The prevalence of benzodiazepine dispensing in the U.S. fell 26.7% from 2013 to 2024, with the largest relative decline among adults ages 18-29, according to a study published Sept. 30 in the American Journal of Psychiatry.
Researchers from Rutgers University in New Brunswick, N.J., and Columbia University in New York City analyzed 1.1 billion benzodiazepine prescription fills among 252 million patients age 2 and older using the IQVIA Longitudinal Prescription dataset. The study examined changes in prescription prevalence, prescription counts and mean total dose dispensed by patient age and prescriber type.
The declines may reflect greater caution in benzodiazepine prescribing, potentially tied to growing awareness of the drugs’ role in opioid-related overdoses and to FDA boxed warnings issued in 2016 and 2020, according to the researchers. The 2016 warning cautioned against prescribing benzodiazepines alongside opioids, and the 2020 warning addressed risks of misuse and addiction.
Here are five things to know:
1. The annual prevalence of benzodiazepine dispensing fell from 7.5% in 2013 to 5.5% in 2024, a 26.7% decrease. Prescription fills declined from 104.4 million to 76.4 million.
2. Adults ages 18-29 saw the largest relative decline in prevalence at 44.8%, followed by adults ages 30-44 at 36.2%, ages 45-64 at 29.4% and those 65 and older at 22.6%. Prevalence also fell 17.2% among adolescents ages 13-17 and 3.8% among children ages 2-12.
3. Primary care physicians accounted for 48.7% of benzodiazepine prescriptions dispensed during the study period, followed by advanced practice providers at 19.7% and psychiatrists and mental health specialists at 17.6%.
4. Prescription counts fell 62.5% among pain medicine specialists, 44.3% among primary care physicians and 38.3% among psychiatrists and mental health specialists. Prescriptions dispensed by advanced practice providers increased 101.5%. Reduced coprescribing with opioids could explain the sharp drop among pain medicine specialists, while the rise among advanced practice providers coincides with their growing share of primary care visits and expanded prescriptive authority in several states, according to study.
5. The mean total dose dispensed per prescription decreased 18.3%, from 427.1 milligrams diazepam equivalents in 2013 to 348.9 milligrams in 2024. Pain medicine specialists recorded the largest decline by prescriber type at 65.3%.
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