Benzodiazepines are Prescribed More Frequently to Patients Already at Risk for Benzodiazepine-Related Adverse Events in Primary Care

Abstract

BACKGROUND: Benzodiazepine use is associated with adverse drug events and higher mortality. Known risk factors for benzodiazepine-related adverse events include lung disease, substance use, and vulnerability to fracture. OBJECTIVE: To determine whether benzodiazepine prescribing is associated with risk factors for adverse outcomes. DESIGN: Longitudinal cohort study between July 1, 2011, and June 30, 2012. PARTICIPANTS: Patients who visited hospital-and community-based practices in a primary care practicebased research network. MAIN MEASURES:Odds ratio of having a target medical diagnosis for patients who received standard and highdose benzodiazepine prescriptions; rates per 100 patients for outpatient and emergency department visits and hospitalizations. KEY RESULTS: Among 65,912 patients, clinicians prescribed at least one benzodiazepine to 15 % (9821). Of benzodiazepine recipients, 5 % received high doses. Compared to non-recipients, benzodiazepine recipients were more likely to have diagnoses of depression (OR, 2.7; 95 % CI, 2.6-2.9), substance abuse (OR, 2.2; 95 % CI, 1.9-2.5), tobacco use (OR, 1.7; 95 % CI, 1.5-1.8), osteoporosis (OR, 1.6; 95 % CI, 1.5-1.7), chronic obstructive pulmonary disease (OR, 1.6; 95 % CI, 1.5-1.7), alcohol abuse (OR, 1.5; 95 % CI, 1.3-1.7), sleep apnea (OR, 1.5; 95 % CI, 1.3-1.6), and asthma (OR, 1.5; 95 % CI, 1.4-1.5). Compared to low-dose benzodiazepine recipients, high-dose benzodiazepine recipients were even more likely to have certain medical diagnoses: substance abuse (OR, 7.5; 95 % CI, 5.5-10.1), alcohol abuse (OR, 3.2; 95 % CI, 2.2-4.5), tobacco use (OR, 2.7; 95 % CI, 2.1-3.5), and chronic obstructive pulmonary disease (OR, 1.5; 95 % CI, 1.2-1.9).Benzodiazepine recipients had more primary care visits per 100 patients (408 vs. 323), specialist outpatient visits (815 vs. 578), emergency department visits (47 vs. 29), and hospitalizations (26 vs. 15; p < .001 for all comparisons). CONCLUSIONS: Clinicians prescribed benzodiazepines and high-dose benzodiazepines more frequently to patients at higher risk for benzodiazepine-related adverse events. Benzodiazepine prescribing was associated with increased healthcare utilization.

A Review of Alprazolam Use, Misuse, and Withdrawal

“…In a longitudinal cohort study between July 1, 2011, and June 30, 2012, more than half of the patients who visited hospital and “community practice-based research network” received benzodiazepine prescriptions at least once from their primary care physician (PCP). Those clinicians were found to prescribe benzodiazepines disproportionately to patients with at least some known risk factors for benzodiazepine-related adverse events including increased age, pulmonary diseases, and other substance use disorders (Kroll et al, 2016). …”

Capsule Commentary on Kroll et al., Benzodiazepines Are Prescribed More Frequently to Patients Already at Risk for Benzodiazepine-Related Adverse Events in Primary Care

“…T his cross-sectional study by Kroll et al 1 reports patient characteristics associated with receipt of benzodiazepines in high and low doses in primary care settings. The authors found that individuals who receive benzodiazepines, particularly at high doses, were more likely to have multiple chronic medical conditions, including a higher likelihood of substance use disorder and depression.…”

O uso de benzodiazepínicos em mulheres atendidas pela estratégia de saúde da família em um município do interior paulista

“…No entanto, entre as décadas de 1980 e 1990, não havia consenso sobre o potencial de abuso e/ou dependência produzido pelos BDZs, possivelmente pela dificuldade encontrada pelos primeiros pesquisadores em induzir dependência e tolerância em animais (LINSEN; ZITMAN; BRETELER, 1995;LADER, 1984;PETURSSON;LADER, 1981 (SONNENBERG et al, 2012;VICENS et al, 2011;HERRERA et al, 2002 -LARIBIÈRE et al, 2016;KROLL et al, 2016;MORGAN et al, 2016;ALONSO et al, 2014;RABELO, 2011;FIRMINO et al, 2011;ESCRIVÁ FERRAIRÓ et al, 2000;ASHTON, 1991 Title("atencao basica" OR "atencao primaria" OR "atendimento primario" OR "cuidado$ primario$" OR "primary health care" OR "primary healthcare" OR "primary care" OR "atencion primaria de salud") And Title(benzodiazepin? * OR benzodia?epina* OR benzodiazepinico* OR ansiolítico* OR anxiolytic* OR psychotropic* OR psicotr?pico OR psychopharmac* OR psicof?rmaco) Na figura 4 vemos a distribuição dos trabalhos pelos países de origem e foram selecionados para compor o gráfico somente os países com mais de cinco publicações.…”

“…Gravidez, problemas hormonais, transtornos psiquiátricos mais predominantes no gênero feminino e qualidade de vida das mulheres usuárias foram temas recorrentes. (BÉNARD-LARIBIÈRE et al, 2016;KROLL et al, 2016;MORGAN et al, 2016;ALONSO et al, 2014;RABELO, 2011;FIRMINO et al, 2011).…”

“…Borges, Hegadoren e Miasso (2015) A existência de uma relação entre ansiedade e hipertensão arterial é tema antigo no meio acadêmico (JAMES et al, 1986;VLACHAKIS et al, 1974) CHAVES;CADE, 2004;KROLL et al, 2016;SRISURAPANONT et al, 2005).…”