Benzodiazepine Use Highest in Older Americans

Pam Harrison

December 17, 2014

Despite inherent risks and questionable efficacy, long-term use of the benzodiazepines steadily increases with age among US residents, and their use is especially prevalent among older women, new research shows.

Investigators led by Mark Olfson, MD, MPH, College of Physicians and Surgeons of Columbia University, New York City, report that in 2008, 5.2% of US adults aged 18 to 80 years used benzodiazepines.

This use increased from 2.6% in individuals aged 18 to 35 years to 5.4% for those between 36 and 50 years of age.

Some 7.4% of individuals between 51 and 64 years of age also used benzodiazepines, as did 8.7% of those between the ages of 65 and 80 years.

The highest rate of use, at 11.9%, was observed among 80-year-old women.

A similar pattern of increasing use with age was seen in the proportion of individuals using benzodiazepines long-term.

The study was published online December 17 in JAMA Psychiatry.

Legal Liability

Defining long-term use as filling at least 120 days of supply during the study year, investigators found that 14.7% of young adults used benzodiazepines long-term compared with 31.4% of older adults.

"Most individuals with long-term benzodiazepine use received all of their benzodiazepine prescription from nonpsychiatrist prescribers," the authors write.

The majority of patients filling benzodiazepine prescriptions received short-acting benzodiazepines.

"Physicians should...be cognizant of the legal liability risk associated with inappropriate benzodiazepine prescription," the authors caution.

"Unless greater clinical attention is devoted to reducing long-term use of benzodiazepines by older primary care patients in the United States, this practice and its attendant risks are likely to increase as the population ages in the coming years."

Little Better Than Placebo

In an accompanying editorial, Nicholas Moore, MD, PhD, and colleagues from the University of Bordeaux, in France, point out that the benzodiazepines "fare little better than placebo" when used for the treatment of insomnia and anxiety, the main indications for their use.

"After an initial improvement, the effect wears off and tends to disappear," they write.

When patients try to discontinue their use, they experience withdrawal insomnia and anxiety, so that after only a few weeks of treatment, "patients are actually worse off than before they started (or at least not better) and cannot stop taking the drug," the authors add.

This might not be a problem if the benzodiazepines were safe with prolonged use.

However, as the editorialists point out, these drugs are "far from safe" and have been associated with both falls and hip fractures among other important side effects, both of which increase with age.

"Benzodiazepines are drugs that should be used at most for a few days or weeks in selected patients, carefully monitored and stopped as soon as possible," Dr Moore and colleagues write.

They should be used only for a very short period or avoided altogether in those who are most susceptible to falls and fractures.

It may also be time to restrict prescription of the benzodiazepines to psychiatrists; the current study suggests that psychiatrists were prescribing the drugs appropriately.

Alternatively, benzodiazepines might be considered in the same light as other dangerous addictive substances and limited to a tight dispensation schedule.

The study was funded by contracts from the National Institutes of Health to Yale University and Columbia University, as well as by other noncommercial sources.

JAMA Psychiatry. Published online December 17, 2014.

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