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Benzodiazepine use among US adults higher than previously reported

Donovan T. Maust

The prevalence of benzodiazepine use among adults in the United States was higher than previously reported, according to a study analyzing data from the National Survey on Drug Use and Health.

Furthermore, the analysis found that the prevalence of benzodiazepine use among adults aged 50 to 64 years exceeded the prevalence among those aged 65 years and older, the group that historically had the highest benzodiazepine use.

“There have been recent increases in benzo-related poisonings (overdoses), which suggests that people may be either taking benzos that they weren’t prescribed or they are taking them other than as-prescribed, since an overdose is obviously not the goal of medication treatment,” Donovan T. Maust, MD, from the department of psychiatry, University of Michigan, Ann Arbor, told Healio Psychiatry.

“Most surveys or other data used to determine the prevalence of benzo-prescribing only assess prescription use, which may lead to underestimates of use,” he continued. “Finally, while benzos are most commonly prescribed to older adults, and they are regulated by the Drug Enforcement Agency due to the potential for misuse or abuse, there previously was actually very little information about how common benzo misuse is among older adults.”

Maust and colleagues conducted a cross-sectional analysis of 2015 and 2016 National Survey on Drug Use and Health data to determine the prevalence of benzodiazepine use and misuse. They also measured substance use disorders, mental illness and demographic characteristics, and compared rates of misuse between younger and older adults (age 18 to 49 years vs. 50 years and older).

Analysis revealed that an estimated 30.6 million adults per year reported past-year benzodiazepine use in the United States and the overall prevalence was 12.6% (95% C1, 12.2-12.9). Of these adults reporting past-year use, 25.3 million reported using benzodiazepines as prescribed (prevalence = 10.4%) and 5.3 million reported misuse (prevalence = 2.2%). In addition, benzodiazepine misuse accounted for 17.2% of overall use, according to the findings. Maust said that alcohol, tobacco and marijuana use increased the likelihood of misuse.

Misuse was highest among those aged 18 to 25 years, with the majority of benzodiazepine use among these younger respondents attributable to misuse (5.2%, 95% CI, 4.8-5.6). Benzodiazepine use as prescribed was highest among adults aged 50 to 64 years (12.9%).

“Use among 50- to 64-year-olds now matches that of those 65 years and older, which did not use to be the case. Given a variety of evidence-based alternatives it is concerning that use is so high in a group that will ’age into’ the particular risks of benzos for older adults,” Maust said.

The study also highlighted that:

• Women and white respondents reported the highest rates of any past-year use.
• Past-year mental illness and poor self-rated health were linked to greater risk for any use.
• The most common reasons respondents reported misuse were to relax/relieve tension or help with sleep.

“Fortunately, misuse is relatively uncommon among older adults, which should be reassuring for clinicians,” Maust told Healio Psychiatry. “After free from a friend or relative, ‘one clinician’ was survey respondents’ second-most common source of the misused benzos, so clinicians just need to be mindful of how patients are actually taking the medication they are prescribing.” – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.