptions, such as diazepam, chlordiazepoxide or zopiclone to alleviate symptoms that patients may experience relating to a fear of flying.
This decision has been made due to the reasons listed below:
- The use of any sedating drug causes longer reaction times and slower thinking which during a flight may put the patient and or other passengers at significant risk of not being able to act in a manner which could save life in the event of an emergency.
- The use of any CNS depressant has the potential to increase the risk of Deep Vein Thrombosis (DVT).
- For some countries it is illegal to import these drugs.
- National guidelines advise that medication should not be used for mild and self-limiting mental health disorders and/or phobias.
- Use of these medications increases the risks of falls and accidents.
Patients with a fear of flying should be signposted to specific travel clinics and services available from airlines that can help with fear of flying for example (this list is not exhaustive and we do not endorse any of these):
Flying Without Fear | Courses to Conquer Your Fear of Flying
Flying with confidence | Information | British Airways
Fear of Flying Course - Fearless Flyer
Flying without fear | Your journey with us | Virgin Atlantic
Treatment - Phobias - NHS
Imaging/Dental Procedures
Royal Docks Medical Practice has a practice policy that we do not issue sedative prescriptions to enable imaging e.g. CT scans or MRI scans or dental procedures
According to the Royal College of Radiologists in 2024, safe and effective analgesia and sedation should be delivered by an appropriately trained and credentialed team with good access to anaesthetics, pre-procedure assessment, sedation plan and checklist, with appropriate monitoring and availability of resuscitation equipment and reversal agents. (Sedation, analgesia and anaesthesia in radiology, third edition | The Royal College of Radiologists). The Royal College of Anaesthetists have also set guidelines for the provision of anaesthesia including sedation in the non-theatre environment (Chapter 7: Guidelines for the Provision of Anaesthesia Services in the Non-theatre Environment 2026 | The Royal College of Anaesthetists).
The reasons for this decision are below:
- Small doses of benzodiazepines are unlikely to cause effective sedation in most adult patients but may cause an increase in agitation/aggression.
- If procedure is delayed and has been issued to take an hour before procedure, then again medication is unlikely to be helpful.
- Often these scans are being arranged by hospital doctors who can prescribe medication if felt to be appropriate.
- The Royal College of Radiologists ‘own guidelines on sedation for imaging makes no mention of GP involvement or provision of low dose anxiolytics and stresses the importance of experienced well-trained staff involved and the monitoring of sedated patients.
These requests should be discussed with the radiologist or requesting hospital consultant regarding the next steps.
All patients who have been advised they require sedation by their hospital or dental teams should obtain the appropriate prescription directly from the responsible clinician.
For more information please see the following links:
Chapter 7: Guidelines for the Provision of Anaesthesia Services in the Non-theatre Environment 2026 | The Royal College of Anaesthetists
Sedation, analgesia and anaesthesia in radiology, third edition | The Royal College of Radiologists
www.saad.org.uk/IACSD%202020.pdf
Muscle Spasm and Back Pain
One of the most common reasons for issuing benzodiazepines is for muscle spasm.
NICE CKS Guidelines from October 2024 do not recommend the use of benzodiazepines for the management of muscle spasm associated with acute low back pain (Scenario: Management | Management | Back pain - low (without radiculopathy) | CKS | NICE).
In general, it is advisable to trial other medications and strategies ahead of using a benzodiazepine in these cases and they should not be routinely issued at first presentation of muscle spasm or back pain.
Anxiety/Panic Disorder
Benzodiazepines were commonly prescribed in the past for anxiety and panic.
NICE CKS Guidelines have most recently been reviewed in April 2025 (Scenario: Management | Management | Generalized anxiety disorder | CKS | NICE)
NICE states that Benzodiazepines are associated with a less good outcome in the long term and should not be issued as part of management of panic disorder.
Guidelines state that one should not offer a benzodiazepine for the treatment of Generalised Anxiety Disorder in primary or secondary care except as a short-term measure during acute crises.
In general it is advisable to trial other medications and strategies ahead of using a benzodiazepine in these cases.
Sleep
One of the most common reasons for issuing Z Drugs is for sleep. NICE CKS Guidelines were updated in November 2025 (Scenario: Managing insomnia | Management | Insomnia | CKS | NICE)
If sleep hygiene measures fail, daytime impairment is severe causing significant distress, and insomnia is likely to resolve soon (for example due to a short-term stressor):
- Consider a short course (3-7 days) of a non-benzodiazepine hypnotic medication (z-drug).
- Do not prescribe hypnotics routinely — use only for short courses if acutely distressed.
- Do not prescribe hypnotics to older people or women who are pregnant or breastfeeding.
If a hypnotic is prescribed:
- Consider the duration of action (short-acting is usually most appropriate), adverse effects, interactions, and potential for dependency and abuse.
- Use the lowest effective dose for the shortest period possible — do not continue treatment for longer than 2 weeks (preferably less than 1 week).
- Inform the patient that further prescriptions for hypnotics will not usually be given, ensure that the reasons for this are understood, and document this in the patient’s notes.
- Do not issue further prescriptions without seeing the patient again.
- If there has been no response to the first hypnotic, do not prescribe another.
Patients who are new to the practice who have had these medications from a previous provider
- It may take time to get accurate medical information about new patients. Until such information is available, GPs may choose not to prescribe any medication. It is our policy that GPs do not prescribe drugs of dependence until they have a full clinical picture.
- GPs may decide not to continue prescribing a benzodiazepine or Z-drug previously prescribed for patients. It may be determined that such a medication is not suitable. It is our policy that GPs do not prescribe drugs of dependence if they feel that previous prescriptions were inappropriate.
- GPs will evaluate patients’ conditions and only prescribe a benzodiazepine or Z-drug of the lowest strength for the shortest time necessary. This may be different to the drug prescribed for a patient at a previous GP Practice.
General Practice Standards
- If the decision to prescribe is taken after a shared discussion of goals, plans, risks and benefits, patients may be required to confirm consent in writing.
- Patients may be asked to complete a withdrawal programme which details our practice’s expectations when prescribing drugs of dependence.
- Patients may need to acknowledge that their care requirements may be complex, and that referral for on-going care for all or part of their healthcare may be required. It is our practice policy that patient care is matched with the level of complexity.
- Patients should be reminded that we have a zero tolerance on issues relating to staff abuse.
What to discuss with the patient when considering use of a benzodiazepine or Z-drug
Ensure the patient is aware that the medication is for short-term use alongside self-care.
Ensure patients are aware of the risks of treatment including Central Nervous System (CNS) depressant effects, including ‘hangover’ effects, unsteadiness, reduced alertness and impaired memory, tolerance, dependence, and withdrawal.
The long-term use of benzodiazepines or Z-drugs is associated with several health conditions and an increased risk of death:
- Over-sedation from long-term use can increase the risk of falls and accidents on the road and in the home.
- Poisoning from overdose may contribute to increased mortality risk.
- Long-term use of benzodiazepines or Z-drugs (usually more than 4 weeks) may be associated with:
- Tolerance — a higher dose is required to obtain the initial effect.
- Dependence — the person feels they need the medication to carry out day-to-day activities, and/or withdrawal symptoms occur upon stopping or dose reduction.
- Other effects of long-term use of benzodiazepines include:
- Cognitive effects, anxiety, agoraphobia, emotional blunting, reduced coping skills, and amnesia.
- Reduced social functioning due to effects on memory, reduced ability to remember new people, appointments etc.
- Depression, either for the first time, or aggravation of pre-exisiting depression with possible precipitation of suicidal tendencies.
- Older people are more vulnerable to the CNS depressant effects of benzodiazepines, possibly leading to confusion, night wandering, amnesia, ataxia, and hangover effects. Impaired cognitive function and memory may be wrongly diagnosed as dementia. In the UK, it has been estimated that older adults receive 80% of all prescriptions written for benzodiazepine hypnotics.
- Provide advice related to driving whilst taking the medication
- Warn of potential serious adverse effects if alcohol and other sedative substances are used with the medication.
Issuing Prescriptions
All benzodiazepines and Z-drugs will be issued as acute prescriptions.
Wherever possible, patients will see the same prescriber for review of the initial prescription.
Where benzodiazepines and Z-drugs are initiated by an external provider, Royal Docks Medical Practice will only consider taking over prescribing once a written request has been received. GPs are under no obligation to prescribe on the advice or recommendation of an external provider and are reminded that they take on prescribing responsibility if they choose to prescribe. Where the GP chooses to accept this, the remainder of this policy applies, especially regarding duration and review.
Where patients are discharged from hospital on Benzodiazepines or Z Drugs, Royal Docks Medical Practice should not automatically add these to the patients’ medications. Patients should be reviewed by the GP prior to any further issue.
All patients will be reviewed within 2- 4 weeks of initiation of a benzodiazepine/Z-drugs prescription.
Patients on long-term benzodiazepines/Z-drugs should be reviewed at least annually if not more frequently.
All benzodiazepines and Z-drugs will be issued on prescriptions with a maximum duration of 30 days
All benzodiazepines and Z-drugs prescriptions will include full directions wherever possible and use of PRN or MDU directions will be avoided.
All prescriptions should have the warning “Please use sparingly. This medication is highly addictive. This medication will require regular medical review” added to the patient information.
Existing patients with a regular prescription for Benzodiazepines or Z Drugs.
Patients registered at Royal Docks Medical Practice who are already receiving regular prescriptions for Benzodiazepines and Z Drugs will be systematically reviewed.
The pharmacist or GP will identify and audit patients who require review and make appropriate recommendations which may include a reduction to stop regime.
Royal Docks Medical Practice will support the Patient to reduce and stop Benzodiazepine and Z drug medication by following the recommendations, the timely issue of prescriptions as per the reduction plan and adhering to the Practice Policy.
Where a patients’ circumstances are such that a reduction regime would cause undue distress or anxiety at the given time, they will be informed that further attempts will be made to reduce and stop at 6-12 monthly intervals.
For any patients who repeatedly fail to engage in a reduction plan without appropriate clinical reason, the GP may cease to prescribe, after taking appropriate specialist advice.
Practice procedure for lost/stolen Controlled Drug Prescriptions
The loss or theft of a controlled drug prescription must be recorded in the patients’ medical record and a READ code added to enable the Practice to monitor/audit.
If the prescription is stolen, the patient must report the incident to the police and obtain a crime number.
The loss or theft of a controlled drug or prescription must be reported to the CD Accountable Officer via cdreporting.co.uk
If Royal Docks Medical Practice needs to send out an alert regarding lost or stolen prescriptions, this can be done by sending an alert template to: EnglandCASalerts@nhs.net.
Royal Docks Medical Practice must review the patient’s records when considering if it is appropriate to re-issue a prescription. Notes should be assessed to identify if there is a pattern of regularly requesting additional prescriptions. Practices may consider reviewing ordering patterns for immediate family and household members when considering patterns of behaviour. If a pattern is identified this could indicate an underlying problem such as abuse, diversion or a safeguarding issue, report via cdreporting.co.uk and refer as appropriate.
The patient should be invited in for review and the appropriate steps taken.
At the review, the clinician should review the appropriateness of the current prescription and steps that can be taken to support the patient such as:
- Reducing and withdrawing medication.
- Reducing script duration e.g. weekly prescriptions.
- Discussion about future action should there be further issues.
- Working with the community pharmacy e.g., if prescriptions are being stolen could the pharmacy collect prescriptions on the patient’s behalf, use of EPS.
