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. 2023 Mar 15;18(3):e0282988.
doi: 10.1371/journal.pone.0282988. eCollection 2023.

"Stabilise-reduce, stabilise-reduce": A survey of the common practices of deprescribing services and recommendations for future services

Ruth E Cooper  1   2 , Michael Ashman  3 , Jo Lomani  4 , Joanna Moncrieff  5   6 , Anne Guy  7 , James Davies  3   8 , Nicola Morant  6 , Mark Horowitz  5   6
Affiliations

"Stabilise-reduce, stabilise-reduce": A survey of the common practices of deprescribing services and recommendations for future services

Ruth E Cooper et al. PLoS One. .

Abstract

Background: Public Health England recently called for the establishment of services to help people to safely stop prescribed drugs associated with dependence and withdrawal, including benzodiazepines, z-drugs, antidepressants, gabapentinoids and opioids. NICE identified a lack of knowledge about the best model for such service delivery. Therefore, we performed a global survey of existing deprescribing services to identify common practices and inform service development.

Methods: We identified existing deprescribing services and interviewed key personnel in these services using an interview co-produced with researchers with lived experience of withdrawal. We summarised the common practices of the services and analysed the interviews using a rapid form of qualitative framework analysis.

Results: Thirteen deprescribing services were included (8 UK, 5 from other countries). The common practices in the services were: gradual tapering of medications often over more than a year, and reductions made in a broadly hyperbolic manner (smaller reductions as total dose became lower). Reductions were individualised so that withdrawal symptoms remained tolerable, with the patient leading this decision-making in most services. Support and reassurance were provided throughout the process, sometimes by means of telephone support lines. Psychosocial support for the management of underlying conditions (e.g. CBT, counselling) were provided by the service or through referral. Lived experience was often embedded in services through founders, hiring criteria, peer support and sources of information to guide tapering.

Conclusion: We found many common practices across existing deprescribing services around the world. We suggest that these ingredients are included in commissioning guidance of future services and suggest directions for further research to clarify best practice.

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Conflict of interest statement

I have read the journal’s policy and the authors of this manuscript have the following competing interests: RC is a Board Member of the International Institute for Psychiatric Drug Withdrawal (IIPDW) and JD an associate member. JD is a secretariat member of the All-Party Parliamentary Group for Prescribed Drug Dependence (APPG-PDD) and founding member of the Council for Evidence based Psychiatry. JM is co-chairperson of the Critical Psychiatry Network, a board member of the Council for Evidence-Based Psychiatry, chief investigator on the RADAR study of antipsychotic reduction funded by the UK government’s National Institute of Health Research (NIHR) and co-investigator on the REDUCE study of antidepressant discontinuation also funded by the NIHR. MH reports that he is co-founder of Outro Health a digital clinic which helps people safely stop unnecessary antidepressants in Canada and North America. He has been commissioned to write the Maudsley Deprescribing Guidelines in Psychiatry. He is co-investigator on the RELEASE trial in Australia investigating gradually stopping antidepressants in a hyperbolic manner. AG is an associate member of the IIPDW, a member of the Council for Evidence-based psychiatry, and the secretariat co-ordinator for the APPG-PDD secretariat 2016-19, 2020-present. MA, NM and JL declare no conflicts of interest. This does not alter our adherence to PLOS ONE policies on sharing data and materials, although there are restrictions to data availability (please see data availability statement)

Figures

Fig 1
Fig 1. The patient journey and deprescribing service features.
See this image and copyright information in PMC

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