Use of benzodiazepines and benzodiazepine‐related drugs in the Nordic countries between 2000 and 2020

Abstract

Use of benzodiazepines (BZ) and related drugs is subject to considerable debate due to problems with dependency and adverse events. We aimed to describe and compare their use across the Nordic countries. Data on the use of clonazepam, BZ‐sedatives, BZ‐hypnotics, and benzodiazepine‐related drugs (BZRD) in adults (≥20 years) were obtained from nationwide registers in Denmark, Finland, Iceland, Norway, and Sweden, 2000–2020. Main measures were therapeutic intensity (TI:DDD/1000 inhabitants [inhab.]/day) and annual prevalence (users/1000 inhab./year). Overall, TI of BZ and related drugs decreased in all Nordic countries from 2004 to 2020. However, there were considerable differences between countries in TI. In 2020, the TI of BZ and related drugs ranged from 17 DDD/1000 inhab./day in Denmark to 93 DDD/1000 inhab./day in Iceland. BZRD accounted for 55–78% of BZ use in 2020, followed by BZ sedatives at 20–44%, BZ‐hypnotics at <1–5%, and clonazepam at <1–2%. Annual prevalence of BZ use increased with age in all countries, and the highest annual prevalence was observed among people ≥80 years. Overall, the use of BZ and related drugs has decreased in all Nordic countries from 2004 to 2020, however, with considerable differences in their use between countries. The highest prevalence was observed among the oldest age groups—despite warnings against their use in this population.

Use of Antidepressant and Anxiolytic Drugs in Scandinavian Countries between 2006 and 2021: A Prescription Database Study

“…These could have resulted in a greater reduction in their use compared to the other two countries. Despite documented adverse events in the older population, including increased risk of falls [19] and cognitive impairment [36], BZD use still remains high in these age groups in Europe [11], Canada [37], and the USA [38]. A recent drug use study showed that the highest BZD use was in older age groups (≥80 years) in all Nordic countries [11], and the results are in agreement with the findings in this study.…”

“…In 2020, Scandinavian countries ranked among the top ten users of antidepressants in Europe while exhibiting lower anxiolytic use compared to other countries [8]. Despite their comparable culture, economies [9], and prevalence of common mental health disorders (i.e., depression and anxiety) [10], recent studies suggest differences both in overall use and age-specific use of antidepressants and anxiolytics between Scandinavian countries over the last two decades [11][12][13]. Notably, the use of anxiolytics reduced overall in Scandinavia from 2004 to 2020, but the decrease was most marked in Denmark, compared to Norway and Sweden [11].…”

“…Despite their comparable culture, economies [9], and prevalence of common mental health disorders (i.e., depression and anxiety) [10], recent studies suggest differences both in overall use and age-specific use of antidepressants and anxiolytics between Scandinavian countries over the last two decades [11][12][13]. Notably, the use of anxiolytics reduced overall in Scandinavia from 2004 to 2020, but the decrease was most marked in Denmark, compared to Norway and Sweden [11]. A population-based study including nearly one million individuals aged 5-19 years reported an over twofold increase in the prevalence of antidepressant users (from 9.3 to 18.0 users per 1000 inhabitants) in Sweden and a smaller rise in Norway, while there was a decrease in Denmark from 2007 to 2017 [12].…”

“…The available register data [21] and compatibility between Norway, Sweden, and Denmark [10] allow us to examine and compare trends in antidepressant and anxiolytic use across countries and over time. Earlier studies have been limited to specific populations [12,15,22], one drug class [11,15], one country [15,23,24], or had shorter study periods [15,23]. To inform future initiatives on drug prescription, revision of clinical guidelines, or allocation of economic resources, investigations of variation in drug use in general populations are needed.…”

High Prescribing and State-Level Variation in Z-Drug Use Among Medicare Patients

“…Therefore, it is clear that in 2018 a significant number of Medicare enrollees received Z-drug prescriptions that were inconsistent with the Beers Criteria and FORTA List. Other research in Nordic countries has found that the use of Z-drugs was highest for those over the age of 80 [22]. As this report was limited to Medicare Part D patients in the US, further research with other databases, including electronic health records, will be necessary to identify additional subsets of Medicare patients where guidelines were not applicable, as well as determination of patient subgroups (e. g., nursing home residents and obese patients) at greatest risk of receiving potentially inappropriate Z-drug prescriptions.…”