From prescribing dilemma to knowledge in practice: The ontological politics of benzodiazepines and Z-drugs

Benzodiazepines/BZRA; Mindlines; Ontological politics; Positioning theory; Prescribing dilemma; Benzodiazepines; Humans; Emotions; Politics; Drug Prescriptions; Benzodiazepines/therapeutic use; Practice Patterns, Physicians'; Health (social science); History and Philosophy of Science

Abstract :

[en] The discrepancy between official guidelines and clinical practice is hardly more pronounced than in the case of benzodiazepines and Z-drugs, also known as benzodiazepine receptor agonists (BZRA). Using social-constructionist positioning theory, we unravel how health care professionals deal with the dilemma of prescribing this medication. Our results reveal a prescribing spectrum that is discursively organised around four different storylines used by professionals. The storylines are organised along three axes that are related to a) prescribers' opinions on prescribing and the negotiation of the related risks, b) the power dynamics between provider and patient in the prescribing process and c) the rhetorical use of arguments. The discerned storylines allow us to explore the emotional and moral side of prescribing and demarcate clinical mindlines -internalised tacit guidelines-that professionals adhere to when they prescribe. By relying on Annemarie Mol's conceptualisation of ontological politics, we explain how these storylines enact multiple versions of this class of medication and justify seemingly contradictory prescribing practices.

Disciplines :

Sociology & social sciences
Public health, health care sciences & services
General & internal medicine

Author, co-author :

Ceuterick, Melissa ; Hedera, Department of Sociology, Faculty of Political and Social Sciences, Ghent University, Ghent, Belgium. Electronic address: melissa.ceuterick@ugent.be

Van Ngoc, Pauline ; Université de Liège - ULiège > Département des sciences cliniques > Médecine générale

Bracke, Piet; Hedera, Department of Sociology, Faculty of Political and Social Sciences, Ghent University, Ghent, Belgium

Scholtes, Béatrice ; Université de Liège - ULiège > Département des sciences cliniques > Médecine générale

Language :

English

Title :

From prescribing dilemma to knowledge in practice: The ontological politics of benzodiazepines and Z-drugs

Publication date :

December 2023

Journal title :

Social Science and Medicine

ISSN :

0277-9536

eISSN :

1873-5347

Publisher :

Elsevier Ltd, England

Volume :

339

Pages :

116358

Peer reviewed :

Peer Reviewed verified by ORBi

Additional URL :

https://api.elsevier.com/content/article/PII:S0277953623007153?httpAccept=text/xml

Funders :

BELSPO - Belgian Federal Science Policy Office [BE]

Funding text :

The authors received financial support from BELSPO ( DR/91/BENZOCARE ) for this study.

Available on ORBi :

since 20 February 2024

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Bibliography

Al-Worafi, Y.M., Medication abuse and misuse. Drug Safety in Developing Countries, 2020, Academic Press, 127–135.
Anthierens, S., Habraken, H., Petrovic, M., Christiaens, T., The lesser evil? Initiating a benzodiazepine prescription in general practice: a qualitative study on GPs' perspectives. Scand. J. Prim. Health Care 25:4 (2007), 214–219.
Baert, F., Van Langenhove, L., James, M., Rethinking role theory in foreign policy analysis: introducing positioning theory to international relations. Pap. Soc. Representations, 28(1), 2019, 4 1.
Baldwin, D.S., Aitchison, K., Bateson, A., Curran, H.V., Davies, S., Leonard, B., Wilson, S., Benzodiazepines: risks and benefits. A reconsideration. J. Psychopharmacol. 27:11 (2013), 967–971.
Baldwin, D.S., Anderson, I.M., Nutt, D.J., Allgulander, C., Bandelow, B., den Boer, J.A., Wittchen, H.U., Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: a revision of the 2005 guidelines from the British Association for Psychopharmacology. J. Psychopharmacol. 28:5 (2014), 403–439.
Britten, N., Prescribing and the defence of clinical autonomy. Sociol. Health Illness 23:4 (2001), 478–496.
Britten, N., Stevenson, F., Gafaranga, J., Barry, C., Bradley, C., The expression of aversion to medicines in general practice consultations. Soc. Sci. Med. 59:7 (2004), 1495–1503.
Calmeyn, M., Petrovic, M., Opinie: kalmte alleen kan u redden. Artsenkrant, 7, 2023.
Ceuterick, M., Christiaens, T., Creupelandt, H., Bracke, P., And they slept happily ever after: online interpretive repertoires on the use of benzodiazepines and z-drugs. Health 27:5 (2021), 847–866.
Ceuterick, M., Vandebroek, I., Identity in a medicine cabinet: discursive positions of Andean migrants towards their use of herbal remedies in the United Kingdom. Soc. Sci. Med. 177 (2017), 43–51.
Christiaens, T., Creupelandt, H., Rogiers, R., Thoen, A., Slaap- en kalmeermiddelen, hoe kunt u uw patiënten bijstaan op zoek naar andere oplossingen? FOD Volksgezondheid, Veiligheid van de Voedselketen en Leefmilieu. Projectgroep Benzodiazepines, 2018.
Cook, J.M., Marshall, R., Masci, C., Coyne, J.C., Physicians' perspectives on prescribing benzodiazepines for older adults: a qualitative study. J. Gen. Intern. Med. 22 (2007), 303–307.
Coteur, K., Mamouris, P., Vaes, B., Van Nuland, M., Matheï, C., Schoenmakers, B., Evolution of benzodiazepine receptor agonist prescriptions in general practice: a registry-based study. Front. Public Health, 10, 2022, 1014734 1014734.
Davies, B., Harré, R., Positioning: the discursive production of selves. J. Theor. Soc. Behav. 20:1 (1990), 43–63.
Dell'osso, B., Lader, M., Do benzodiazepines still deserve a major role in the treatment of psychiatric disorders? A critical reappraisal. Eur. Psychiatr. 28:1 (2013), 7–20.
Dennis, F., Rhodes, T., Harris, M., More-than-harm reduction: engaging with alternative ontologies of ‘movement’ in UK drug services. Int. J. Drug Pol., 82, 2020, 102771.
Dowell, J., Williams, B., Snadden, D., Patient-centered Prescribing. 2007, Taylor & Francis.
Ferris, G.R., Fedor, D.B., Chachere, J.G., Pondy, L.R., Myths and politics in organizational contexts. Group Organ. Stud. 14:1 (1989), 83–103.
Freedman, A.M., Drugs and society: an ecological approach. Compr. Psychiatr. 13:5 (1972), 411–420.
Gabbay, J., Le May, A., Evidence based guidelines or collectively constructed “mindlines?” Ethnographic study of knowledge management in primary care. BMJ, 329(7473), 2004, 1013.
Gabbay, J., Le May, A., Practice-based Evidence for Healthcare: Clinical Mindlines. 2010, Routledge.
Gabbay, J., Le May, A., Mindlines: making sense of evidence in practice. Br. J. Gen. Pract. 66:649 (2016), 402–403.
Gabe, J., Towards a sociology of tranquillizer prescribing. Br. J. Addict. 85:1 (1990), 41–48.
Gabe, J., Coveney, C.M., Williams, S.J., Prescriptions and proscriptions: moralising sleep medicines. Sociol. Health Illness 38:4 (2016), 627–644.
Gabe, J., Lipshitz-Phillips, S., Evil necessity? The meaning of benzodiazepine use for women patients from one general practice. Sociol. Health Illness 4:2 (1982), 201–209.
Gabe, J., Lipshitz-Phillips, S., Tranquillisers as social control?. Socio. Rev. 32:3 (1984), 524–546.
Gisle, L., Drieskens, S., Demarest, S., Van der Heyden, J., Geestelijke gezondheid: gezondheidsenquête 2018. Brussel, België: Sciensano; Rapportnummer: D/2020/14.440/4, 2020.
Green, J.L., Brock, C., Baker, W.D., Harris, P., Positioning theory and discourse analysis: An explanatory theory and analytic lens. Handbook of the Cultural Foundations of Learning, 2020, Routledge, 119–140.
Harré, R., Moghaddam, M., Cairnie, T.P., Rothbart, D., Sabat, S.R., Recent advances in positioning theory. Theor. Psychol. 19:1 (2009), 5–31.
Haw, C., Stubbs, J., Benzodiazepines—a necessary evil? A survey of prescribing at a specialist UK psychiatric hospital. J. Psychopharmacol. 21:6 (2007), 645–649.
Heberlein, A., Bleich, S., Kornhuber, J., Hillemacher, T., Benzodiazepine dependence: causalities and treatment options. Fortschr. Neurol. Psychiatr. 77:1 (2008), 7–15.
Hollister, L.E., Motzenbecker, F.P., Degan, R.O., Withdrawal reactions from chlordiazepoxide (“Librium”). Psychopharmacologia 2 (1961), 63–68.
Lader, M., Iatrogenic sedative dependence and abuse–have doctors learnt caution?. Addiction, 93(8), 1998, 1133.
Lancaster, K., Rhodes, T., Towards an ontological politics of drug policy: intervening through policy, evidence and method. Int. J. Drug Pol., 86, 2020, 102932.
Leibovici, L., Lièvre, M., Medicalisation: peering from inside medicine: professionals and lay people should work together to a common purpose. BMJ, 324(7342), 2002, 866.
Liebrenz, M., Schneider, M., Buadze, A., Gehring, M.T., Dubé, A., Caflisch, C., High-dose benzodiazepine dependence: a qualitative study of patients' perceptions on initiation, reasons for use, and obtainment. PLoS One, 10(11), 2015, e0142057.
Maust, D.T., Lin, L.A., Blow, F.C., Benzodiazepine use and misuse among adults in the United States. Psychiatr. Serv. 70:2 (2019), 97–106.
Mol, A., Ontological politics. A word and some questions. Socio. Rev. 47:1_Suppl. l (1999), 74–89.
Musto, D.F., Iatrogenic addiction: the problem, its definition and history. Bull. N. Y. Acad. Med., 61(8), 1985, 694.
Parish, P.A., Sociology of prescribing. Br. Med. Bull. 30:3 (1974), 214–217.
Pienaar, K., Dilkes-Frayne, E., Telling different stories, making new realities: the ontological politics of ‘addiction’ biographies. Int. J. Drug Pol. 44 (2017), 145–154.
Pilgrim, D., Rogers, A., Gabe, J., Social Aspects of Psychotropic Medication. 2011, The SAGE Handbook of Mental Health and Illness, 367–388.
Roe, G., Harm reduction as paradigm: is better than bad good enough? The origins of harm reduction. Crit. Publ. Health 15:3 (2005), 243–250.
Rogers, A., Pilgrim, D., Brennan, S., Sulaiman, I., Watson, G., Chew-Graham, C., Prescribing benzodiazepines in general practice: a new view of an old problem. Health 11:2 (2007), 181–198.
Saini, R., Using" Positioning" Theory to analyze a female school teacher's experiences with care-work during COVID-19 in India: towards Decolonizing Feminist Research. Curr. Issues Comp. Educ., 24(1), 2022.
Salzman, C., The APA Task Force report on benzodiazepine dependence, toxicity, and abuse. Am. J. Psychiatr. 148:2 (1991), 151–152.
Sarangi, A., McMahon, T., Gude, J., Benzodiazepine misuse: an epidemic within a pandemic. Cureus, 13(6), 2021.
Schwartz, R.K., Soumerai, S.B., Avorn, J., Physician motivations for nonscientific drug prescribing. Soc. Sci. Med. 28:6 (1989), 577–582.
Sim, M.G., Khong, E., Wain, T.D., The prescribing dilemma of benzodiazepines. Aust. Fam. Physician, 36(11), 2007.
Sirdifield, C., Anthierens, S., Creupelandt, H., Chipchase, S.Y., Christiaens, T., Siriwardena, A.N., General practitioners' experiences and perceptions of benzodiazepine prescribing: systematic review and meta-synthesis. BMC Fam. Pract. 14 (2013), 1–13.
Slocum-Bradley, N., The positioning diamond: a trans-disciplinary framework for discourse analysis. J. Theor. Soc. Behav. 40:1 (2010), 79–107.
Soyka, M., Treatment of benzodiazepine dependence. N. Engl. J. Med. 376:12 (2017), 1147–1157.
Stevenson, F., Britten, N., Barry, C.A., Bradley, C.P., Barber, N., Perceptions of legitimacy: the influence on medicine taking and prescribing. Health 6:1 (2002), 85–104.
Van der Geest, S., Whyte, S.R., Hardon, A., The anthropology of pharmaceuticals: a biographical approach. Annu. Rev. Anthropol. 25:1 (1996), 153–178.
Van der Heyden, J., Berete, F., Drieskens, S., Gezondheidsenquête 2018: gebruik van geneesmiddelen. Brussel, België: Sciensano; D/2020/14.440/17, 2020.
Weiss, M.C., The rise of non-medical prescribing and medical dominance. Res. Soc. Adm. Pharm. 17:3 (2021), 632–637.
Whyte, S.R., Van der Geest, S., Hardon, A., Social Lives of Medicines. 2002, Cambridge University Press.
Wieringa, S., Greenhalgh, T., 10 years of mindlines: a systematic review and commentary. Implement. Sci. 10 (2015), 1–11.