NIH. US: Despite known risks for older people, use of
benzodiazepines—a class of sedative and anti-anxiety medications—remains
common in this group. The findings raise questions about why so many
prescriptions are written for older adults when there are often safer
alternatives.
Practice guidelines now recommend psychotherapy approaches and
antidepressants as the initial treatment for anxiety. For insomnia,
guidelines recommend behavioral interventions as first treatment.
Despite the large number of benzodiazepine prescriptions in the
United States — 85 million in 2007 — relatively little has been known
about prescription patterns. Dr. Mark Olfson at the New York State
Psychiatric Institute and Columbia University, Dr. Marissa King at Yale
University, and Dr. Michael Schoenbaum at NIH’s National Institute of
Mental Health (NIMH) thus examined rates of benzodiazepine use by sex
and age.
The researchers examined prescription patterns from 2008 using
data from a national prescription database (IMS LifeLink LRx
Longitudinal Prescription database) and a national database on medical
expenditures collected by the Agency for Healthcare Research and
Quality. The study appeared online on December 17, 2014, in JAMA Psychiatry.
Among all adults ages 18 to 80 years, about 1 in 20 received a
benzodiazepine prescription in 2008. This fraction rose substantially
with age, from 2.6% among those 18 to 35, to 8.7% in those 65 to 80.
Long-term use—for more than 120 days—also increased markedly with age.
Of people 65 to 80 who used benzodiazepines, 31.4% received
prescriptions for long-term use, vs. 14.7% of adults 18 to 35.
In all age groups, women were about twice as likely as
men to receive benzodiazepines. Among women 65 to 80 years old, 1 in
10 was prescribed one of these medications, with almost a third of
those receiving long-term prescriptions.
Most prescriptions for benzodiazepines were written by
non-psychiatrists. Overall, about two-thirds of prescriptions for
long-term use were written by non-psychiatrists; for adults 65 to 80,
the figure was 9 out of 10.
“These medications can pose real risks, and there are often safer
alternatives available,” Schoenbaum says. “Our findings strongly
suggest that we need strategies to reduce benzodiazepine use,
particularly for older women.”