Zolpidem Restrictions: How Are General Practitioners Coping?

A survey involving more than 200 healthcare professionals found that not all general practitioners have integrated the zolpidem prescribing restrictions issued in 2017 into their routine practice the same way.

In 2017, proprietary drugs containing zolpidem became subject to a secure prescription requirement, and the duration of prescriptions was limited to 28 days. These regulatory changes were designed to limit cases of abuse, dependence, and misuse associated with this benzodiazepine. But how have general practitioners perceived these changes and complied with this new regulation?

The ZORRO Study

To find out, a team based in Nantes, France, conducted the ZORRO (Zolpidem and the Reinforcement of the Regulation of Prescription Orders) study. The team had previously shown that the new regulation led to a drop in prescriptions in France. In this new study, the researchers conducted a survey between July 2018 and January 2020 among randomly selected prescribers across France.

Prescribers were asked to indicate their professional profile and their perception of awareness of the regulatory change. Possible responses to the latter included "it doesn't change anything," "it constitutes an additional problem," "it is helping to raise awareness of the risks of zolpidem," "it is recognizing the risks of hypnotics," and "it is helping the discontinuation of zolpidem." In addition, prescribers gave the estimated proportions of patients for whom the zolpidem dose had consequently been reduced, for whom zolpidem had been discontinued with or without replacement with another treatment, and for whom there had been no change.

Younger Prescribers Adapting Better

The study collected the responses of 204 physicians, 88.8% of whom were urban. Approximately 24% of physicians had been practicing for 21 to 30 years, and 30% had been practicing for over 30 years. Responses showed that the majority considered this new regulation to be both helpful for promoting discontinuation (60.7%) and a problem (55%).

Among those who described this new regulation as helpful, the main strategy followed was discontinuing zolpidem and replacing it (39% of their patients), but no change was made for a third of them. This group consisted primarily of practitioners who had been practicing for fewer than 5 years (30% of them, 61% of them having practiced for fewer than 20 years).

Among the group who considered the restriction to be a problem only, most of the physicians had maintained their prescribing practices (68% of their patients). This group also included physicians who had been practicing for a longer period (47.1% had been practicing for more than 30 years, 5.9% for fewer than 5 years).

The main factor practitioners cited as determining their prescribing strategy was the number of years of treatment with zolpidem. For a patient older than 65 years, the most common strategies were to maintain the drug or, at a minimum, decrease the zolpidem dose.

Thus, different approaches to prescribing have arisen, motivated by concern regarding the difficulty of managing sleep disorders and meeting the specific needs of patients. Appropriate measures aimed at monitoring general practitioners' perception of this type of regulation would be useful to optimize its success.

This article was translated from Univadis France.

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