Benzodiazepine Use in the United States

Abstract

enzodiazepines are widely used in the treatment of anxiety and sleep problems. 1-3 The efficacy of benzodiazepines surpasses placebos in controlling a range of anxiety symptoms 4,5 and reducing the onset of sleep latency. 6 Although practice guidelines recommend newer antidepressants in place of benzodiazepines as first-line treatments for anxiety disorders, 7 there is no evidence for the superior short-term efficacy of antidepressants for anxiety disorders. 8 Moreover, practice guidelines recommend that initial approaches to the management of primary insomnia should include behavioral interventions, 9,10 although behavioral interventions and benzodiazepines yield similar short-term sleep-related outcomes. 11 When benzodiazepines are used for extended periods of time, they may lead to problems associated with discontinuation and withdrawal symptoms 12,13 and abuse. 14 In 2008, there were approximately 272 000 emergency department visits in the United States involving nonmedical use of benzodiazepines, of which 40.0% also involved alcohol, 15 which increased to approximately 426 000 visits in 2011, of which 24.2% also involved alcohol. 16 Among older individuals, medical benzodiazepine use poses risks of serious adverse effects including impaired cognitive functioning, 17 reduced mobility and driving skills, 18,19 and increased risks of falls. 20 Research further indicates that the risks of falls is greater for benzodiaz-IMPORTANCE Although concern exists regarding the rate of benzodiazepine use, especially long-term use by older adults, little information is available concerning patterns of benzodiazepine use in the United States. OBJECTIVE To describe benzodiazepine prescription patterns in the United States focusing on patient age and duration of use. DESIGN, SETTING, AND PARTICIPANTS A retrospective descriptive analysis of benzodiazepine prescriptions was performed with the 2008 LifeLink LRx Longitudinal Prescription database (IMS Health Inc), which includes approximately 60% of all retail pharmacies in the United States. Denominators were adjusted to generalize estimates to the US population. MAIN OUTCOMES AND MEASURES The percentage of adults filling 1 or more benzodiazepine prescriptions during the study year by sex and age group (18-35 years, 36-50 years, 51-64 years, and 65-80 years) and among individuals receiving benzodiazepines, the corresponding percentages with long-term (Ն120 days) benzodiazepine use, prescription of a long-acting benzodiazepine, and benzodiazepine prescriptions from a psychiatrist. RESULTS In 2008, approximately 5.2% of US adults aged 18 to 80 years used benzodiazepines. The percentage who used benzodiazepines increased with age from 2.6% (18-35 years) to 5.4% (36-50 years) to 7.4% (51-64 years) to 8.7% (65-80 years). Benzodiazepine use was nearly twice as prevalent in women as men. The proportion of benzodiazepine use that was long term increased with age from 14.7% (18-35 years) to 31.4% (65-80 years), while the proportion that received a benzodiazepine prescription from a psychi...

Benzodiazepine and z-hypnotic prescribing for older people in primary care: a cross-sectional population-based study

“…27,35 This study's observation that 12.1% of people ≥65 years old were prescribed one or more B&Zs, that is, one in four of the care home population and one in nine of the non-care home residents, with care home residents approximately three times more likely to have a B&Z prescribed, is also comparable to the wider literature, 2,25,[27][28][29]37 but is lower than that found among a Canadian sample. 1 This study found anxiolytic prescribing for non-care home residents to be comparable with previous studies.…”

“…However, more personalised data are available for health boards and approved researchers. As with other studies of this nature, the lack of information on drug indications linked to prescribing is a limiting factor, 1,2,[27][28][29]35 but details of prescription indications in patients' clinical notes are known to be incomplete or lacking. 24 This may improve with the introduction of the Scottish Primary Care Resource (SPIRE), a collaboration between the Scottish Government and NHS National Services Scotland to simplify and standardise the process for extracting data from GP practice systems for audit, disease surveillance, benchmarking, planning, and research.…”

The Future of Social Network Analysis of Health Care System Data: Promise and Concerns

“…The rate at which patients received benzodiazepine prescriptions in the Ong et al study 1 (5.1 % of total patients) is similar to that in a recent study by Olfson et al, 6 which estimated that 5.2 % of adults in the United States in 2008 received prescriptions for benzodiazepines. Interestingly, Olfson et al found that most benzodiazepine prescribing was done by non-psychiatrists.…”

“…Given that the study by Olfson et al 6 suggests that the highest rates of benzodiazepine use were among 65-to 80-year-olds, Ong et al's study excludes an important sub-population that may be at greater risk for overlapping benzodiazepine prescriptions, and may underestimate the potential effects of medical comorbidities. Moreover, in light of the indications for benzodiazepines, future studies should include measures of mental health comorbidities.…”

A Systematic Review and Meta-Synthesis of Patients’ Experiences and Perceptions of Seeking and Using Benzodiazepines and Z-Drugs: Towards Safer Prescribing

“…This is concerning, as BZDs and zdrugs are known to have limited long-term therapeutic benefits, and also have adverse consequences for patients, such as dependency, daytime sedation, cognitive impairment and increased rates of falls and accidents [5]. Despite the risks, use of these drugs is particularly common in older people [7]. In a previous study, we conducted a systematic review and meta-synthesis which identified influences on general practitioner (GP) prescribing of these drugs.…”