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A study published in the Journal of General Internal Medicine found that standard and high-dose benzodiazepines were prescribed more often to patients at higher risk for benzodiazepine-related adverse events.
Use of benzodiazepines is tied to adverse drug events and increased mortality. Risk factors such as lung disease, substance abuse, and vulnerability to fracture, have been associated with benzodiazepine-related adverse events. Researchers from Harvard Medical School aimed to determine whether benzodiazepine prescribing was associated with risk factors for adverse effects.
Study authors conducted a longitudinal cohort study between July 1, 2011 and June 30, 2012 of patients who visited hospital- and community-based practices in a primary care practice-based research network. The main outcome measure was the odds ratio of having a target diagnosis for patients who received standard and high-dose benzodiazepines, and rates per 100 patients for outpatient and emergency department visits and hospitalizations.
Of the total 65,912 patients in the study, clinicians prescribed at least 1 benzodiazepine to 15% (n=9,821), of which 5% received high doses. Those who received benzodiazepines were more likely to be diagnosed with depression (odds ratio [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 those who did not receive benzodiazepines.
In addition, patients who received high-dose benzodiazepines had an even higher likelihood of having 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), compared to those who received low-dose benzodiazepines. There were 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<0.001 for all values) in the benzodiazepine recipients vs. non-recipients, respectively.
The researchers concluded that benzodiazepine prescribing was associated with higher healthcare utilization.
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