Prescription Benzodiazepine Use Among Older Adults: A Critical Review

Gerlach, Lauren B.; Wiechers, Ilse R.; Maust, Donovan T.

doi:10.1097/hrp.0000000000000190

Cited by 48 publications

(28 citation statements)

References 68 publications

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“…Clozapine significantly reduces suicidality and suicide attempts in patients with schizophrenia [21]. Benzodiazepines (BZDs) are indicated for use in patients with sleep disorders, anxiety and affective disorders, delirium, alcohol withdrawal, and aggressive and violent behaviors during psychosis [26, 27]. However, there is a lack of agreement on how sedatives such as BZDs should be used and the role they should play in the treatment of psychiatric disorders [26].…”

Section: Introductionmentioning

confidence: 99%

Association between benzodiazepines and suicide risk: a matched case-control study

et al. 2019

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BackgroundIt is unclear whether benzodiazepines increase the risk of suicide. The aim of this study was to test the hypothesis that benzodiazepines are associated with an increased risk of suicide, by comparing psychopharmacological interventions between psychiatric patients who committed suicide and a group of matched controls.MethodsThe case group comprised 154 psychiatric patients (101 men, 53 women; age range: 13–96 years) who had committed suicide in Örebro County, Sweden. Control psychiatric patients matched by age, sex, and main psychiatric diagnosis were selected for each case. Binary logistic regression was used to calculate odds ratios in unadjusted and adjusted models.ResultsBenzodiazepine prescriptions were more common among cases than controls (65/154 [42.2%] versus 43/154 [27.9%], p = 0.009, odds ratio: 1.89 [95% CI: 1.17–3.03]). This association remained significant in a model adjusted for previous suicide attempts and somatic hospitalizations (odds ratio: 1.83 [95% CI: 1.06–3.14]). No statistically significant differences were seen between the groups in the use of any other subtype of psychopharmaceutical agent.ConclusionsThese data indicate that benzodiazepine use may increase the risk of suicide. However, this study is limited by the potential for indication bias.

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Section: Introductionmentioning

confidence: 99%

Association between benzodiazepines and suicide risk: a matched case-control study

et al. 2019

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“…63 Sleep disturbances 64 and significant anxiety 65,66 are common in older adults, with benzodiazepines commonly employed as treatment. 67 On the other hand, prescription stimulant misuse is often driven by academic and cognitive enhancement motives, 38,68,69 and academic demands tend to be concentrated in adolescence and young adulthood. Elevated rates of prescription stimulant misuse in young adult college students and recent graduates supports this idea.…”

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confidence: 99%

Prescription Drug Misuse: Taking a Lifespan Perspective

et al. 2020

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Prescription drug misuse (PDM), or medication use without a prescription or in ways not intended by the prescriber, is a notable public health concern, especially in the United States. Accumulating research has characterized PDM prevalence and processes, but age-based or lifespan changes in PDM are understudied. Given age-based differences in the medical or developmental concerns that often underlie PDM, it is likely that PDM varies by age. This review summarizes the literature on PDM across the lifespan, examining lifespan changes in prevalence, sources, motives and correlates for opioid, stimulant, and tranquilizer/sedative (or benzodiazepine) PDM. In all, prevalence rates, sources and motives vary considerably by age group, with fewer age-based differences in correlates or risk factors. PDM prevalence rates tend to decline with aging, with greater use of physician sources and greater endorsement of self-treatment motives in older groups. Recreational motives (such as to get high) tend to peak in young adulthood, with greater use of peer sources or purchases to obtain medication for PDM in younger groups. PDM co-occurs with other substance use and psychopathology, including suicidality, across age groups. The evidence for lifespan variation in PDM is strongest for opioid PDM, with a need for more research on tranquilizer/sedative and stimulant PDM. The current literature is limited by the few studies of lifespan changes in PDM within a single sample, a lack of longitudinal research, little research addressing PDM in the context of polysubstance use, and little research on minority groups, such as sexual and gender minorities.

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“…While some of this use may be psychiatrically indicated, the concern is that a large amount may be unnecessary and preventable. Sedative-hypnotic misuse is an underrecognized public health problem in the general population [3,25]. Our study suggests that women who have mastectomy and reconstructive surgery are susceptible to prolonged use of these medications, placing them at risk of future dependence on and misuse of these agents.…”

Section: Discussionmentioning

confidence: 79%

New and persistent controlled substance use among patients undergoing mastectomy and reconstructive surgery

Cogan

Raghunathan

Beauchemin

et al. 2021

Breast Cancer Res Treat

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Prolonged use of controlled substances can place patients at increased risk of dependence and complications. Women who have mastectomy and reconstructive surgery (M+R) may be vulnerable to becoming new persistent users (NPUs) of opioid and sedative-hypnotic medications. MethodsUsing the MarketScan health care claims database, we identi ed opioid-and sedative-hypnotic-naïve women who had M+R from 2008-2017. Women who lled ≥1 peri-operative prescription and ≥2 post-operative prescriptions within one year after surgery were classi ed as NPUs. Univariate and multivariable logistic regression analyses were used to estimate rates of new persistent use and predictive factors. Risk summary scores were created based on the sum of associated factors. ResultsWe evaluated 25,270 opioid-naïve women and 27,651 sedative-hypnotic-naïve women.We found that 18,931 opioid-naïve women lled a peri-operative opioid prescription, and of those, 3,315 (17.5%) became opioid NPUs postoperatively. Additionally, 10,781 sedative-hypnotic-naïve women lled a peri-operative sedative-hypnotic prescription, and of those, 1,837 (17.0%) became sedative-hypnotic NPUs. Development of new persistent sedative-hypnotic use was associated with age ≤49 (OR 1.79 [95% CI 1.43-2.25]) and age 50-64 (1.65 [1.31-2.07]) compared to age ≥65; Medicaid insurance (1.92 [1.23-2.98]); southern residence (1.38 [1.20-1.59]); breast cancer diagnosis (1.78 [1.09-2.91]); and chemotherapy (2.24 [2.02-2.49]). Risk of NPU increased with higher risk score. Women with ≥3 of these risk factors were three times more likely to become sedative-hypnotic NPUs than patients with 0 or 1 factors (3.03 [2.60-3.53]). Comparable ndings were seen regarding new persistent opioid use. ConclusionWomen who have M+R are at risk of developing both new persistent opioid and new persistent sedative-hypnotic use. A patient's risk of becoming an NPU increases as their number of risk factors increases. Non-pharmacologic strategies are needed to manage pain and anxiety following cancer-related surgery.

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Prescription Benzodiazepine Use Among Older Adults: A Critical Review

Cited by 48 publications

References 68 publications

Association between benzodiazepines and suicide risk: a matched case-control study

Association between benzodiazepines and suicide risk: a matched case-control study

Prescription Drug Misuse: Taking a Lifespan Perspective

New and persistent controlled substance use among patients undergoing mastectomy and reconstructive surgery

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