The epidemiology of long-term benzodiazepine use

Neutel, C. Ineke

doi:10.1080/09540260500071863

Cited by 124 publications

(86 citation statements)

References 24 publications

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“…Other studies, however, reveal that having once entered a cohort of benzodiazepine use, the probability of still being part of that cohort in the following years is consistently high in different populations (Isacson, 1997;Neutel, 2005).…”

Section: Discussionmentioning

confidence: 99%

Disability pension as predictor of later use of benzodiazepines among benzodiazepine users

Hartz¹,

Tverdal

Skille³

2010

Social Science & Medicine

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The proportion of Norwegians on disability pensions has doubled since the 1980s. The Norwegian Government wants action to stimulate the working capacity in those disability pensioners who have the potential to work. Information on factors that may impair rehabilitation efforts, including the unfavourable use of benzodiazepines, may be useful in this context. A longitudinal design, including data on 40-42 year old participants in Norwegian health surveys (year 1985-89) linked to a prescription database (year 2004-06), was used to describe risk of long-term use of benzodiazepines among disability pension recipients. The study-population constituted benzodiazepine users at baseline.More than half of those on disability pensions, 57% of all men and 65% of all women, retrieved benzodiazepine prescriptions 20 years later, a span covering a large part of the potential active workforce period. Further, the observed amount of benzodiazepines dispensed over a three year period indicated more than sporadic use; e.g. half of the female disability pensioners were dispensed an amount of benzodiazepines corresponding to the use of a daily dose every second day over a three year period (median 450 daily doses). The majority of those who was dispensed benzodiazepines, was dispensed opioids as well: half of all men and 3 out of four women. And last, being on a disability pension was a predictor of benzodiazepine use 20 years later.In conclusion, this prospective study provides new information on the epidemiology of benzodiazepine use in disability pensioners. Our study suggests that benzodiazepines are extensively and unfavourably used among disability pensioners, and that disability 3 pension may have an independent effect on long-term use. Improved management of benzodiazepine use may be one alternative to get disability pensioners with the potential to work back into employment.

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Section: Discussionmentioning

confidence: 99%

Disability pension as predictor of later use of benzodiazepines among benzodiazepine users

Hartz¹,

Tverdal

Skille³

2010

Social Science & Medicine

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“…Most studies that have explored this question were performed outside of North America. [17][18][19][20][21][22][23][24][25][26] These works identified some demographic predictors of benzodiazepine prescription (e.g., increased age and female gender) and an association with higher medical comorbidity in general, but did not focus on specific medical diagnoses. While benzodiazepines have known risks of adverse events in the elderly, including fractures, and in patients with lung disease and Previous Presentations Preliminary data from this study were presented at the 61st Annual Meeting of the Academy of Psychosomatic Medicine, Fort Lauderdale, Florida, November 14, 2014; additional data will be presented in part at the 62nd Annual Meeting of the Academy of Psychosomatic Medicine, New Orleans, Louisiana, November 13, 2015.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2016

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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.

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“…Guidelines suggest that if these drugs are prescribed, they should only be used short-term [1][2][3][4]. However, research indicates that they are often prescribed long-term [5,6]. 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].…”

Section: Introductionmentioning

confidence: 99%

“…However, research indicates that they are often prescribed long-term [5,6]. 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].…”

Section: Introductionmentioning

confidence: 99%

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

Sirdifield

Chipchase

Owen

et al. 2016

Patient

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Acknowledgements: Thank you to Rebecca Porter (School of Health and SocialCare, University of Lincoln) for her support with data extraction for this project.Sirdifield led the study and contributed to all stages of the analysis and write-up Chipchase contributed to all stages of the analysis and write up Owen read and commented on drafts of the paper and model, and proof read the final version Siriwardena had the idea for this study, and has contributed to the design, conception, analysis and drafts of the paper (including final revisions). AbstractBackground: Benzodiazepines and z-drugs are used to treat complaints like insomnia, anxiety and pain. These drugs are recommended for short-term use only, but many studies report long-term use, particularly in older people.Objective: To identify and synthesise qualitative studies exploring patients' experiences and perceptions of receiving benzodiazepines and z-drugs, and through this identify factors which perpetuate use of these drugs, and strategies for achieving safer prescribing.Methods: A systematic search of six databases for qualitative studies exploring patients' experiences and perceptions of primary care benzodiazepine and z-drug prescribing published between January 2000 and April 2014 in a European language, and conducted in Europe, the United States, Australia or New Zealand. Reference lists of included papers were also searched. Study quality was assessed using the Critical Appraisal Skills Programme qualitative checklist. Findings were synthesised using thematic synthesis.Results: Nine papers were included and seven analytical themes were identified relating to patients' experiences and perceptions and, within that, strategies for safer prescribing of benzodiazepines and z-drugs: 1) patients' negative perceptions of insomnia and its impact, 2) failed self-care strategies, 3) triggers to medical helpseeking, 4) attitudes towards treatment options and service provision, 5) varying patterns of use, 6) withdrawal, 7) reasons for initial or ongoing use. Conclusions:Inappropriate use and prescribing of benzodiazepines and z-drugs is perpetuated by psychological dependence, absence of support and patients' denial/lack of knowledge of side-effects. Education strategies, increased availability of alternatives, and targeted extended dialogue with patients could support safer prescribing. Key Points Long-term use of benzodiazepines and z-drugs can have adverse consequences, but research reports long-term use, particularly in older people 4  We identified seven themes from published qualitative research which add to our understanding of patients' experiences and perceptions of seeking and using these drugs, and factors perpetuating their use  Safer prescribing could be supported through education strategies for patients and healthcare professionals, increased availability of alternatives, and targeted extended dialogue between patients and healthcare professionals 5

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The epidemiology of long-term benzodiazepine use

Cited by 124 publications

References 24 publications

Disability pension as predictor of later use of benzodiazepines among benzodiazepine users

Disability pension as predictor of later use of benzodiazepines among benzodiazepine users

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

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

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