{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T10:50:12Z","timestamp":1779879012341,"version":"3.53.1"},"reference-count":27,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2023,5,29]],"date-time":"2023-05-29T00:00:00Z","timestamp":1685318400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","award":["NIHR200695"],"award-info":[{"award-number":["NIHR200695"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Department of Health and Social Care (DHSC) Research and Development Committee","award":["NHS England and Improvement (NHSE-I)"],"award-info":[{"award-number":["NHS England and Improvement (NHSE-I)"]}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Health Serv Res Policy"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>We set out to map the quantitative and qualitative systematic review evidence available to inform the optimal prescribing of drugs that can cause dependency (benzodiazepines, opioids, non-benzodiazepine hypnotics, gabapentinoids and antidepressants). We also consider how this evidence can be used to inform decision-making in the patient care pathway for each type of medication.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Eight bibliographic databases were searched for the period 2010 to 2020. All included reviews were initially appraised using four items from the Collaboration for Environmental Evidence Synthesis Assessment Tool, with reviews that scored well on all items proceeding to full quality appraisal. Key characteristics of the reviews were tabulated, and each review was incorporated into an evidence and gap map based on a patient care pathway. The care pathway was based upon an amalgamation of existing NICE guidelines and feedback from clinical and patient stakeholders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We identified 80 relevant reviews and displayed them in an evidence and gap map. The evidence included in these reviews was predominantly of low overall quality. Areas where systematic reviews have been conducted include barriers and facilitators to the deprescribing of drugs that may cause dependency, although we identified little evidence exploring the experiences or evaluations of specific interventions to promote deprescribing. All medications of interest, apart from gabapentinoids, were included in at least one review.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The evidence and gap map provides an interactive resource to support (i) policy developers and service commissioners to use evidence in the development and delivery of services for people receiving a prescription of drugs that may cause dependency, where withdrawal of medication may be appropriate, (ii) the clinical decision-making of prescribers and (iii) the commissioning of further research. The map can also be used to inform the commissioning of further systematic reviews. To address the concerns regarding the quality of the existing evidence based raised in this report, future reviews should be conducted according to best-practice guidelines. Systematic reviews focusing on evaluating interventions to promote deprescribing would be particularly beneficial, as would reviews focusing on addressing the paucity of evidence regarding the deprescription of gabapentinoids.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/13558196231164592","type":"journal-article","created":{"date-parts":[[2023,5,29]],"date-time":"2023-05-29T17:52:30Z","timestamp":1685382750000},"page":"271-281","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Optimising the prescribing of drugs that may cause dependency: An evidence and gap map of systematic reviews"],"prefix":"10.1177","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6092-5019","authenticated-orcid":false,"given":"Liz","family":"Shaw","sequence":"first","affiliation":[{"name":"Research Fellow, Faculty of Health and Life Sciences, Exeter Policy Research Programme Evidence Review Facility, University of Exeter, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Nunns","sequence":"additional","affiliation":[{"name":"Research Fellow, Faculty of Health and Life Sciences, Exeter Policy Research Programme Evidence Review Facility, University of Exeter, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Briscoe","sequence":"additional","affiliation":[{"name":"Information Specialist, Faculty of Health and Life Sciences, Exeter Policy Research Programme Evidence Review Facility, University of Exeter, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruth","family":"Garside","sequence":"additional","affiliation":[{"name":"Associate Professor in Evidence Synthesis, Faculty of Health and Life Sciences, Exeter Policy Research Programme Evidence Review Facility and Faculty of Health and Life Sciences, European Centre for Environment and Health, University of Exeter, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malcolm","family":"Turner","sequence":"additional","affiliation":[{"name":"Patient and Public Representative, Faculty of Health and Life Sciences, Exeter Policy Research Programme Evidence Review Facility, University of Exeter, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"GJ","family":"Melendez-Torres","sequence":"additional","affiliation":[{"name":"Professor in Clinical and Social Epidemiology, Faculty of Health and Life Sciences, Exeter Policy Research Programme Evidence Review Facility, University of Exeter, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hassanat M","family":"Lawal","sequence":"additional","affiliation":[{"name":"Graduate Research Associate, Faculty of Health and Life Sciences, Exeter Policy Research Programme Evidence Review Facility, University of Exeter, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo Thompson","family":"Coon","sequence":"additional","affiliation":[{"name":"Professor of Evidence Synthesis and Health Policy \u2013 National Institute for Health and Care Research Applied Research Collaborations, Faculty of Health and Life Sciences, Exeter Policy Research Programme Evidence Review Facility, University of Exeter, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2023,5,29]]},"reference":[{"key":"bibr1-13558196231164592","unstructured":"National Institute for Health and Care Excellence. Diazepam, https:\/\/cks.nice.org.uk\/topics\/generalized-anxiety-disorder\/prescribing-information\/diazepam\/(2022, accessed 24 October 2022)."},{"key":"bibr2-13558196231164592","unstructured":"National Institute for Health and Care Excellence. Antidepressant treatment in adults, https:\/\/pathways.nice.org.uk\/pathways\/depression\/antidepressant-treatment-in-adults#content=view-node%3Anodes-stopping-or-reducing-antidepressants (2021, accessed 3 March 2021)."},{"key":"bibr3-13558196231164592","unstructured":"National Institute for Health and Care Excellence. What issues should I be aware of when prescribing Z-drugs? https:\/\/cks.nice.org.uk\/topics\/insomnia\/prescribing-information\/z-drugs\/#:\u223c:text=Z%2Ddrugs_licensed_for_the,mg_once_daily_at_bedtime (2022, accessed 24 October 2022)."},{"key":"bibr4-13558196231164592","unstructured":"National Institute for Health and Care Excellence. Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain, https:\/\/www.nice.org.uk\/guidance\/ng193\/resources\/chronic-pain-primary-and-secondary-in-over-16s-assessment-of-all-chronic-pain-and-management-of-chronic-primary-pain-pdf-66142080468421 (2021, accessed 24 October 2022)."},{"key":"bibr5-13558196231164592","volume-title":"Dependence and withdrawal associated with some prescribed medicines: an evidence review","author":"Taylor S","year":"2019"},{"key":"bibr6-13558196231164592","unstructured":"NHS England and NHS Improvement South West. Opioid prescribing for chronic pain, https:\/\/www.england.nhs.uk\/south\/info-professional\/safe-use-of-controlled-drugs\/opioids\/ (accessed 1 March 2021)."},{"key":"bibr7-13558196231164592","unstructured":"Shanahan W. Opioids: understanding the current state in the UK, https:\/\/www.priorygroup.com\/blog\/opioids-understanding-the-current-state-in-the-uk (accessed 1 March 2021)."},{"key":"bibr8-13558196231164592","doi-asserted-by":"publisher","DOI":"10.1208\/s12248-008-9056-1"},{"key":"bibr9-13558196231164592","first-page":"2121","volume":"61","author":"Longo LP","year":"2000","journal-title":"Am Fam Physician"},{"key":"bibr10-13558196231164592","unstructured":"Harvard Medical School. Sedative, Hypnotic or Anxiolytic Drug Use Disorde, https:\/\/www.health.harvard.edu\/a_to_z\/sedative-hypnotic-or-anxiolytic-drug-use-disorder-a-to-z (2018, accessed 1 March 2021)."},{"key":"bibr11-13558196231164592","doi-asserted-by":"publisher","DOI":"10.1177\/026988119901300321"},{"key":"bibr12-13558196231164592","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(19)30032-X"},{"key":"bibr13-13558196231164592","doi-asserted-by":"publisher","DOI":"10.1177\/2045125319872344"},{"key":"bibr14-13558196231164592","volume-title":"Good practice in prescribing and managing medicines and devices","author":"General Medical Council","year":"2013"},{"key":"bibr15-13558196231164592","doi-asserted-by":"publisher","DOI":"10.1002\/cl2.1125"},{"key":"bibr16-13558196231164592","unstructured":"Shaw E, Nunns M, Briscoe S, et al. Optimising prescribing of drugs to prevent CVD and drugs that cause dependency: an evidence-gap map: Final report. Exeter Policy and Research Programme Evidence Review Facility, http:\/\/hdl.handle.net\/10871\/128337 (2021, accessed 24 September 2021)."},{"key":"bibr17-13558196231164592","volume-title":"Systematic Reviews: CRD's guidance for undertaking reviews in health care","author":"Centre for Reviews and Dissemination","year":"2008"},{"key":"bibr18-13558196231164592","unstructured":"Shaw E, Nunns M, Briscoe S, et al. Optimal prescribing of drugs to prevent CVD and drugs that cause dependence: an evidence and gap map. Exeter Policy and Research Programme Evidence Review Facility, https:\/\/osf.io\/5qynw (2020, accessed 13 August 2020)."},{"key":"bibr19-13558196231164592","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"bibr20-13558196231164592","doi-asserted-by":"publisher","DOI":"10.5195\/jmla.2021.809"},{"key":"bibr21-13558196231164592","volume-title":"Medicines optimisation: the safe and effective use of medicines to enable the best possible outcomes","author":"National Institute for Health and Care Excellence","year":"2015"},{"key":"bibr22-13558196231164592","unstructured":"National Institute for Health and Care Excellence. Scenario: Benzodiazepine and z-drug withdrawal, https:\/\/cks.nice.org.uk\/topics\/benzodiazepine-z-drug-withdrawal\/management\/benzodiazepine-z-drug-withdrawal\/ (2019, accessed 3 March 2021)."},{"key":"bibr23-13558196231164592","unstructured":"Oxford University Hospitals NHS Foundation Trust. Guidance for opioid reduction in primary care, https:\/\/www.ouh.nhs.uk\/services\/referrals\/pain\/documents\/gp-guidance-opioid-reduction.pdf (2017, accessed 3 March 2021)."},{"key":"bibr24-13558196231164592","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2004.11.063"},{"key":"bibr25-13558196231164592","unstructured":"Collaboration for Environmental Evidence. The collaboration for environmental evidence synthesis appraisal tool (CEESAT). Version 2.1. CEE 2018 https:\/\/environmentalevidence.shinyapps.io\/CEEDER\/ (2020, accessed 13 Jan 2021)."},{"key":"bibr26-13558196231164592","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.j4008"},{"key":"bibr27-13558196231164592","volume-title":"EPPI mapper, version 1.2.5","author":"Digital Solution Foundry","year":"2020"}],"container-title":["Journal of Health Services Research &amp; Policy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/13558196231164592","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/13558196231164592","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/13558196231164592","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T08:45:09Z","timestamp":1777452309000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/13558196231164592"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,5,29]]},"references-count":27,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2023,10]]}},"alternative-id":["10.1177\/13558196231164592"],"URL":"https:\/\/doi.org\/10.1177\/13558196231164592","relation":{},"ISSN":["1355-8196","1758-1060"],"issn-type":[{"value":"1355-8196","type":"print"},{"value":"1758-1060","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,5,29]]}}}