Benzodiazepine Use On The Rise to Treat Pain

Patients are increasingly using drugs in the benzodiazepine family to treat chronic pain, according to a recent cross-sectional study featured in JAMA Network Open.

Valium and Xanax are included in the benzodiazepine umbrella; benzodiazepines are often prescribed to treat anxiety and insomnia. But in the study, the researchers found an increase in benzodiazepine prescriptions from primary care physicians.

The researchers gathered data from the National Ambulatory Medical Care Survey, which collects information on adult outpatient visits, spanning Jan. 1, 2003, through Dec. 31, 2015.

https://twitter.com/BZInfoCoalition/status/1090633343052468225

During the study period there were 386,457 ambulatory care visits, including 919 benzodiazepine visits in 2003 and 1,672 in 2015, totaling a national representation of 27.6 million visits in 2003 and 62.6 million visits in 2015. Overall, just more than half of benzodiazepine visits were to primary care physicians (52.3% [95% CI, 50.0%-54.6%]). The rate of benzodiazepine visits nearly doubled from 3.8% (95% CI, 3.2%-4.4%) in 2003 to 7.4% (95% CI, 6.4%-8.6%; P < .001) in 2015. Benzodiazepine visits to psychiatrists did not significantly change during the study period (2003, 29.6% [95% CI, 23.3%-36.7%] vs. 2015, 30.2% [95% CI, 25.6%-35.2%]; P = .90), and increases were modest for anxiety and depression (2003, 26.6% [95% CI, 22.6%-31.0%] vs. 2015, 33.5% [95% CI, 28.8%-38.6%]; P = .003) and neurologic conditions (2003, 6.8% [95% CI, 4.8%-9.5%] vs. 2015, 8.7% [95% CI, 6.2%-12.1%]; P < .001); for insomnia, rates decreased slightly (2003, 26.9% [95% CI, 19.3%-36.0%] vs. 2015, 25.6% [95% CI, 15.3%-39.6%]; P = .72). However, all other physicians aside from psychiatrists saw increases—including primary care physicians (2003, 3.6% [95% CI, 2.9%-4.4%] vs. 2015, 7.5% [95% CI, 6.0%-9.5%]; P < .001)—and there was a jump in benzodiazepine visits pertaining to back and/or chronic pain (2003, 3.6% [95% CI, 2.6%-4.9%] vs. 2015, 8.5% [95% CI, 6.0%-11.9%]; P < .001) and other conditions (2003, 1.8% [95% CI, 1.4%-2.2%] vs. 2015, 4.4% [95% CI, 3.7%-5.2%]; P < .001). There were also significant increases in coprescribing benzodiazepines with other medications, including opioids (2003, 0.5% [95% CI, 0.3%-0.7%] vs. 2015, 2.0% [95% CI, 1.4%-2.7%]; P < .001) and other sedating medications (2003, 0.7% [95% CI, 0.5%-0.9%] vs. 2015, 1.5% [95% CI, 1.1%-1.9%]; P < .001).

https://twitter.com/instapsych/status/1092539509382750208

The uptick is important because there has also been an increase in benzodiazepine-related overdose mortality, the study authors noted, which went from 0.6 per 100,000 adults in 1999 to 4.4 per 100,000 adults in 2016. Non-fatal outcomes, including falls and fractures, motor vehicle crashes, and cognitive impairment, have also led to more benzodiazepine-related emergency department visits.

A concerning trend of increased #benzodiazepine prescribing across many settings and indications https://t.co/drbpBbqdXH

— Suzanne Nielsen PhD MPS (@DrSuziNielsen) February 5, 2019

“These risks are more pronounced when benzodiazepines are combined with alcohol, opioids, or other medications that affect the central nervous system (CNS),” the study authors added.

Despite the widespread use of benzodiazepine across multiple specialties, there are “surprisingly few guidelines” for it, according to the researchers.

“As we have seen with the opioid epidemic and in light of increasing death rates related to benzodiazepine overdose, addressing prescribing patterns may help curb the growing use of benzodiazepines,” the study authors concluded.

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Source: JAMA Network Open