Benzodiazepine Discontinuation is Associated With Increased Mortality and Other Negative Outcomes

Benzodiazepine medications are commonly prescribed and their use may be associated with harms, including overdose death. However, discontinuation of benzodiazepine medications may be risky. This retrospective study used 2013–2019 commercial US health insurance claims data to examine the risk of death and other outcomes associated with benzodiazepine discontinuation among individuals who were prescribed benzodiazepines at a stable dose for over a year at baseline and followed for another year, stratified by presence of an additional opioid prescription. The analysis adjusted for a number of potential confounders including age, sex, benzodiazepine dose, psychiatric and substance use disorders.

• Of the 297,853 individuals prescribed benzodiazepines included in this study, 40 percent had at least one opioid medication prescription within the last 30 days of the baseline period. Of these patients, 60,297 (20 percent) experienced benzodiazepine discontinuation during the one-year follow-up. The methods of discontinuation were not specified.
• In adjusted analyses among all patients, benzodiazepine discontinuation was associated with an increased risk of mortality (risk ratio [RR], 1.6).
• Benzodiazepine discontinuation was also associated with an increased risk of nonfatal overdose (RR, 1.2), emergency department use (RR, 1.2), and suicidal ideation (RR, 1.4), regardless of opioid medication receipt.

Comments: Benzodiazepine medications, like opioids, should be prescribed judiciously. However, as is also the case with opioid medications, it appears that benzodiazepine discontinuation can be risky. Other factors that may influence risk include the reason for discontinuation, how this was done (e.g., rapid versus slow taper), and receipt of other medications and supports during the taper period.

Lia Penn, MD* & Darius A. Rastegar, MD

*Contributing editorial intern and addiction medicine fellow, Johns Hopkins Medicine

Reference: Maust DT, Petzold K, Strominger J, et al. Benzodiazepine discontinuation and mortality among patients receiving long-term benzodiazepine therapy. JAMA Network Open. 2023;6(12):e2348557.