pharmacoepidemiology and drug safety 2003; 12: 49–53
Published online 21 November 2002 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/pds.784
Comparing patterns of long-term benzodiazepine use between
a Dutch and a Swedish community
Rolf van Hulten PhD1*, Dag Isacson PhD2, Albert Bakker PhD1and Hubert G. Leufkens PhD1
1Department of Pharmacoepidemiology and Pharmacotherapy, Institute for Pharmaceutical Sciences (UIPS), Utrecht,
2University of Uppsala, Uppsala, Sweden
foundation for interventions for appropriate use.
To compare long-term usage patterns of benzodiazepines in a Dutch and a Swedish community in different
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 13500, the data of a cohort of 1358 benzodiazepine users
were analysed during the years 1984–1991; in the Swedish community of 20000 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 sup-
porttothe ideatostimulate interventions toreducelong-term benzodiazepine use.Copyright # 2002 John Wiley & Sons,Ltd.
There is much concern about the widespread long-term use of benzodiazepines. Utilisation data can give a
key words—benzodiazepines; longitudinal study; long-term use
Long-term use of benzodiazepines has been an
important pharmacoepidemiologic subject for many
years.1–4Although benzodiazepines are among the
safest, most effective and most widely used drugs in
the world, there is ample evidence that their long-term
use is far from recommended therapy and a clear risk
factor for dependence and abuse.5,6Benzodiazepines
are mostly indicated in the short-term treatment of
anxiety disorders, muscle relaxation and insomnia.7–9
The literature abounds with articles dealing with
interventions and strategies to reduce and control ben-
zodiazepine abuse.10,11However, so far, only a few
programmes have been shown to be effective in this
respect in the long run. Moreover, regulation of ben-
alternative drug-taking behaviour. A report on the
reduction of inappropriate prescribing of benzodiaze-
pines by the New York State Department of Health
showed that regulation was effective in reducing both
the number of patients being prescribed benzodiaze-
pines and the number of prescriptions given to those
who remain on benzodiazepines.12However, prescrip-
tions for agents like hydroxyzine, meprobamate,
chloral hydrate and barbiturates were increasingly
seen in the population studied.
In developing intervention strategies to enhance
appropriate benzodiazepine prescribing, it is important
to have in-depth insight into the patterns of long-term
use and into the target groups that may benefit most
Received 28 June 2001
Revised 3 October 2002
Accepted 10 October 2002
Copyright # 2002 John Wiley & Sons, Ltd.
*Correspondence to: Dr Rolf van Hulten, Department of Pharma-
coepidemiology and Pharmacotherapy, Utrecht University, PO Box
80.082, 3508 TB Utrecht, The Netherlands.