TOPLINE

Benzodiazepine dispensing decreased significantly between 2013 and 2024 in the US, with adults aged 18-29 years showing the steepest decline, a study of more than 1.1 billion prescription fills showed. Primary care physicians, pain medicine specialists, neurologists, and psychiatrists/mental health specialists dispensed fewer benzodiazepine prescriptions during this period, whereas advanced practice providers dispensed more prescriptions, and the mean dose dispensed per prescription declined across most patient age groups.

METHODOLOGY

• In a repeated cross-sectional analysis, investigators analyzed prescription fill data obtained from the IQVIA Longitudinal Prescription dataset in the US from 2013 to 2024.
• A total of 1,100,233,787 benzodiazepine prescription fills among 252,103,453 unique patients aged 2 years or older were analyzed to estimate the annual dispensing prevalence, prescription fill counts, and the mean total dose dispensed per prescription.
• Benzodiazepines included alprazolam, chlordiazepoxide, clobazam, clonazepam, clorazepate dipotassium, diazepam, estazolam, flurazepam, halazepam, lorazepam, midazolam, oxazepam, prazepam, quazepam, temazepam, and triazolam.
• The analysis was stratified by patient age groups (2-12 years, 13-17 years, 18-29 years, 30-44 years, 45-64 years, and 65 years or older) and prescriber types (primary care physicians, psychiatrists/mental health specialists, advanced practice providers, dentists/oral surgeons, neurologists, pain medicine specialists, and others).

TAKEAWAY

• The annual prevalence of benzodiazepine dispensing decreased by 26.7% (from 7.5% to 5.5%) from 2013 to 2024, with a sharper decline observed in adults (-28.3%) than in children and adolescents (-10.1%).
• Across age groups, the steepest relative decline in the prevalence of benzodiazepine dispensing was observed among adults aged 18-29 years (-44.8%), followed by those aged 30-44 years (-36.2%), 45-64 years (-29.4%), 65 years or older (-22.6%), and adolescents aged 13-17 years (-17.2%) from 2013 to 2024. A smaller relative decline was observed in children aged 2-12 years (-3.8%). However, the prevalence of dispensing antiseizure benzodiazepines increased from 2013 to 2024 among children (aged 2-12 years, from 0.4% to 0.8%) and adolescents (aged 13-17 years, from 0.9% to 1.3%).
• Declines in dispensing benzodiazepine prescriptions were the most pronounced among pain medicine specialists (-62.5%), primary care physicians (-44.3%), psychiatrists/mental health specialists (-38.3%), and neurologists (-9.2%). In contrast, dispensing increased among advanced practice providers (+101.5%), driven largely by nurse practitioners (+134.79%). In children and adolescents aged 2-17 years, neurologists increased benzodiazepine dispensing from 2013 to 2024.
• The mean dose dispensed per benzodiazepine prescription decreased across most patient age groups and prescriber types, with the sharpest relative reductions noted among young adults (-29.8%) and pain medicine specialists (-65.3%).

IN PRACTICE

"Our findings suggest that prescribing practices may have become more cautious or selective over the past decade, but continued monitoring is important to ensure that patients receive the safest care," lead author Naomi Cruz, PhD, Rutgers School of Public Health, New Jersey, said in a press release.

SOURCE

The study was published online on September 30 in The American Journal of Psychiatry.

LIMITATIONS

The study could not capture all US benzodiazepine prescriptions and lacked data on race or ethnicity, clinical indication, actual use, and coprescription trends. The study relied on data obtained annually, which limited the analysis from being conducted in a more detailed manner in terms of changes that coincided with the COVID pandemic. Given the absence of a prescriber workforce database, researchers could not estimate prescription prevalence within each prescriber type.

DISCLOSURES

Data were acquired through a project funded by the Preparedness and Treatment Equity Coalition and IQVIA, and the analysis was funded by The Pew Charitable Trusts. Disclosure information for the study investigators is available in the original study publication.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.