Pathways to chronic benzodiazepine use: a qualitative study of user and professional perspectives

Benzodiazepines (BZD) have become a public health issue due to their high use and problems arising from their misuse. Both health professionals and users are becoming aware of the situation but recognise few alternatives to their prescription and acknowledge the difficulties involved in discontinuing them. It is important to understand the factors that influence their chronic use after a first BZD prescription to be able to design future strategies for those factors which can be modified once identified. The aim of this study is to explore the factors underlying chronic BZD use following an initial prescription from the perspectives of users and Primary Care (PC) and Mental Health (MH) professionals. An exploratory-explanatory qualitative study based on Grounded Theory carried out in two autonomous communities between 2023 and 2024. Sampling was theoretical, purposive and convenience, seeking maximum variability among users and PC and MH professionals. Interviews following a semi-structured thematic script were audio-recorded, transcribed and analysed in duplicate. Information was collected until saturation was reached. Users (5 in a focus group; 23 individual; 64% women) and professionals (40 in five focus groups; 88% women) were interviewed. Interpretive analysis was performed through an iterative inductive process until a definitive explanatory framework was obtained. The factors that influence chronic BZD use are related to users and the health system. Within the system, factors associated with the professionals, such as clinical management strategies, their perceptions and attitudes towards BZD, and the user-professional interaction clearly emerge. The organisation of the system, including the duration of consultation, continuous training and coordination between health professionals also play a role. Regarding users, biopsychosocial factors, medical history and perceptions and attitudes concerning the health issue and BZD are notable. Chronic BZD use is influenced by factors related to the user and the health system, some of which can be modified. Taking these factors into account could improve appropriate BZD use, patient safety and the sustainability of the system while simultaneously promoting self-care.