Discontinuing chronic benzodiazepine use for insomnia with blended care: results of a pragmatic cluster-RCT

Background: Problematic benzodiazepine receptor agonists (BZRA) use is a global health issue. The complications of long-term use jeopardise the personal health of benzodiazepine users and come with substantial socio-economic costs. Nevertheless, general practitioners find it difficult to manage the decrease and stopping of BZRA. Given the success of blended care for the treatment of sleeping disorders and the support of substance use disorders, research suggests that a blended care approach, combining in-person treatment by the GP with web-based self-learning by the patient, could be beneficial for the discontinuation of chronic BZRA use for primary insomnia in general practice. This project aimed to evaluate the long-term effect (12 months) of a blended care approach for the discontinuation of BZRA use, as assessed by toxicological urine analysis.

Methods: A pragmatic cluster-randomized controlled trial (c-RCT) was used to evaluate the effectiveness of blended care for the discontinuation of chronic BZRA use for primary insomnia in general practice. Primary outcome was the result of toxicological urine analysis at twelve months, secondary outcome included the results at six months. Data collected between September 2019 and July 2021 were analysed according to intention-to-treat principles.

Results: In total, 916 patients were randomised. There were no significant differences in baseline characteristics between control and intervention group. According to urine analysis results, 19% of patients had discontinued BZRA use at twelve months. At six months, 15% had no trace of BZRA in their sample. There was no statistically significant effect found to the advantage of blended care.

Conclusion: Although there was not a higher probability of discontinuing in the intervention group, the study did confirm the effect of addressing BZRA use in a primary care population. The average discontinuation rates were 5% higher than expected in the control group.