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Benzodiazepine prescriptions increased among Swedish youth

Between 2006 and 2013, the prevalence rate of benzodiazepine dispensation among youth aged 24 years and younger increased by 22% in Sweden, data published in PLOS Medicine revealed.

In addition, more than 75% of over 100,000 participants were dispensed other psychotropic medication simultaneously with a benzodiazepine, and 30% were prescribed benzodiazepines for longer than 6 months, according to the study.

“Despite being scarce, studies on pediatric [benzodiazepine] use raise a series of concerns, in particular related to inappropriate prescriptions, concurrent use of psychotropic drugs, changes in the characteristics of the prescribers towards a higher involvement of nonpsychiatrists and primary care physicians, and long-term use,” Anna Sidorchuk, PhD, of the Centre for Psychiatry Research at Karolinska Institutet, Stockholm, and colleagues wrote. “It is important to establish predictors and attributes of benzodiazepine prescribing patterns in these age groups to serve as an evidence base for guiding clinicians in their prescribing practices.”

Researchers evaluated the prevalence rates, rate changes over time and prescribing patterns for benzodiazepine dispensation in Swedish youth from 2006 to 2013. They also assessed demographic, clinical, pharmacological and prescriber-related aspects of benzodiazepine prescribing in this population.

The investigators collected data from three nationwide Swedish health and administrative registers on 17,500 children aged 11 years and younger, 15,039 teenagers aged 12 to 17 years and 85,200 young adults aged 18 to 24 years with at least one dispensed prescription for a benzodiazepine. They adjusted age-specific yearly prevalence rates of benzodiazepine dispensations for population growth and analyzed how dispensation varied by sex, psychiatric morbidity, simultaneous psychotropic drug prescription, type of benzodiazepine and health care provider type. Prescribing patterns were measured by duration, dosage and user category (regular, heavy or occasional users).

Between 2006 and 2013, the prevalence rate of benzodiazepine dispensation among children and young adults increased by 22%, from 0.81 per 100 people to 0.99 per 100 people. This surge in benzodiazepine prevalence rates was attributable to a steady rise in the rate among young adults, with more modest increases in children and teenagers, according to the results.

Overall dispensation of benzodiazepine anxiolytics and clonazepam dropped over time within each age category, whereas prescription of benzodiazepine hypnotics/sedatives (including Z-drugs) rose between the allotted time period.

Of 117,739 participants with dispensed prescriptions, 65% initiated benzodiazepine prescriptions outside of psychiatric services in primary care or nonpsychiatric specialty settings (92% of children, 60% of adolescents 60% of young adults). In addition, 76% were dispensed other psychotropic medications simultaneously along with a benzodiazepine (46% of children, 80% of adolescents and 81% of young adults).

Almost 30% of the participants were prescribed a benzodiazepine for longer than 6 months (18% of children, 31% of teens and 31% of young adults). Sidorchuk and colleagues observed high-dose prescription in 2.6% and heavy use in 1.7% of participants.

“It is critical to improve prescribing practices through close monitoring of [benzodiazepine] utilization in young people, strengthening the adherence to [benzodiazepine] prescribing guidelines among primary care practitioners and other nonpsychiatric specialists, and improving communication between nonspecialized care and specialized psychiatric services,” the authors concluded. – by Savannah Demko

Disclosure: Sidorchuk reports financial support from the health care commissioner in the Stockholm County Council. Please see the study for all other authors’ relevant financial disclosures.