Abstract
BackgroundDespite an increase in the prevalence of sleep problems, few studies have investigated changes in the prescribing of drugs that are often used to manage insomnia.AimTo explore changes in the pattern of benzodiazepine (BZD), Z-drug (zolpidem, zopiclone), and non-BZD prescriptions.Design and settingOpen-cohort study comprising 1 773 525 patients (55 903 294 consultations) who attended one of 404 Australian general practices at least three times in two consecutive years between 2011 and 2018.MethodData were extracted from MedicineInsight, a database of 662 general practices in Australia. Prescription rates per 1000 consultations, the proportion of repeat prescriptions above recommendations, and the proportion of prescriptions for patients with a recent (within 2 years) recorded diagnosis of insomnia were analysed using adjusted regression models.ResultsRates of BZD, Z-drug, and non-BZD prescriptions were 56.6, 4.4, and 15.5 per 1000 consultations in 2011 and 41.8, 3.5, and 21.5 per 1000 consultations in 2018, respectively. Over the whole study period, temazepam represented 25.3% of the prescriptions and diazepam 21.9%. All BZD and zolpidem prescriptions declined over the whole study period (annual change varying from −1.4% to −10.8%), but non-BZD and zopiclone prescriptions increased in the same period (annual change 5.0% to 22.6%). Repeat prescriptions that exceeded recommended levels remained at <10% for all medications, except melatonin (64.5%), zolpidem (63.3%), zopiclone (31.4%), and alprazolam (13.3%). In 2018, >50% of Z-drug and melatonin prescriptions were for patients with insomnia. There was an annual increase of 0.8–5.9% in the proportion of prescriptions associated with a recently recorded diagnosis of insomnia.ConclusionOverall, BZD prescriptions in Australia declined between 2011 and 2018. However, the prescription of some of these drugs increased for patients with a recently recorded diagnosis of insomnia. This is concerning because of the potential adverse effects of these medications and the risk of dependence.
Highlights
The prescription of some of these drugs increased for patients with a recently recorded diagnosis of insomnia
The prevalence of sleep problems in Australia increased from 20–35% in 2010 to 33–45% in 2016;1–2 in 2016–2017, the total cost of insomnia and other sleep disorders in Australia was estimated to be A$66.3 billion.[3]
Benzodiazepines (BZDs), Z-drugs, and some antidepressants can be used to treat insomnia and other sleep disorders; they are recommended for short-term management and only if non-pharmacological therapies are ineffective.[9]
Summary
Benzodiazepines (BZDs), Z-drugs (that is, a group of sedative drugs that differ from BZD and include zolpidem, zopiclone, and zaleplon), and some antidepressants can be used to treat insomnia and other sleep disorders; they are recommended for short-term management and only if non-pharmacological therapies are ineffective.[9] Long-term use of these medications has been linked to an increased risk of misuse, dependency, drug tolerance, traffic accidents, falls/fractures, impaired quality of life, reduced productivity, hospitalisations, and deaths.[10,11,12,13,14,15] Of concern, the death rate in Australia that is potentially associated with BZD use increased from 1.9 per 100 000 people in 2008 to 3.5 per 100 000 people in 2018;16 a similar pattern of increased deaths associated with BZD use was reported in the US between 1996 and 2013.13 This reflects that the issue does not affect Australia alone. Despite an increase in the prevalence of sleep problems, few studies have investigated changes in the prescribing of drugs that are often used to manage insomnia
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