Benzodiazepines overused, especially in elderly women

Benzodiazepines are frequently prescribed long-term and to elderly patients, despite guidelines to the contrary, a recent study found.

Researchers used a prescription database that includes about 60% of U.S. retail pharmacies to identify prescriptions for benzodiazepines in 2008 and then extrapolated the results to the U.S. population. Overall, about 5.2% of adults age 18 to 80 filled a prescription for a benzodiazepine in 2008, the study found. Study results were published by JAMA Psychiatry on Dec. 17.

Any benzodiazepine use increased with age, from 2.6% in 18- to 35-year-olds to 5.4% in 36- to 50-year-olds to 8.7% in 65- to 80-year-olds. Long-term benzodiazepine use (defined as receiving a prescription for 120 days of medication) also increased with each age group, from 14.7% in the youngest to 31.4% in the oldest. Use was nearly twice as prevalent in women as in men, and older patients were much less likely to get their prescription from a psychiatrist than younger ones. In all age groups, about a quarter of prescriptions were for a long-acting benzodiazepine.

The study shows that benzodiazepine use remains common, especially in older patients, despite evidence of risks including falls, fractures, and motor vehicle crashes, the study authors said. The data don't show why the prescriptions were written, but it's likely that many were intended to treat insomnia, despite guidelines indicating that benzodiazepines should only be used for severe and impairing insomnia on a short-term basis. Physicians' failure to follow the guidelines might be attributable to deficits in clinicians' knowledge, time, or access to alternatives or to patient unwillingness to consider alternatives.

It appears that guidelines are insufficient to dissuade physicians from prescribing benzodiazepines to older patients, so other strategies should be tried, the study authors said. For patients on the drugs, the authors recommended gradual withdrawal with psychotherapy, if possible, or at least sending a letter or email encouraging patients to stop or reduce use. Inappropriate prescriptions could put prescribers at liability risk, the authors said.

Benzodiazepines “fare little better than placebos” for effectiveness and are “far from safe,” an accompanying editorial said. To reduce inappropriate use, it may be necessary to restrict prescriptions of the drugs to psychiatrists or to categorize them as controlled substances, with limited-duration prescriptions with no refills, the editorialists concluded.