Call for Action: Benzodiazepine Prescription Prevalence Analysis Shows Off-Label Prescription in One in Eleven Citizens

López‐Pelayo, Hugo; Coma, Anna; Gual, Antoni; Zara, Corinne; Lligoña, Anna

doi:10.1159/000502518

Cited by 11 publications

(6 citation statements)

References 11 publications

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“…This is in line with data according to which benzodiazepines and other tranquilizers were the third most commonly misused drug in the USA (2.2%) [32]. According to European data, 11.1% of the Spanish population uses benzodiazepines with or without a prescription [33]. Alcohol-cannabis (3.2%) and alcohol-sedative (1.04%) were found to be the most prevalent co-occurring SUDs.…”

Section: Discussionsupporting

confidence: 87%

The Epidemiology of Substance Use Disorders among the Adult Jewish Population in Israel

Bar-Or¹,

Kor²,

Jaljuli³

et al. 2021

Eur Addict Res

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Introduction: Substance use disorders (SUDs) are a leading cause of morbidity and mortality worldwide, having a profound and global impact on health, well-being, safety, and productivity. Although traditionally the prevalence of SUDs in Israel has been estimated to be lower than those in high-income countries, estimates and characteristics of individuals with SUDs in the past decade are lacking. In this work, we explored the prevalence of SUDs among the adult Jewish population in Israel, per different classes of substances across sex, age group, and other sociodemographic factors. Methods: Data from an online representative sample of 4,025 respondents were collected, including the alcohol, smoking, and substance involvement screening test (ASSIST) metric and sociodemographic data. Results: We found that the most common SUDs were alcohol (10.5% [9.5–11.4]), cannabis (9.0% [8.2–9.9]), and sedative (3.6% [3.0–4.2]) use disorders. Alcohol-cannabis (3.2% [2.7–3.7]) and alcohol-sedative (1.04% [0.7–1.35]) were the most prevalent co-occurring SUDs. Among those with cannabis use disorder, the prevalence of alcohol use disorder was found to be 35.3% [30.4–40.2]. The estimated risk for alcohol use disorder was found to be inversely proportional to age, cannabis use disorder increased, peaked, and decreased with age, and that of sedative use disorder increased with age, particularly among women. While older individuals (in the 51–60 years of age group) were at lower risk (OR = 0.5 [0.3, 0.8]) compared to those <20 years of age for alcohol use disorder, they were at increased risk for sedative use disorder (OR = 3.1 [1.2, 9.7]). Conclusions: These findings represent substantially higher rates of SUDs in Israel than those previously reported and should affect resources allocated to addiction prevention and treatment. Further research on the role of gender, age, culture, and ethnicity in the propensity to develop SUDs is necessary for the development of more focused preventive and intervention measures. Focusing on non-Jewish populations in Israel and broadening the scope to include behavioral addictions should be addressed in future studies.

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Section: Discussionsupporting

confidence: 87%

The Epidemiology of Substance Use Disorders among the Adult Jewish Population in Israel

Bar-Or¹,

Kor²,

Jaljuli³

et al. 2021

Eur Addict Res

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“…Benzodiazepines, allosteric agonists of the γ-aminobutyric acid (GABA) A receptor, are a class of psychotropic drugs commonly prescribed to treat acute anxiety and/or insomnia [ 1 ]. The worldwide global prevalence use of benzodiazepines ranges from 2.6 to 12.5% [ 2 ] and increases with age [ 3 , 4 ], with a mean or median age of use around 55 years [ 5 – 7 ]. Adverse effects like cognitive deterioration, paradoxical response, risk of falling, misuse, and dependence have led several countries to reduce prescription duration [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…The worldwide global prevalence use of benzodiazepines ranges from 2.6 to 12.5% [ 2 ] and increases with age [ 3 , 4 ], with a mean or median age of use around 55 years [ 5 – 7 ]. Adverse effects like cognitive deterioration, paradoxical response, risk of falling, misuse, and dependence have led several countries to reduce prescription duration [ 2 ]. However, despite general warnings from drug regulatory agencies, the long-term use and overprescription of benzodiazepines persist, particularly in the aging population.…”

Section: Introductionmentioning

confidence: 99%

Lack of direct involvement of a diazepam long-term treatment in the occurrence of irreversible cognitive impairment: a pre-clinical approach

Carton

Niot

Kyheng³

et al. 2021

Transl Psychiatry

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Several observational studies have found a link between the long-term use of benzodiazepines and dementia, which remains controversial. Our study was designed to assess (i) whether the long-term use of benzodiazepines, at two different doses, has an irreversible effect on cognition, (ii) and whether there is an age-dependent effect. One hundred and five C57Bl/6 male mice were randomly assigned to the 15 mg/kg/day, the 30 mg/kg/day diazepam-supplemented pellets, or the control group. Each group comprised mice aged 6 or 12 months at the beginning of the experiments and treated for 16 weeks. Two sessions of behavioral assessment were conducted: after 8 weeks of treatment and after treatment completion following a 1-week wash-out period. The mid-treatment test battery included the elevated plus maze test, the Y maze spontaneous alternation test, and the open field test. The post-treatment battery was upgraded with three additional tests: the novel object recognition task, the Barnes maze test, and the touchscreen-based paired-associated learning task. At mid-treatment, working memory was impaired in the 15 mg/kg diazepam group compared to the control group (p = 0.005). No age effect was evidenced. The post-treatment assessment of cognitive functions (working memory, visual recognition memory, spatial reference learning and memory, and visuospatial memory) did not significantly differ between groups. Despite a cognitive impact during treatment, the lack of cognitive impairment after long-term treatment discontinuation suggests that benzodiazepines alone do not cause irreversible deleterious effects on cognitive functions and supports the interest of discontinuation in chronically treated patients.

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“…Long‐term use of benzodiazepine receptor agonists (BZRAs) remains a common public health problem that puts patients at risk of memory, psychomotor and cognitive impairment. 1 , 2 Although it has often been associated with addiction, 3 , 4 , 5 most primary care patients use their BZRA as prescribed, often maintaining a steady dose and without signs of craving. 4 , 6 , 7 When discontinuing long‐term use, psychological or functional decline are possible, 3 and are likely to relate to withdrawal symptoms because of physical dependence.…”

Section: Introductionmentioning

confidence: 99%

Reducing long‐term use of benzodiazepine receptor agonists: In‐depth interview study with primary care stakeholders

Coteur,

Peters,

Jansen

et al. 2023

Health Expectations

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AimsTo increase our understanding of which factors contribute to long‐term benzodiazepine receptor agonist (BZRA) use for insomnia in primary care, from a patients', general practitioners' (GP) and pharmacists' perspective.DesignQualitative research following a grounded theory approach.SettingPrimary care in Belgium.ParticipantsTwenty‐four participants were interviewed, including nine patients, six GPs and nine pharmacists.MeasurementsIn‐depth, semistructured interviews with iterative cycles of data collection and analysis. Transcripts were analysed using the framework method. Thematic findings were interpreted in the context of the Theoretical Domains Framework.FindingsA reflexive relation was identified between views about hypnotic use at the level of society, healthcare and patients. Behaviour change appeared to depend strongly on context and social influence, including a need for supporting relationships by all stakeholders. Six key messages captured factors that contribute to long‐term BZRA use for insomnia in primary care: societal beliefs as a game changer, the opportunity of nonpharmacological treatment, collaborative primary care, patient‐centred goals, informed consent and self‐management.ConclusionsLong‐term BZRA use for insomnia is a complex and multifaceted public health problem that is not adequately addressed in primary care at this time. Although primary care professionals in this study found discontinuation of long‐term BZRA use relevant to the patient's health, many organisational and personal barriers were reported. Moreover, the current social and healthcare context is not empowering patients and professionals to reduce long‐term BZRA use for insomnia. Specifically, for primary care, all stakeholders reported the need for a nonmedicalised relationship between the patient and GP to lower prescribing rates.Patient or Public ContributionThe Flemish Patient Platform, a patient representative organisation, assisted with recruitment by launching a call for participants in their newsletter and volunteered to disseminate the results. The call for recruitment was also published online in social media groups regarding insomnia and via posters in public pharmacies. Patients or public were not involved in designing or conducting the interview study.

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Call for Action: Benzodiazepine Prescription Prevalence Analysis Shows Off-Label Prescription in One in Eleven Citizens

Cited by 11 publications

References 11 publications

The Epidemiology of Substance Use Disorders among the Adult Jewish Population in Israel

The Epidemiology of Substance Use Disorders among the Adult Jewish Population in Israel

Lack of direct involvement of a diazepam long-term treatment in the occurrence of irreversible cognitive impairment: a pre-clinical approach

Reducing long‐term use of benzodiazepine receptor agonists: In‐depth interview study with primary care stakeholders

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