Trends in the prescription of drugs used for insomnia: an open-cohort study in Australian general practice, 2011–2018

Abstract

Background: Despite an increase in the prevalence of sleep problems, few studies have investigated changes in the prescribing of drugs often used for managing insomnia. Aim: To explore changes in the pattern of benzodiazepine (BZD), z-drugs (zolpidem, zopiclone) and non-BZD prescriptions. Design and Setting: Open cohort study including 1,773,525 patients (55,903,294 consultations) regularly attending 404 Australian general practices from 2011-2018 (MedicineInsight). Method: Prescription rates per 1,000 consultations, the proportion of repeat prescriptions above recommendations, and the proportion of prescriptions for patients with a recent recorded insomnia diagnosis (i.e. within 2 years) were analysed using adjusted regression models. Results: Rates of BZD, z-drugs and non-BZD prescriptions were 56.6, 4.4 and 15.5/1,000 consultations in 2011 and 41.8, 3.5 and 21.5/1000 consultations in 2018, respectively. Temazepam represented 25.3% of the prescriptions and diazepam 21.9%. All BZD and zolpidem prescriptions declined from 2011-2018 [annual change varying from -1.4% to -10.8%], while non-BZD and zopiclone prescriptions increased in the same period [annual change: +5.0% to +22.6%]. Repeat prescriptions above recommendations remained below 10% for most medications, except melatonin (64.5%), zolpidem (63.3%), zopiclone (31.4%) and alprazolam (13.3%). In 2018, almost 50% of z-drugs and melatonin prescriptions were for patients with insomnia. There was 3.2%-5.9% annual increase in the proportion of prescriptions associated with a recently recorded insomnia diagnosis. Conclusion: Overall, BZD prescriptions in Australia declined from 2011-2018. However, the prescription of some of these drugs increased for patients with a recently recorded insomnia diagnosis. This is concerning because of potential adverse effects and risk of dependence.

Long‐term benzodiazepines and z‐drug prescribing in Australian general practice between 2011 and 2018: A national study

“…Also, we did not consider repeats for the investigated BZD prescriptions (approximately 10% of all BZD scripts provided in general practice between 2011 and 2018 had one or more repeats). 6 Our findings are consistent with results from other high-income countries, such as the US and Canada. 11,14 The odds of benzodiazapine use in the US between 1999 and 2014 increased for mediumterm (Odds Ratio [OR] = 1.45) and for long-term use (OR = 2.17).…”

“…32 A previous study using MedicineInsight data also showed that despite a decrease in total BZD and related drugs, there has been an increased proportion of patients with a clinical history of insomnia or sleep problems receiving these medications. 6 These findings are consistent with evidence of a recent qualitative paper examining GPs perceptions on managing insomnia. The 2020 study highlighted the challenges faced by GPs when they treat patients with long-term medication dependence, especially given that support services and referral pathways can be difficult to access.…”

“…Although previous Australian studies have suggested a reduction in the total number of BZD prescriptions, 5,6 our figures showed a 2.5% annual increase in long-term prescribing between 2011 and 2018. These results may be an underestimation of the real magnitude of the problem, given that prescriptions to patients included in our study by GPs and other health professionals who are not part of MedicineInsight, are not captured.…”

“…9 These findings coincide with a higher number of hospitalizations and deaths associated with BZD use in Australia, 34 despite an overall decline in their prescribing. 6 Long-term use of BZD is a particular problem especially among elderly women and could potentially be linked to the increased prevalence of chronic mental health issues and use for insomnia management. To reduce harm, especially in the elderly, there should be availability of non-pharmacological approaches to help avoid BZD initiation, as well as access to programs to help with cessation of long-term BZD use.…”

Acupuncture treatment of hypertension with insomnia

“…Simultaneously, most drugs mainly effect on anti-anxiety, sedation and hypnosis, and long-term use may produce adverse reactions and drug dependence. [ 5 ] In addition, it is easy to relapse or appear withdrawal symptoms after drug stopping. [ 6 ] Acupuncture is an important part of traditional Chinese medicine, and has been widely used in China and some western countries.…”