Addiction to benzodiazepines and codeine

Supporting safer use

Article date: July 2011

Two reports commissioned by the Department of Health have recently been published on addiction to prescribed and over-the-counter medicines.

National Treatment Agency for Substance Misuse, May 2011. Addiction to medicine: an investigation into the configuration and commissioning of treatment services to support those who develop problems with prescription-only or over-the-counter medicine.

The National Addiction Centre, King’s College London, and School of Social and Community Medicine, University of Bristol, 2011. The changing use of prescribed benzodiazepines and z-drugs and of over-the-counter codeine-containing products in England: a structured review of published English and international evidence and available data to inform consideration of the extent of dependence and harm.


Since the 1980s, there have been concerns about the risk of dependence and withdrawal reactions after long-term use of benzodiazepines. For more than 20 years, the duration of use of these products has been limited to 2 to 4 weeks (see Current Problems in Pharmacovigilance, Jan 1988).

Reports of the National Treatment Agency and National Addiction Centre

The data showed that the overall level of prescribing of benzodiazepines decreased between 1991 and 2009. This fall was mainly in the use of benzodiazepines as hypnotics. Use of anxiolytic benzodiazepines increased during this period. The data also showed a gradual increase in sales of over-the-counter codeine-containing medicines since these were placed on the market in 2006.

It was not possible to establish the extent of long-term prescribing of benzodiazepines nationally, but a regional breakdown of data showed very large variations in prescribing practice across England. Benzodiazepine prescribing was highest in the north-west, and prescribing of opiate analgesics was highest in the north-east. The reason for this regional variation is unclear.

Reminder for healthcare professionals:

  • given the risks associated with the use of benzodiazepines, patients should be prescribed the lowest effective dose for the shortest time possible. Maximum duration of treatment should be 4 weeks, including the dose-tapering phase
  • over-the-counter codeine-containing medicines should be used for the short-term (3 days) treatment of acute, moderate pain which is not relieved by paracetamol, ibuprofen, or aspirin alone (see Drug Safety Update September 2009)

Management of dependence

The national drug-treatment data suggested that most local areas provide some treatment for people who develop problems with prescription or over-the-counter medicines (without concurrent problems with illegal drugs). Most provision is within primary care and delivered by GPs. Treatment data for those who attend drug-treatment services for problems with prescription or over-the-counter medicines indicate that they engage well and achieve better outcomes than those who use illegal drugs.

Further information

BNF sections 4.1 hypnotics and anxiolytics, and 4.7.2 opioid analgesics

Article citation: Drug Safety Update July 2011, vol 4 issue 12: H1.

Published 11 December 2014