Use of benzodiazepines and z-drugs not compliant with guidelines and associated factors: a population-based study

Eur Arch Psychiatry Clin Neurosci. 2020 Feb;270(1):3-10. doi: 10.1007/s00406-018-0966-3. Epub 2018 Dec 11.


Benzodiazepines and z-drugs are primarily indicated for the treatment of sleep disorders and anxiety symptoms. Their frequent long-term use contrasts with the international guidelines that limit treatment duration to a maximum of 4 weeks. The objective of this study was to assess the frequency of their use that was not in accordance with guidelines in the French general population between 2007 and 2012 and associated characteristics. A cohort of 67,550 benzodiazepine new users was set up in an exhaustive database for health-care reimbursements and representative of the French population. Benzodiazepine use not in accordance with guidelines was defined as the concomitant dispensation of several benzodiazepines, the dispensation of treatment over a period longer than recommended, or a new dispensing within the 2 months following the end of a previous treatment of maximum recommended duration, considering that French recommendations distinguish between hypnotic (4 weeks) and anxiolytic benzodiazepines (12 weeks). Benzodiazepine use not in accordance with guidelines was high, in about 30% of new hypnotic users and 20% of new anxiolytic users. Its frequency was stable over the study period. Associated characteristics were similar for new hypnotic or anxiolytic users, i.e.. older age, treatment initiation by a psychiatrist, presence of a chronic disease, hospitalization, or another psychotropic treatment. These findings provide a solid basis for establishing a public health policy to reduce benzodiazepine use not compliant with guidelines. They should be further explored in patients most at risk in the present study, e.g., patients treated by a psychiatrist.

Keywords: Benzodiazepines; Cohort studies; Drug misuse; Health insurance claims database; Z-drugs.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Anti-Anxiety Agents / therapeutic use*
  • Azabicyclo Compounds / therapeutic use
  • Benzodiazepines / therapeutic use*
  • Cohort Studies
  • Drug Prescriptions / statistics & numerical data*
  • Female
  • France
  • Guideline Adherence / statistics & numerical data*
  • Humans
  • Hypnotics and Sedatives / therapeutic use*
  • Middle Aged
  • National Health Programs / statistics & numerical data*
  • Piperazines / therapeutic use
  • Sex Factors
  • Young Adult
  • Zolpidem / therapeutic use


  • Anti-Anxiety Agents
  • Azabicyclo Compounds
  • Hypnotics and Sedatives
  • Piperazines
  • zopiclone
  • Benzodiazepines
  • Zolpidem