Why are some doctors high-prescribers of benzodiazepines and minor opiates? A qualitative study of GPs in Norway

BACKGROUND: Registration studies have shown great variations in prescribingvolume and prescribing patterns of benzodiazepines (BZDs) and minor opiatesamong GPs. OBJECTIVES: We aimed to form a basis for hypotheses and buildtheories about prescribing, in order to investigate how high-prescribingdoctors can legitimize their own prescribing pattern. METHODS: Aqualitative interview study of doctors with previously known high, mediumand low prescribing volumes was performed. The interpretation focused onthe doctors' self-explanations and how they influence their daily decisionof prescribing. RESULTS AND CONCLUSIONS: It was a striking feature thatmany of the attitudes towards the drugs were common both within and betweenthe three groups of prescribers. All doctors regarded the task ofprescribing as difficult, and the great majority strongly advocatedrestriction in prescribing. In order to cope with daily practice and tolive with high prescribing volumes, doctors make use of effective workingstrategies. These strategies, of ascribing responsibility to the previousdoctor, to patient autonomy and responsibility, to the patient's age and toconcomitant diseases, are described in this study. An allocation ofresponsibility to other persons or circumstances delimits the doctors'professional discretion in this matter. Striking differences betweenprescriber groups were not found in the analysis, but when all smalltendencies in all steps of the decision-making process were added, a cleartrend was revealed.