Background: Despite an increase in the prevalence of sleep problems, few studies have investigated changes in the prescribing of drugs often used for managing insomnia. Aim: To explore changes in the pattern of benzodiazepine (BZD), z-drugs (zolpidem, zopiclone) and non-BZD prescriptions. Design and Setting: Open cohort study including 1,773,525 patients (55,903,294 consultations) regularly attending 404 Australian general practices from 2011-2018 (MedicineInsight). Method: Prescription rates per 1,000 consultations, the proportion of repeat prescriptions above recommendations, and the proportion of prescriptions for patients with a recent recorded insomnia diagnosis (i.e. within 2 years) were analysed using adjusted regression models. Results: Rates of BZD, z-drugs and non-BZD prescriptions were 56.6, 4.4 and 15.5/1,000 consultations in 2011 and 41.8, 3.5 and 21.5/1000 consultations in 2018, respectively. Temazepam represented 25.3% of the prescriptions and diazepam 21.9%. All BZD and zolpidem prescriptions declined from 2011-2018 [annual change varying from -1.4% to -10.8%], while non-BZD and zopiclone prescriptions increased in the same period [annual change: +5.0% to +22.6%]. Repeat prescriptions above recommendations remained below 10% for most medications, except melatonin (64.5%), zolpidem (63.3%), zopiclone (31.4%) and alprazolam (13.3%). In 2018, almost 50% of z-drugs and melatonin prescriptions were for patients with insomnia. There was 3.2%-5.9% annual increase in the proportion of prescriptions associated with a recently recorded insomnia diagnosis. Conclusion: Overall, BZD prescriptions in Australia declined from 2011-2018. However, the prescription of some of these drugs increased for patients with a recently recorded insomnia diagnosis. This is concerning because of potential adverse effects and risk of dependence.

Despite reducing benzodiazepine prescribing, benzodiazepine‐involving deaths have substantially increased in Australia. This study aimed to explore patterns in long‐term prescribing of medications (benzodiazepine and z‐drugs [BZD]) used for sleep‐issues/insomnia in Australia to better understand these changes. Open cohort study using de‐identified electronic health records of 1 414 593 adult patients regularly attending 404 Australian general practices from 2011 to 2018 (MedicineInsight). We used logistic regression adjusted for patient and practice characteristics to; (1) estimate long‐term BZD prescribing prevalence (≥3 prescriptions in 6 months) and the associated sociodemographic factors, and (2) Poisson regression to compute annual changes in prescribing rates. Long‐term BZD prescribing changed from 4.4% in 2011 to 5.8% in 2015, remaining relatively stable until 2018 (annual increase +2.5% [95% CI +2.0%;+3.0%]). Long‐term BZD prescribing in any year was up to six times more likely in elderly rather than in younger patients and 30%–43% more prevalent in females, or patients living in or attending a practice located in more disadvantaged areas. The increase was more pronounced among males, adults aged 35–49 years, and individuals living in advantaged areas. The median duration among incident cases decreased from 1183 to 322 days between 2011 and 2017, and was up to 197 days longer among elderly females than males. Despite a slight increase and recent stability in long‐term BZD prescribing, the higher rates and durations among elderly patients, women, or those living in more disadvantaged areas are concerning and highlights the need for interventions that reduce the potential harms of long‐term BZD use in vulnerable groups.