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

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.