Use of benzodiazepines and related drugs in Manitoba: a population-based study

Abstract

Background: Despite their favourable toxicology profile, benzodiazepines and the related Z-drugs (zopiclone, zolpidem and zaleplon) have been associated with physiological tolerance, dependence and addiction. Evidence of harm (e.g., falls, motor vehicle collisions and cognitive disturbances) has been reported in older populations. The aim of this study was to determine the relation between users' characteristics and the use of benzodiazepines and Z-drugs in Manitoba over a 16-year period. Methods:This time-series analysis was based on prescription data from Apr. 1, 1996, to Mar. 31, 2012, obtained from the Drug Product Information Network database of Manitoba. We obtained sociodemographic information on benzodiazepine and Z-drug users from the Population Registry and determined changes in utilization rates over time using generalized estimating equations.Results: Overall, the prevalence of benzodiazepine use remained stable at about 61.0 per 1000 population between 1996/97 and 2011/12; however, the prevalence of Z-drug use increased steadily from 10.9 to 37.0 per 1000 over the same period. In older people (≥ 65 yr), the incidence of benzodiazepine use decreased from 55.5 to 30.3 users per 1000, whereas the incidence of Z-drug use increased from 7.3 to 20.3 users per 1000 over the study period. Among those 18-64 years of age, the incidence of benzodiazepine use decreased from 30.1 to 27.6 users per 1000, but the increase in incidence of Z-drug use was more than 2-fold. The youngest population (≤ 17 yr) showed the lowest rates of use of these drugs. The highest rates of use were observed among older women and the low-income population.Interpretation: Over the study period, benzodiazepines have been prescribed less frequently to older patients in Manitoba; however, zopiclone prescribing has continued to increase for all age groups. The reasons for this increase remain to be determined. AbstractCMAJ OPEN, 2(4) E209 Research CMAJ OPEN Methods Study populationAll Manitoba residents registered with the provincial health care system who were prescribed a benzodiazepine or a Z-drug between 1996/97 and 2011/12 were included. No age restrictions were applied, but patients were stratified by sex and age (0-17, 18-64 and ≥ 65 yr). Location of residence (urban v. rural) and socioeconomic status were also assessed. According to validated definitions, 23 incident (new) users were defined as people who had not received a prescription for any of the medications of interest in the year before receiving their first prescription, while prevalent users for each fiscal year were defined as people who had received at least 1 pres cription for a medication of interest that year.

Long-term sedative use among community-dwelling adults: a population-based analysis

“…3,50 Similar to previous studies, 7,8,14,20,51 we found adults had increased odds of long-term sedative use if they were women, if they had low incomes and if they had relatively poor health status. We also found that having a surname of Chinese or South Asian origin was associated with a protective effect on the odds of long-term sedative use.…”

“…Moreover, because some prescriptions will be written but not filled, this measure is arguably an understatement of the extent of long-term sedative prescribing in BC. Although our findings mirror recent trends in total benzodiazepine and z-drug dispensations from another Canadian province, 8 it is important to note that they are based on BC's population and may not be generalizable to other jurisdictions with different prescription monitoring programs and deprescribing strategies in place.…”

Benzodiazepine and Z‐drug prescribing in Ireland: analysis of national prescribing trends from 2005 to 2015

“…This study examined prescribing trends for benzodiazepines and Z‐drugs in Ireland from 2005 to 2015 using national pharmacy claims data for the GMS population aged ≥16 years. An overall significant reduction in benzodiazepine prescribing was observed, coupled with significant increases in Z‐drug prescribing, which mirrors trends observed in other countries . However, it is difficult to make direct comparisons between the observed prescribing rates and those reported in other countries because of differences in the nature of the dataset, sample population and time periods examined .…”

National Trends in Antidepressant, Benzodiazepine, and Other Sedative-Hypnotic Treatment of Older Adults in Psychiatric and Primary Care

“…34–37 , though international findings about benzodiazepine prescribing have been more mixed. 34,35,38,39 …”