TOPLINE

Initial benzodiazepine prescriptions longer than 7 days were associated with prolonged use and a lower likelihood of discontinuation compared with shorter courses, a large cohort study showed. However, prescribing a single benzodiazepine and using short-acting agents were associated with a lower likelihood of long-term use.

METHODOLOGY

• A population-based retrospective cohort study used data for more than 1.8 million adults (median age, 53 years; 63% women) in Canada with new benzodiazepine prescriptions between 2013 and 2020.
• The first prescription duration was categorized as 7 days or less (reference), 8-14 days, 15-30 days, or more than 30 days. The duration of action (short-acting, long-acting, or both), number of benzodiazepines dispensed (one vs two or more), and the mean daily dose in diazepam milligram equivalents (DMEs) were also analyzed.
• Because long-term use of benzodiazepines has been linked previously to increased morbidity and mortality, the primary outcome in the current analysis was benzodiazepine discontinuation, defined as no new benzodiazepine dispensing within 1.5 times the days’ supply of the last prescription or a minimum of 30 days, until death, 3 years from cohort entry, or the end of 2021.
• The analysis was adjusted for demographics, prescriber discipline, and the presence of concurrent mental health conditions or comorbidities.

TAKEAWAY

• The median time to benzodiazepine discontinuation was 19 days. Compared with durations of 7 days or less, longer durations of index prescriptions were associated with reduced likelihood of benzodiazepine discontinuation, including 8-14 days (adjusted hazard ratio [aHR], 0.54), 15-30 days (aHR, 0.26), and longer than 30 days (aHR, 0.14).
• Compared with short-acting benzodiazepines alone, prescription of short-acting and long-acting benzodiazepines together (aHR, 0.84) and long-acting benzodiazepines alone (aHR, 0.80) were linked to reduced likelihood of discontinuation.
• Initial prescription of two or more vs a single benzodiazepine was also associated with reduced odds of discontinuation (aHR, 0.59).
• Compared with mean daily doses of 5 or less DMEs, doses exceeding 20 DMEs were linked to reduced likelihood of discontinuation (aHR, 0.98), and doses from 6 to 20 DMEs were linked to increased likelihood of discontinuation (aHR, 1.03).

IN PRACTICE

“These findings suggest that simple changes to prescribing practice including limiting initial prescriptions to < 7 days and choosing a single, short-acting agent could reduce prolonged benzodiazepine use and associated morbidity and mortality,” the investigators wrote.

SOURCE

This study was led by Nikki Bozinoff, MD, Centre for Addiction and Mental Health in Toronto, Ontario, Canada. It was published online on June 18 in PLoS Medicine.

LIMITATIONS

The study relied on pharmacy dispensing records and assumed individuals took medications as prescribed, which could result in misclassification of exposure variables and outcomes. Z-drugs were excluded from analysis, potentially resulting in misclassification, and the use of other psychiatric drugs was not included. Last, the study’s observational design limits causal inference, and residual confounding cannot be excluded. 

DISCLOSURES

This study was funded by a Womenmind grant. Disclosure information for the study investigators is available in the original article.

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