Primary, secondary and tertiary prevention of long-term benzodiazepine receptor agonists use in Belgium: a policy Delphi

Background: The long-term use of benzodiazepine receptor agonists (BZRAs) poses a significant public health challenge in Belgium because of the associated risks of physical and psychological dependence. Despite guidelines recommending short-term use, BZRAs are frequently prescribed beyond the recommended duration, leading to chronic use and associated harm. To address this issue, a policy Delphi study was conducted to assess targeted strategies for preventing long-term BZRA use through the lenses of primary, secondary, and tertiary prevention. Methods: The study involved a panel of experts, including healthcare professionals and patients, who participated in two rounds of questionnaires to evaluate 27 policy recommendations. These recommendations were assessed for feasibility, support, and importance, and participants were also asked whether the necessary conditions were in place to implement each recommendation. This approach aimed to identify areas of consensus and divergence among participants. Results: Key findings reveal a strong consensus on the need for awareness campaigns aimed at healthcare professionals and the general public to highlight the risks associated with BZRA withdrawal. There was also significant support for implementing training programs to equip healthcare providers with the skills needed to manage BZRA withdrawal effectively. However, some recommendations, such as increasing remuneration for long follow-up consultations and establishing a peer support "benzo-buddy" system, garnered less agreement, suggesting that these proposals require further refinement. Conclusion: This study highlights the complexity of addressing long-term BZRA use and advocates for a comprehensive, multifaceted approach. This approach should integrate education, awareness, and tailored healthcare practices to increase prevention efforts. The findings emphasise the importance of coordinated interventions across different levels of prevention to effectively mitigate long-term use on BZRAs in Belgium. By refining and implementing these strategies, the likelihood of achieving meaningful improvements in the management and reduction of chronic BZRA use could be significantly increased, contributing to better public health outcomes.