Risk of long-term benzodiazepine and Z-drug use following the first prescription among community-dwelling adults with anxiety/mood and sleep disorders: a retrospective cohort study

Abstract

ObjectiveTo measure the incidence of long-term benzodiazepine receptor agonist (BZRA) use among individuals with anxiety, mood and/or sleep disorders. To identify factors associated with long-term use following the first prescription.MethodsThis was a population-based retrospective cohort study using administrative databases in Manitoba, Canada. Individuals with anxiety/mood or sleep disorder who received their first BZRA between 1 April 2001 and 31 March 2015 were included. Long-term use was defined as ≥180 days. Logistic regression modelling was used to examine predictors of long-term use.ResultsAmong 206 933 individuals included, long-term BZRA use in the first episode of use was 4.5% (≥180 days) following their first prescription. Factors associated with ≥180 days of use included male sex (adjusted OR (aOR) 1.33, 95% CI 1.27 to 1.39), age ≥65 (aOR 5.15, 95% CI 4.81 to 5.52), income assistance (aOR 1.68, 95% CI 1.55 to 1.81), previous non-BZRA psychotropic (aOR 1.93, 95% CI 1.83 to 2.02) or opioid use (aOR 1.16, 95% CI 1.11 to 1.22), high comorbidity (aOR 1.43, 95% CI 1.32 to 1.55), high healthcare use (aOR 1.46, 95% CI 1.33 to 1.60) and psychiatrist prescriber (aOR 2.11, 95% CI 1.93 to 2.32).ConclusionsLess than 1 in 20 patients use BZRAs ≥180 days in their first treatment episode. Several factors were associated with long-term use following the first prescription and further investigation into whether these factors need to be considered at the point of prescribing is warranted. In light of these findings, future research should examine the predictors of cumulative repeat episodes of BZRA exposure.

Recurrent prescription of sleep medication among primary care patients with type 2 diabetes: an observational study of real-world registry data

“…Whether sedative sleeping drugs (such as benzodiazepine-like medication) should be entirely avoided, particularly among older patients [ 21 ], which the present study sample also included, is under debate. Unfortunately, it seems that older patients aged 65 or over have long-term prescriptions for sedative sleep medication five to six times more often than younger ones [ 22 , 23 ].…”

A Focus on Abuse/Misuse and Withdrawal Issues with Selective Serotonin Reuptake Inhibitors (SSRIs): Analysis of Both the European EMA and the US FAERS Pharmacovigilance Databases

“…One could argue that this large volume of entries from a single country is probably related to a recently growing awareness of pharmacovigilance and drug safety risk assessment, in parallel with the launch of the Japanese Adverse Drug Event Report (JADER) system’s free access/free use in 2012 [ 42 , 43 , 44 ]. Concomitant drugs prescribed with ADs in both the EV and FAERS datasets included benzodiazepines and opioids, e.g., molecules that are typically prescribed on a chronic basis [ 45 , 46 , 47 ]. Data regarding ADs’ dispensed prescriptions suggest a long-term (>12 months) prescribing pattern as well [ 2 , 28 ], despite this approach being debatable [ 27 , 48 ].…”

Update on treatments for anxiety-related disorders

“…However, a careful risk-benefit analysis by clinical experts in discussion with the patient is needed because of the risks of abuse, addiction, physical dependence and withdrawal reactions. Benzodiazepines remain an important evidence-based option for reducing suffering in those with treatment-refractory anxiety disorders [9–13].…”