Comparing patterns of long-term benzodiazepine use between a Dutch and Swedish community

Department of Pharmacoepidemiology and Pharmacotherapy, Institute for Pharmaceutical Sciences (UIPS), Utrecht, The Netherlands.
Pharmacoepidemiology and Drug Safety (Impact Factor: 2.94). 01/2003; 12(1):49-53. DOI: 10.1002/pds.784
Source: PubMed


There is much concern about the widespread long-term use of benzodiazepines. Utilisation data can give a foundation for interventions for appropriate use.
To compare long-term usage patterns of benzodiazepines in a Dutch and a Swedish community in different periods.
Eight-year follow-up patterns of use were investigated with respect to the characteristics of those who continued use over the whole follow-up period. In the Dutch community of 13,500, the data of a cohort of 1358 benzodiazepine users were analysed during the years 1984-1991; in the Swedish community of 20,000 people, a cohort of 2038 benzodiazepine users was followed from 1976.
At the end of the follow-up period, 32.9% of the Dutch cohort and 33% of the Swedish cohort had continued use of benzodiazepines. The two overall survival curves showed similar patterns. Stratification for age, gender, previous versus initial use and heavy versus non-heavy use showed comparable proportions of patients continuing benzodiazepine use over time.
The parallels in the results of two cohorts in different countries and different periods are striking and give support to the idea to stimulate interventions to reduce long-term benzodiazepine use.

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    • "Earlier literature [65] Use of > 3 and < 6 months (n = 2) [34] [35] The definition of 5 months limit was based the format of the data set [34] Use of 6 months (n = 10) [12,37–41,50,53,59 a ,64 b ] The study [12] defined three BZD use definitions Any use during past year Short term use of maximum three months Long-term use of BZD in the past year when 6 months use has been exceeded. These recommendations have been used to justify the use of this long-term definition in studies [41] [50] Tolerance would be developing after six months use if ever [40] Use of > 6 months and < 1 year (n = 3) [45] [47] [55] Use of 1 year (n = 5) [19] [48] [57] [66] [68] The definition used in the study [48] was based on previous literature Study specific definitions (n = 3). Long-term users were filling subsequent prescriptions and the use continued with periods of < 15 days between two consecutive BZD Rx [28]. "
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    ABSTRACT: Background: Numerous treatment guidelines recommend that long-term use of benzodiazepines (BZD) should be avoided primarily due to development of tolerance and a risk for BZD dependence. Despite this, long-term BZD use remains a controversial subject in clinical patient care with "for and against" debates. However, there is no explicit understanding of what is meant by long-term BZD use in real world. The aim of this study was to assess different definitions, usage patterns, prevalence and other characteristics of long-term BZD use based on published register-based studies. Synthesis of these characteristics is essential to derive a meaningful definition of long-term BZD. Methods: Systematic review of register-based studies on long-term BZD use published in 1994-2014. Results: Fourty-one studies met our predetermined inclusion criteria. The length of BZD use defined as "long-term" varied in these studies ranging from one month to several years. The most common definition was six months or longer during a year. The prevalence of long-term BZD use in the general population was estimated to be about 3%. The relative proportion of long-term BZD users (all definitions) in adult BZD users ranged from 6% to 76% (mean 24%; 95% CL 13-36%). The estimates were higher in studies only on the elderly (47%; 95% CL 31-64%). Long-term use involved typically steady treatment with low BZD doses. However, in elderly patients long-term BZD use and exceeding recommended doses was relatively common. Several characteristics associated with long-term use were found. Conclusions: Long-term BZD use is common and a clinical reality. Uniform definitions for "long-term", which is in line with population-based evidence, is needed to have more comparable results between studies. Our systematic review suggests that duration of BZD treatment over six months, the most common definition for long-term BZD use in the included studies. As also recommended previously, it is a useful starting point for further analyses on disadvantages but also potential advantages associated with long-term BZD use.
    European Psychiatry 11/2015; 30(8):1037–1047. DOI:10.1016/j.eurpsy.2015.09.003 · 3.44 Impact Factor
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    • "Because anxiety and insomnia are problems which are often presented to health care practitioners after disasters [7e10], it is possible that in times of crisis a proportion of the patients is exposed to benzodiazepines for the first time [11]. Although benzodiazepines have several favorable aspects, they are also known to cause physical and psychological dependence when taken for longer periods of time [12] [13]. Clinical guidelines, therefore, recommend benzodiazepines only for short-time relief [14] [15]. "
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    ABSTRACT: Benzodiazepines are typically prescribed for anxiety and insomnia, two complaints often reported after disasters. Benzodiazepines can cause mental or physical dependence, especially when taken for a long time. This study aims at evaluating benzodiazepine use in a disaster-stricken community with the help of computer-based records. This prospective cohort study covers a period of 4 years. For every patient, predisaster baseline data are available. Multilevel regression is applied to study differences in benzodiazepine use in 496 patients whose children were involved in the Volendam café fire on January 1, 2001 compared with 1,709 community controls, and 4,530 patients from an unaffected cohort. In community controls and patients from the unaffected cohort, benzodiazepine use remained stable in the course of the years. In the first year postfire, parents of disaster victims were 1.58 times more likely to use benzodiazepines than community controls (95% confidence interval 1.13-2.23). With regard to long-term use, differences between community controls and parents were statistically nonsignificant. In the studied community, benzodiazepines were predominantly prescribed as a short-term intervention. Clinical guidelines that advocate a conservative prescription policy were well adhered to.
    Journal of Clinical Epidemiology 09/2007; 60(8):795-802. DOI:10.1016/j.jclinepi.2006.10.023 · 3.42 Impact Factor
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    ABSTRACT: Background: A comprehensive insight into drug utilization as an economic and primarily a public health issue can only be acquired in the context of overall health state of the respective population. The objectives of the study were: 1) to determine the real outpatient utilization of psychopharmaceuticals in Zagreb, 2) to determine the psychopharmaceutical prescribing quality during the study period; and 3) to propose appropriate interventions in Zagreb on the basis of the results obtained. Subjects and methods: Data on drug utilization were obtained from all Zagreb pharmacies. The number of defined daily doses (DDD) and number of DDD per 1000 inhabitants per day (DDD/1000/day) were calculated from the number of particular drug packages. The Drug Utilization 90% (DU90%) method was used as a criterion of prescribing quality. Results: Outpatient utilization of psychopharmaceuticals showed a declining pattern from 115.40 DDD/1000/day in 2001 to 93.15 DDD/1000/day in 2006. Anxiolytics accounted for the majority of this drug group utilization in the City of Zagreb, although the anxiolytic/antidepressant ratio decreased from 7.19 in 2001 to 3.86 in 2006. The utilization of selective serotonin reuptake inhibitors showed a 2.5- fold increase and accounted for 90% of overall antidepressant utilization. A 2.5-fold decrease was recorded in the utilization of antipsychotics, while the atypical/typical antipsychotic ratio changed from 1:2 in 2001 to 1.1:1 in 2006. Conclusion: Despite some improvement observed in the prescribing quality, the predominance of benzodiazepines in the utilization of psychopharmaceuticals points to the need of additional rationalization in the field.
    Psychiatria Danubina 03/2009; 21(1). · 1.30 Impact Factor
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