Receipt of Benzodiazepine Medications Not Commonly Associated With Long-term Use or Dose Escalation in a Danish Cohort

Benzodiazepine receptor agonists (BZRAs)—including benzodiazepines and Z-drugs—are commonly prescribed medications for insomnia and anxiety, but carry risk of physiologic dependence and unhealthy use. BZRAs are therefore generally recommended only for short-term use, although the prevalence of long-term receipt of BZRA medications and whether it is associated with dose escalation is not well understood. Researchers followed more than 4,000,000 persons aged 20–80 years from a Danish registry to examine: 1) the frequency and correlates of long-term receipt of BZRAs; and 2) the risk of dose escalation over time. BZRAs were sub-categorized as hypnotic benzodiazepines, anxiolytic benzodiazepines, or Z-drugs.

• Overall, 22 percent of the cohort (n=950,767) received BZRA medications. Of these individuals, 15 percent received them for more than one year; 3 percent were prescribed BZRAs for more than seven years.
• Z-drugs were the most common BZRA subtype to result in long-term use (18 percent for one year, 4 percent for seven years).
• Co-occurring substance use disorder was associated with increased likelihood of long-term BZRA receipt at one and seven years.
• Among persons with long-term continuous receipt of BZRAs, 7 percent experienced dose escalations higher than recommended guidelines.
• Co-occurring substance use disorder, dementia, and female gender were associated with BZRA dose escalation.

Comments: This study provides evidence that BZRA prescriptions do not necessarily result in long-term use or dose escalations. Given differences in population characteristics and provision of health care between Denmark and other countries, however, extrapolating these findings to other populations should be made with caution. Future research is needed to examine BZRA prescription patterns in the US and elsewhere.

Carrie Mintz, MD

Reference: Rosenqvist TW, Wium-Andersen MK, Wium-Andersen IK, et al. Long-term use of benzodiazepines and benzodiazepine-related drugs: a register-based Danish cohort study on determinants and risks of dose escalation. American J Psychiatry. 2024;181(3):246–254.