Benzodiazepines Are Prescribed More Frequently to Patients Already at Risk for Benzodiazepine-Related Adverse Events in Primary Care

J Gen Intern Med. 2016 Sep;31(9):1027-34. doi: 10.1007/s11606-016-3740-0. Epub 2016 May 13.

Abstract

Background: Benzodiazepine use is associated with adverse drug events and higher mortality. Known risk factors for benzodiazepine-related adverse events include lung disease, substance use, and vulnerability to fracture.

Objective: To determine whether benzodiazepine prescribing is associated with risk factors for adverse outcomes.

Design: Longitudinal cohort study between July 1, 2011, and June 30, 2012.

Participants: Patients who visited hospital- and community-based practices in a primary care practice-based research network.

Main measures: Odds ratio of having a target medical diagnosis for patients who received standard and high-dose benzodiazepine prescriptions; rates per 100 patients for outpatient and emergency department visits and hospitalizations.

Key results: Among 65,912 patients, clinicians prescribed at least one benzodiazepine to 15 % (9821). Of benzodiazepine recipients, 5 % received high doses. Compared to non-recipients, benzodiazepine recipients were more likely to have diagnoses of depression (OR, 2.7; 95 % CI, 2.6-2.9), substance abuse (OR, 2.2; 95 % CI, 1.9-2.5), tobacco use (OR, 1.7; 95 % CI, 1.5-1.8), osteoporosis (OR, 1.6; 95 % CI, 1.5-1.7), chronic obstructive pulmonary disease (OR, 1.6; 95 % CI, 1.5-1.7), alcohol abuse (OR, 1.5; 95 % CI, 1.3-1.7), sleep apnea (OR, 1.5; 95 % CI, 1.3-1.6), and asthma (OR, 1.5; 95 % CI, 1.4-1.5). Compared to low-dose benzodiazepine recipients, high-dose benzodiazepine recipients were even more likely to have certain medical diagnoses: substance abuse (OR, 7.5; 95 % CI, 5.5-10.1), alcohol abuse (OR, 3.2; 95 % CI, 2.2-4.5), tobacco use (OR, 2.7; 95 % CI, 2.1-3.5), and chronic obstructive pulmonary disease (OR, 1.5; 95 % CI, 1.2-1.9). Benzodiazepine recipients had more primary care visits per 100 patients (408 vs. 323), specialist outpatient visits (815 vs. 578), emergency department visits (47 vs. 29), and hospitalizations (26 vs. 15; p < .001 for all comparisons).

Conclusions: Clinicians prescribed benzodiazepines and high-dose benzodiazepines more frequently to patients at higher risk for benzodiazepine-related adverse events. Benzodiazepine prescribing was associated with increased healthcare utilization.

Keywords: anxiety; benzodiazepines; psychopharmacology; sleep disorders.

MeSH terms

  • Adult
  • Aged
  • Alcoholism / drug therapy
  • Alcoholism / epidemiology
  • Benzodiazepines / adverse effects*
  • Cohort Studies
  • Drug Prescriptions* / standards
  • Female
  • Humans
  • Longitudinal Studies
  • Lung Diseases / drug therapy
  • Lung Diseases / epidemiology
  • Male
  • Middle Aged
  • Patient Acceptance of Health Care*
  • Primary Health Care / standards
  • Primary Health Care / trends*
  • Risk Factors
  • Smoking / adverse effects
  • Smoking / epidemiology
  • Substance-Related Disorders / drug therapy
  • Substance-Related Disorders / epidemiology

Substances

  • Benzodiazepines