Keywords: anxiety, benzodiazepines, depression, insomnia, mental health, prescription drug overuse

Background:

Benzodiazepines (BZDs) and Z-drugs are frequently prescribed for treating anxiety and insomnia, but their long term use is strongly discouraged by many international expert societies. Nevertheless, prescribing rates for these drugs continue to rise in many countries, with frequent inappropriate use.

Research questions:

Do family physicians (FPs) prescribe BZDs and Z-drugs long term and for which clinical indications?

Method:

We conducted a cross-sectional study on a purposive sample in four family medicine practices (FMPs) across Croatia (caring for 6899 insured patients). Patients who were prescribed one or more BZDs and Z drugs at least twice in the last five years (1.1.2019–31.12.2024) were included. We recorded when, for which indication, and who first suggested the medication (FP or other specialist), duration of therapy, changes made, and whether the patient took antidepressants. All data were shown as absolute values and ratios.

Results:

A total of 1139 patients (average 59.6±15.9 years) were prescribed at least one benzodiazepine or Z drug (15.5 – 23.1% of patients in each FMP, 67.5% female). Two or more prescribed drugs were found in 149 patients (13.1%). Diazepam was the most prescribed in 538 patients (42.2%), followed by alprazolam in 369 (28.9%). Long term use (>3 months) was identified in 509 patients (39.5%), but only 154 of them were prescribed an antidepressant (30.2%). In 832 patients (64.5%), a benzodiazepine or Z drug was initiated by a FP. The main indications were anxiety disorders in 398 (30.9%), insomnia in 193 (15.0%), and back pain in 158 patients (12.3%). These are preliminary findings of an ongoing study.

Conclusions:

The results from this study show that FPs in Croatia frequently prescribe BZDs and Z-drugs long term, with anxiety and insomnia being the most frequent indications. Greater insight into (over)prescribing trends may inform interventions to improve adherence to evidence-based guidelines in mental health care.

Points for discussion:

For which indications are benzodiazepines most frequently being prescribed outside of their intended use by EBM guidelines?

Are EBM guidelines for treating mental health conditions usable in an FP’s practice?

What are the potential consequences of widespread benzodiazepine overuse long term?