Between prescription and deprescription: a qualitative study on the trajectory and challenges in the use of benzodiazepines among older adults.

Introduction: In Brazil, benzodiazepines rank among the twenty most prescribed medications in primary healthcare. Beyond the lack of robust evidence supporting chronic use, there has been a growing utilization of this drug class for managing conditions that were previously not formally diagnosable or treatable, such as secondary insomnia and bereavement experiences. Objective: In the context of benzodiazepine deprescription, the aim was to understand the trajectory of benzodiazepine use among older adults treated in Primary Health Care, identifying reasons for use and expectations related to its maintenance in pharmacotherapy. Method: An exploratory qualitative study was conducted through semi-structured interviews with twenty-nine individuals aged 60 years or older who had been using benzodiazepines for at least 1 month. Data were recorded in a field diary and interviews were audio-recorded. Subsequently, the data were analyzed using thematic analysis. Results: From the data analysis, two thematic categories emerged that together describe the trajectory of benzodiazepine use: the reasons related to initiation and the difficulties in discontinuation. In the first category, core meanings such as insomnia, life events, and work-related illness were identified, while in the second category the expectations regarding medication use stood out, reinforcing continuity and hindering deprescription. Conclusion: Prescriptions were often not clinically justified or were based on a merely medicalizing logic. Furthermore, the deprescription process was found to be extremely complex for health professionals, as it is influenced by a series of biopsychosocial barriers.