Abstract

Zaleplon, zolpidem, and zopiclone (‘Z-drugs’)
prescribing is gradually rising in the UK, while that of
benzodiazepine hypnotics is falling. This situation is
contrary to current evidence and guidance on hypnotic
prescribing. The aim of this study was to determine
and compare primary care physicians’ perceptions of
benefits and risks of benzodiazepine and Z-drug use,
and physicians’ prescribing behaviour in relation to
hypnotics using a cross-sectional survey. In 2005 a
self-administered postal questionnaire was sent to all
GPs in West Lincolnshire Primary Care Trust. The
questionnaire investigated perceptions of benefits and
disadvantages of benzodiazepines and Z-drugs. Of the
107 questionnaires sent to GPs, 84 (78.5%) analysable
responses were received. Responders believed that Zdrugs
were more effective than benzodiazepines in
terms of patients feeling rested on waking (P<0.001),
daytime functioning (P<0.001), and total sleep time
(P = 0.03). Z-drugs were also thought to be safer in
terms of tolerance (P<0.001), addiction (P<0.001),
dependence (P<0.001), daytime sleepiness (P<0.001),
and road traffic accidents (P = 0.018), and were
thought to be safer for older people (P<0.001). There
were significant differences between GPs’ perceptions
of the relative benefits and risk of Z-drugs compared
with benzodiazepines. The majority of practitioners
attributed greater efficacy and lower side effects to
Z-drugs. GPs’ beliefs about effectiveness and safety
are not determined by current evidence or national
(NICE) guidance which may explain the increase in Zdrug
prescribing relative to benzodiazepine prescribing.