eprintid: 10166891 rev_number: 7 eprint_status: archive userid: 699 dir: disk0/10/16/68/91 datestamp: 2023-03-22 11:50:09 lastmod: 2023-03-22 11:50:09 status_changed: 2023-03-22 11:50:09 type: article metadata_visibility: show sword_depositor: 699 creators_name: Cooper, Ruth E creators_name: Ashman, Michael creators_name: Lomani, Jo creators_name: Moncrieff, Joanna creators_name: Guy, Anne creators_name: Davies, James creators_name: Morant, Nicola creators_name: Horowitz, Mark title: "Stabilise-reduce, stabilise-reduce": A survey of the common practices of deprescribing services and recommendations for future services ispublished: pub divisions: UCL divisions: B02 divisions: C07 divisions: D79 divisions: FH7 keywords: Drug addiction, Antidepressants, Drug dependence, Mental health and psychiatry, Clinical psychology, Psychological and psychosocial issues, Mental health therapies, Social psychology note: This work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third-party material in this article are included in the Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/ 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. date: 2023-03-15 date_type: published publisher: Public Library of Science (PLoS) official_url: https://doi.org/10.1371/journal.pone.0282988 oa_status: green full_text_type: pub language: eng primo: open primo_central: open_green verified: verified_manual elements_id: 2011591 doi: 10.1371/journal.pone.0282988 medium: Electronic-eCollection pii: PONE-D-22-27505 lyricists_name: Horowitz, Mark lyricists_name: Morant, Nicola lyricists_id: MAHOR74 lyricists_id: NMORA50 actors_name: Flynn, Bernadette actors_id: BFFLY94 actors_role: owner full_text_status: public publication: PLOS ONE volume: 18 number: 3 article_number: e0282988 event_location: United States citation: Cooper, Ruth E; Ashman, Michael; Lomani, Jo; Moncrieff, Joanna; Guy, Anne; Davies, James; Morant, Nicola; Cooper, Ruth E; Ashman, Michael; Lomani, Jo; Moncrieff, Joanna; Guy, Anne; Davies, James; Morant, Nicola; Horowitz, Mark; - view fewer <#> (2023) "Stabilise-reduce, stabilise-reduce": A survey of the common practices of deprescribing services and recommendations for future services. PLOS ONE , 18 (3) , Article e0282988. 10.1371/journal.pone.0282988 <https://doi.org/10.1371/journal.pone.0282988>. Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10166891/1/journal.pone.0282988.pdf