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. 2019 Jan 4;2(1):e187399.
doi: 10.1001/jamanetworkopen.2018.7399.

Patterns in Outpatient Benzodiazepine Prescribing in the United States

Sumit D Agarwal  1   2 , Bruce E Landon  3   4
Affiliations

Patterns in Outpatient Benzodiazepine Prescribing in the United States

Sumit D Agarwal et al. JAMA Netw Open. .

Erratum in

  • Incorrect Column Headings in 2 Tables.
    [No authors listed] [No authors listed] JAMA Netw Open. 2019 Mar 1;2(3):e191203. doi: 10.1001/jamanetworkopen.2019.1203. JAMA Netw Open. 2019. PMID: 30821820 Free PMC article. No abstract available.

Abstract

Importance: Benzodiazepines are implicated in a growing number of overdose-related deaths.

Objectives: To quantify patterns in outpatient benzodiazepine prescribing and to compare them across specialties and indications.

Design, setting, and participants: This serial cross-sectional study (January 1, 2003, through December 31, 2015) used nationally representative National Ambulatory Medical Care Survey data. The yearly population-based sample of outpatient visits among adults, ranging from 20 884 visits in 2003 (representing 737 million visits) to 24 273 visits in 2015 (representing 841 million visits) was analyzed. Prescribing patterns were examined by specialty and indication and used to calculate the annual coprescribing rate of benzodiazepines with other sedating medications. Data were analyzed from July 1, 2017, through November 30, 2018.

Main outcomes and measures: Annual benzodiazepine visit rate.

Results: Among the 386 457 ambulatory care visits from 2003 through 2015, a total of 919 benzodiazepine visits occurred in 2003 and 1672 in 2015, nationally representing 27.6 million and 62.6 million visits, respectively. The benzodiazepine visit rate doubled from 3.8% (95% CI, 3.2%-4.4%) to 7.4% (95% CI, 6.4%-8.6%; P < .001) of visits. Visits to primary care physicians accounted for approximately half of all benzodiazepine visits (52.3% [95% CI, 50.0%-54.6%]). The benzodiazepine visit rate did not change among visits to psychiatrists (29.6% [95% CI, 23.3%-36.7%] in 2003 to 30.2% [95% CI, 25.6%-35.2%] in 2015; P = .90), but increased among all other physicians, including primary care physicians (3.6% [95% CI, 2.9%-4.4%] to 7.5% [95% CI, 6.0%-9.5%]; P < .001). The benzodiazepine visit rate increased slightly for anxiety and depression (26.6% [95% CI, 22.6%-31.0%] to 33.5% [95% CI, 28.8%-38.6%]; P = .003) and neurologic conditions (6.8% [95% CI, 4.8%-9.5%] to 8.7% [95% CI, 6.2%-12.1%]; P < .001), but more so for back and/or chronic pain (3.6% [95% CI, 2.6%-4.9%] to 8.5% [95% CI, 6.0%-11.9%]; P < .001) and other conditions (1.8% [95% CI, 1.4%-2.2%] to 4.4% [95% CI, 3.7%-5.2%]; P < .001); use did not change for insomnia (26.9% [95% CI, 19.3%-36.0%] to 25.6% [95% CI, 15.3%-39.6%]; P = .72). The coprescribing rate of benzodiazepines with opioids quadrupled from 0.5% (95% CI, 0.3%-0.7%) in 2003 to 2.0% (95% CI, 1.4%-2.7%) in 2015 (P < .001); the coprescribing rate with other sedating medications doubled from 0.7% (95% CI, 0.5%-0.9%) to 1.5% (95% CI, 1.1%-1.9%) (P < .001).

Conclusions and relevance: The outpatient use of benzodiazepines has increased substantially. In light of increasing rates of overdose deaths involving benzodiazepines, understanding and addressing prescribing patterns may help curb the growing use of benzodiazepines.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Agarwal reported receiving salary support from National Research Service Award for Primary Care T32-HP10251 from the Health Resources and Services Administration and the Ryoichi Sasakawa Fellowship Fund. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Benzodiazepine Visit Rate in the United States
Error bars indicate 95% CI.
Figure 2.
Figure 2.. Benzodiazepine Visits by Specialty
Figure 3.
Figure 3.. Coprescribing Rate for Benzodiazepines With Opioids and Other Central Nervous System (CNS) Depressants
Error bars indicate 95% CI.
See this image and copyright information in PMC

References

    1. Bachhuber MA, Hennessy S, Cunningham CO, Starrels JL. Increasing benzodiazepine prescriptions and overdose mortality in the United States, 1996-2013. Am J Public Health. 2016;106(4):-. doi:10.2105/AJPH.2016.303061 - DOI - PMC - PubMed
    1. National Institute on Drug Abuse Overdose death rates. https://www.drugabuse.gov/related-topics/trends-statistics/overdose-deat.... Updated August 2018. Accessed October 3, 2017.
    1. National Center for Health Statistics Multiple cause of death 1999-2016. https://wonder.cdc.gov/wonder/help/mcd.html. Reviewed December 6, 2018. Accessed January 12, 2018.
    1. Johnson B, Streltzer J. Risks associated with long-term benzodiazepine use. Am Fam Physician. 2013;88(4):224-226. - PubMed
    1. Substance Abuse and Mental Health Services Administration (SAMHSA) Benzodiazepine abuse treatment admissions have tripled from 1998 to 2008. https://www.samhsa.gov/newsroom/press-announcements/201106091200. Updated November 25, 2018. Accessed May 1, 2018.

MeSH terms