At the tipping point: Patient experiences of addiction to benzodiazepines and motivation to seek treatment.

INTRODUCTION: Addiction to benzodiazepines is a serious problem, and it is important to better understand how individuals can be motivated to quit. Few studies have investigated patients' perceptions and experiences of addiction to benzodiazepines and there is a need to better understand the influence of motivational factors on treatment seeking. METHODS: In this qualitative study, nineteen adults undergoing treatment for addiction to benzodiazepines participated in semi-structured individual interviews which were analyzed using reflexive thematic analysis. RESULTS: Participants both defined addiction in relation to and found motivation to quit using benzodiazepines in the negative effects they experienced. Three themes were identified relating to a patient's journey towards a "tipping point" where they were motivated to seek treatment. Participants described that as their addiction grew, benzodiazepine use became a constant mental preoccupation resulting in the need to procure more medication. Participants faced a crossroads as their benzodiazepines became less effective, and many entered a negative cycle of dose escalation and withdrawal symptoms. Participants also described many negative impacts on psychosocial and practical aspects of their daily lives as they lost control to benzodiazepines. CONCLUSIONS: The results of this study provide insight to patient perspectives on benzodiazepine addiction and suggests that patients find motivation to quit when the consequences related to benzodiazepine use reach a tipping point. Motivation is of clinical importance in the decision to seek treatment, and by working to identify and cultivate individual motivational factors, healthcare providers may be able to help more patients recover from addiction to benzodiazepines.

Changing the pill: developments toward the promise of an ultra-long-acting gastroretentive dosage form.

INTRODUCTION: The development of oral sustained release dosage forms has been a longstanding goal due to the potential for ease of administration, improved pharmacokinetics, reduced dosing frequency, and improved adherence. The benefits of multiday single-dose drug delivery are evident in the success and patient adoption of injected and implanted dosage forms. However, in the space of oral medications, all current commercially available gastric resident dosage forms, and most in development, are limited to gastric residence of less than 1 day. AREAS COVERED: Reviews of systems to extend gastric residence reveal that 1 day or more residence has been an unmet challenge. New dosage forms are in development that seek to address many of the key physiological and design challenges of long-term gastric retention beyond 24 h  and up to a week or longer. The present analysis highlights the design, material considerations and implications of unfolding dosage form systems with ultra-long-term gastric residence. EXPERT OPINION: The development of oral dosage forms providing sustained release of high potency medications over days or weeks could transform care, significantly decrease patient burden in chronic disease management and improve outcomes.