February 7, 2019

Troubling Trends for Benzodiazepines

Benzodiazepines are a class of psychoactive drugs with sedative properties, often prescribed in workers’ comp for the treatment of anxiety, muscle spasms, insomnia, neuropathic pain and other indications. Though benzodiazepines have their place in care, they are not meant to be taken long-term due to adverse effects such as cognitive impairment, physical dependence, respiratory depression, overdose, and more.

And while the opioid epidemic has dominated headlines due to rampant harm, problematic concerns surrounding other prescription drugs still grow, and benzodiazepines are seeing increases in prescribing, use, misuse, and overdose.

A new study from the Journal of the American Medical Association (JAMA) examined 386,457 ambulatory care visits from 2003-2015, taken from the National Ambulatory Medical Care Survey, finding that benzodiazepine prescribing has nearly doubled, occurring in 3.8% of visits in 2003 and 7.4% of visits in 2015. It should be noted that the results in JAMA are not reflective of the workers’ compensation population specifically - however the overall trend of increased prescribing is worth noting.

While prescribing trends remained steady among psychiatrists, they increased among all other types of physicians, doubling for primary care physicians, who prescribed half of all benzodiazepine prescriptions.

Prescribing rates for anxiety and depression diagnoses increased from 26.6% to 33.5%. But also of note is that prescribing also increased for some conditions commonly seen in workers’ comp –prescribing for back and/or chronic pain more than doubled. Co-prescribing of benzodiazepines and opioids, a dangerous and potentially fatal combination, also increased.

And unfortunately, more prevalent prescribing seems to be contributing to a higher incidence of overdose deaths, especially as research by the American Journal of Public Health, looking at data from the Medical Expenditure Panel Survey from the Centers for Disease Control, found that the rate of overdose deaths involving benzodiazepine quadrupled from 1996-2013.

Patient-solicited data also supports that more Americans are using benzodiazepines. A recent study from Psychiatric Services examined 2015 and 2016 data from the National Survey on Drug Use and Health, limiting results to adults aged 18 and older, finding that 30.6 million Americans, or 12.6% of the population, reported using a least one benzodiazepine within a year of taking the survey.

The study also found that misuse accounted for nearly 20% of benzodiazepine use overall, with 5.3 million adults, or 2.2% of the population, misusing benzodiazepines. The misuse rate was particularly higher among adults aged 18-25 at 5.2%, and lower for adults 65 and up at 0.6%. However, those aged 50-64 saw the highest rate of prescribing at 12.9%. Other studies indicate that benzodiazepine use is twice as prevalent in women than men, sending more women to emergency rooms than men, making population analysis critical.

Commonly prescribed benzodiazepines include Xanax (alprazolam), Valium (diazepam), and Atvian (lorazepam). JAMA claims that alprazolam is the most commonly misused benzodiazepine, and that the most commonly cited reasons for benzodiazepine misuse was relaxation and help sleeping, with older adults in particular using benzodiazepine for insomnia.

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