Benzodiazepines, psychoactive drugs used to treat anxiety, insomnia, and stress (eg. Xanax, Ativan, and Klonopin), have become much more popular over the past decade. The increasing pervasiveness of benzodiazepines (as well as concern about potential overprescribing) has some policymakers and patients wondering how much benzo prescribing has increased, who is prescribing benzos, and for what indications?
Fortunately, a new study from Harvard Medical School researchers Dr. Sumit Agarwal and Dr. Bruce Landon (former Lown Conference speaker) answers these questions. Agarwal and Landon looked at a nationally representative sample of 386,457 outpatient visits from 2003 – 2015 to identify benzodiazepine prescribing patterns.
What they found was unsettling. Overall, outpatient visits in which a benzodiazepine was prescribed doubled from 3.8% of visits in 2003 to 7.4% in 2015. While most of the prescriptions were for FDA-approved indications, such as anxiety and depression, the largest increases in prescribing were for non-FDA-approved indications, such as back pain and chronic pain. Additionally, while benzo prescriptions by psychiatrists remained stable, the proportion of primary care visits in which benzos were prescribed more than doubled.
What does this tell us about the use of benzodiazepines in the U.S.? It seems as though benzos are being increasingly prescribed for conditions for which opioids used to be prescribed, like chronic pain. It’s possible primary care doctors have the perception that opioids are risky but benzos are “safe.” However, there are real risks to prescribing benzos long term, including physical dependence and debilitating withdrawal symptoms. Also, the use of benzos along with opioids can lead to overdose and death, as demonstrated by the skyrocketing rate of overdoses involving benzos over the past decade.
This also shows that primary care doctors are increasingly tasked with treating patients with chronic pain and mental health issues, and are turning to benzos as one answer. Primary care physicians usually do not have the time, resources, or training to handle a large number of chronic pain patients, noted Dr. Anna Lembke, associate professor of psychiatry at Stanford University School of Medicine, in an NPR interview.
As we implement policies to reduce opioid overprescribing, we have to also increase awareness of the potential harms of benzodiazepines, especially for long-term use, as well as give primary care physicians more non-pharmacological treatment options for chronic pain.