Many individuals who initiate benzodiazepines, related drugs have subsequent long-term use

Incidence of subsequent long-term benzodiazepine and related drug use following their initiation appeared high, according to results of a population-based cohort study published in JAMA Network Open.

“Despite all the recommendations, a vast amount of literature shows that long-term use is still very common, especially in older patients, and further research on the topic is needed to optimize the use of [benzodiazepines and related drugs] (BZDRs),” Heidi Taipale, PhD, of the department of forensic psychiatry at the University of Eastern Finland, and colleagues wrote. “Among older persons, BZDR use has been associated with cognitive and psychomotor adverse effects and an increased risk [for] falls, fractures and even mortality. General factors associated with long-term BZDR use, according to previous studies, include sex, comorbid conditions, older age, lower income and poorer health status.”

Results of prior studies suggested problems related to specific substances, such as alprazolam and clonazepam, as well as concerns regarding the increasing use of benzodiazepine-related drugs, specifically zolpidem. However, data are lacking regarding clinical decision-making for initiation of BZDRs, renewing prescriptions and attempting discontinuation of use.

Taipale and colleagues sought to evaluate the incidence of long-term BZDR use, as well as factors linked to its development. They analyzed data of new users of BZDRs aged 18 years or older who they identified via the prescription register maintained by the Social Insurance Institution of Finland and conducted follow-up until death, long-term hospitalization, a 2-year gap in BZDR use or December 31, 2015. The investigators conducted the analysis according to age at treatment, which was divided into subcohorts with participants aged 65 years and younger or 65 years and older. They used Cox proportional hazards models to compare long-term BZDR use of 180 days or longer and factors associated with long-term vs. short-term use.

Data were available of 129,732 incident users of BZDR, for whom the mean age was 52.6 years and of whom 60.1% were women. Results showed 39.4% of BZDR users became long-term users during the follow-up period. The older subcohort was more likely than the younger subcohort to engage in long-term treatment. A total of 28,586 (22%) individuals had become long-term users at 6 months, with 11,805 in the older subcohort and 16,781 in the younger subcohort. Individuals who initiated treatment with nitrazepam, temazepam, lorazepam or clonazepam comprised the largest proportions of initiators who became long-term users. Male sex, older age, receipt of social benefits, psychiatric comorbidities and substance abuse were linked to the development of long-term use.

“These results are valuable for optimization of BZDR treatment in clinical practice, for algorithms designed for knowledge-based treatment decisions and in the early consideration of potential clinical and sociodemographic risk factors when prescribing BZDRs for the first time,” Taipale and colleagues wrote.