Factors associated with long-term prescription of benzodiazepine: a retrospective cohort study using a health insurance database in Japan

Abstract

ObjectivesCurrent clinical guidelines discourage long-term prescription of benzodiazepines and Z-drugs (BZD); however, the practice continues to exist. The aim of this study was to investigate the proportion of long-term BZD prescriptions and its risk factors.DesignRetrospective cohort study using a health insurance database.SettingJapan.ParticipantsA total of 86 909 patients were identified as outpatients aged 18 to 65 years who started BZD between 1 October 2012 and 1 April 2015. After excluding patients who underwent surgery on the day of first BZD prescription (n=762) and patients without 8 months follow-up (n=12 103), 74 044 outpatients were analysed.Main outcome measuresWe investigated the proportion of long-term prescriptions for ≥8 months among new BZD users. We assessed patient demographics, diagnoses, characteristics of the initial BZD prescription and prescribers as potential predictors of the long-term BZD prescription. Multivariable logistic regression was performed to assess the association between long-term prescription and potential predictors.ResultsOf the new BZD users, 6687 (9.0%) were consecutively prescribed BZD for ≥8 months. The long-term prescription was significantly associated with mood and neurotic disorder, cancer, prescription by psychiatrists, multiple prescriptions, hypnotics and medium half-life BZD in the initial prescription.ConclusionDespite the recent clinical guidelines, 9% of new BZD users were given prescriptions for more than 8 months. Physicians should be aware of risk factors when prescribing BZDs for the first time.

Incidence of and Characteristics Associated With Long-term Benzodiazepine Use in Finland

“… 20 Previous studies have mainly assessed long-term BZDR use in prevalent users, whereas this study population included only incident BZDR users. Previous studies assessing new BZDR users have found that the incidence of long-term use is 11.8% in the general population, 33 9% among working-aged persons (requiring longer use periods of ≥8 months without gaps), 34 26% among older adults, 35 22% among persons with bipolar disorder, 29 and 30% among older persons with Alzheimer disease. 36 All of these estimates are lower than the 39.4% incidence reported in this study.…”

Are Seniors Dependent on Benzodiazepines? A National Clinical Survey of Substance Use Disorder

“…Many psychiatric disorders can have anxiety and insomnia symptoms (i.e., mood disorders, such as major depressive disorder (MDD), and anxiety disorders, such as generalized anxiety disorder (GAD)), and BZD/Z can alleviate these disabling symptoms 36 . Excessive and long‐term use of BZD have been found to be associated with psychiatric illnesses, such as MDD, anxiety disorders (such as GAD) and neuroticism 37–40 . It can be understood that BZD consumption is a severity marker of the underlying illness.…”

“…36 Excessive and long-term use of BZD have been found to be associated with psychiatric illnesses, such as MDD, anxiety disorders (such as GAD) and neuroticism. [37][38][39][40] It can be understood that BZD consumption is a severity marker of the underlying illness. In the same way, substance abuse is a well-known complication of anxiety disorder and mood disorder.…”

Factors Associated with Benzodiazepines Prolonged-Term Use in Post-Stroke Subjective Sleep Disturbance: A Single-Centre Retrospective Study from China

“…11 However, the prolonged use of BZD is common in the United States, 12 England, 13 France, 14 Germany, 15 and other areas of the world, 16 and has led to a serious public health problem. This worldwide dilemma is related to a series of factors, including demographic factors, 14 treatmentrelated factors, 17 psychological factors, 17 personalityrelated factors, 18 and some other factors. 19 Until now, the research community has not paid sufficient attention to the prolonged use of BZD in post-stroke insomniacs.…”

“…We selected these observation factors based on previous literature related to the prolonged use of BZD in other populations, post-stroke insomnia, 15,[17][18][19]38 and our own clinical practice.…”