Patterns Of Benzodiazepine Use Research Articles

Pattern of benzodiazepine use among death cases in Republic of North Macedonia

The aim of this study was to determine the pattern of benzodiazepine related deaths in Republic of North Macedonia. Retrospective survey of post-mortem toxicology data from eight-year period, obtained from Laboratory of Forensic Toxicology was performed, including cases with known gender, age, cause and manner of death and complete toxicology report. Post-mortem toxicology analyses were conducted with Fluorescence Polarization/Enzymatic Immunoassay and Biochip Array Technology method for screening of urine and blood respectively, and confirmation by GC-MS after solid phase extraction. Total of 1169 cases were investigated. Benzodiazepines were detected in 30.05% of the cases, with statistically significant difference between cases of natural and of violent cause of death, as well as between genders, but without statistically significant difference due to the age between both genders. Study revealed women were more likely to use benzodiazepines with the median age to be 52.88 and 49.87 for males and females, respectively. According to post-mortem toxicology data benzodiazepines are the most used drugs in our country. Of them, diazepam was found to be the most often used one. Data analyses have shown that benzodiazepines were often combined with alcohol, psychoactive medicines and drugs of abuse. In 46.6% of all cases with positive findings for benzodiazepines, use of drugs of abuse was detected, mostly heroine and methadone. Important note should be given to the simultaneous use of benzodiazepines with heroine and methadone, which have resulted in increased number of fatal intoxications. Further studies are needed to determine the reason for popular use of benzodiazepines among drug addicts. Keywords: Abuse, diazepam, drug-related deaths, intoxication, post-mortem

Patterns of Benzodiazepine Use and Excess Risk of All-Cause Mortality in the Elderly: A Nationwide Cohort Study.

Despite the risks associated with their use, benzodiazepines remain used more widely than wisely. In this context, a better understanding of how their patterns of use can be associated with an increased risk of death appears essential. Indeed, the studies that investigated this association so far are inconsistent and question the influence of potential biases. The objective of this study was to investigate the association ofvarious patterns of benzodiazepine use with all-cause mortality. A nationwide cohort of non-prevalent benzodiazepine users aged ≥ 65years was identified using French healthcare insurance system claims databases. Exposure to benzodiazepines considered short-term, chronic (defined as a cumulated ≥ 6-month period over the previous 12months), ongoing, and discontinued use. Using a Cox model, adjusted hazard ratios for all-cause mortality were estimated according to benzodiazepine patterns of use; exposure and confounders were treated as time-dependent variables. In the cohort of 54,958 individuals aged ≥ 65years, adjusted hazard ratios for all-cause mortality and benzodiazepines were 2.26 (95% confidence interval 1.96-2.61) for short-term use, 3.86 (3.04-4.90) for chronic use-discontinued, and 3.05 (2.17-4.29) for chronic use-ongoing. At age 80years, these were 1.62 (1.48-1.79), 2.00 (1.82-2.19) and 1.13 (1.02-1.26), respectively. Adjusted hazard ratios show similar decreases with age for all patterns of benzodiazepine use. These findings confirm the existence of an excess risk of mortality associated with benzodiazepine use and provide pattern- and age-specific estimates. Higher risks were observed for patients aged < 80years, short-term use, or chronic use recently interrupted. If the two latter can relate to an indication bias, the associations found for ongoing chronic use and short-term use conversely support a potential causal hypothesis.

Benzodiazepines use in elderly patients attended at a Public Pharmacy in Pernambuco Brazil

: The elderly people are the group that most use psychotropic drugs, due to psychiatric comorbidity and somatic conditions. In Brazil some benzodiazepines are part of the National List of Essential Medicines (RENAME) being distributed free of charge, facilitating the population access, which can lead to irrational use. Methods: Cross-sectional, descriptive research through a qualitative and quantitative study of benzodiazepine use in patients attended at the Cedro Basic Pharmacy in the city of Cedro-PE. The data collection was done with the application of a semi-structured questionnaire. The pattern of benzodiazepine use has been described through patient-reported symptomatology, therapeutic adherence, medical specialty, dose increase without medical consultation, and adverse effects reported during the drug use. Results: There was a predominance of females (58.33%). The most commonly used benzodiazepine was diazepam (66.67%). The purchase of benzodiazepine without a prescription was reported by 16.67% of the elderly interviewed and an increase in the drug dose without doctor consulting by 25% of the interviewees. Final considerations: The prescription of these drugs for the elderly, as well as the chronic use, should consider the physiological changes caused by aging and the adverse effects of these drugs in order to guarantee a safe treatment. Keywords : Aged; Psychotropic drugs; Drug utilization.

Usages et mésusages des benzodiazépines chez les patients souffrant de troubles psychiatriques

The psychiatric patients are not only particularly exposed to benzodiazepines; they may also be more vulnerable to their side effects than general population. Benzodiazepines are frequently misused in psychiatric patients in terms of duration, dose and number of concomitant medications. There is no evidence that benzodiazepines are effective against most psychiatric disorders, including depression and suicidal risk. Several studies have shown associations between benzodiazepine use and depression worsening, increased disinhibition, suicide risk, anxiety, aggression, and even mortality in patients with psychiatric disorders. Despite the common use of benzodiazepine drugs by clinicians, large and methodologically sound studies are lacking to document the patterns of benzodiazepine use in populations with psychiatric disorders and their specific risks in these patients. It is not known whether it is legitimate to apply the good practice recommendations for benzodiazepines in patients with severe psychiatric disorders.

Patterns and correlates of benzodiazepine use in nurses: A nationwide, population-based study.

In the present study, we examined patterns of benzodiazepine (BZD) use in nurses, and compared the characteristics of frequent users with those of infrequent users. Data on all nurses enrolled in the study were derived from the reimbursement claim records in Taiwan's National Health Insurance Research Database for the period 2004-2008. The case group comprised 33588 nurses with BZD use, and the control group was exactly matched to each case according to age and sex. The patterns of occasional, frequent, and daily BZD use demonstrated an increasing trend from 2004 to 2008. This trend was observed for most of the BZD with a short or intermediate half-life. Older nurses (>45years) and those with greater experience (≥5years) were more likely to use BZD frequently. Moreover, the risk of frequent BZD use increased significantly when nurses exhibited comorbid depression (adjusted odds ratio (aOR): 2.58), anxiety (aOR: 1.78), or sleep disorders (aOR: 2.29) compared with infrequent BZD use. The results indicated that nurses with BZD use had comorbidities of anxiety, depression, and sleep disorders. The increasing trend of patterns of BZD use and its association with sleep disorders, depression, and anxiety can be used as references for stress and sleep management in nurses.

Commentary on Raitasalo et al. (2015): the great potential in nation-wide registers to study prescription drug use and abuse.

In their paper, Raitasalo et al. 1 identify mothers who are at greater risk for benzodiazepine use; namely, those with substance use problems and psychiatric problems. A second important finding is that the use of benzodiazepines was lowest during pregnancy for all groups, followed by a sharp increase during the years after the children were born. While, from our perspective, the study is important in several ways, this commentary can address only a few of these. One point is that information about the use of addictive prescription drugs among women of childbearing age is scarce; there is a lack of information on both the effect of benzodiazepine use during pregnancy and the effect that maternal use may have on the children. Observational studies using data from prescription registries are therefore an appropriate approach to map the prevalence of benzodiazepine use, as well as the use of other prescription drugs such as z-hypnotics and opioids. By studying any benzodiazepine use, Raitasalo et al.’s study captures the full spectrum of use. Some studies have shown that the misuse of benzodiazepines is associated with several negative risk factors and behaviours 2, 3. While less is known about the consequences of the therapeutic use of benzodiazepines, a recent study refuted any strong association between prenatal therapeutic use of benzodiazepines and lower language competence in offspring at age 3 years 4. This study adds the important knowledge that many female benzodiazepine users of childbearing age belong to groups with other risk factors, such as substance abuse, psychiatric disease or poverty. Thus, Raitasalo et al. show that benzodiazepine use is another factor that might be important in identifying ‘at-risk’ families. In order to identify families that should be offered additional follow-up as a preventive measure, it is therefore important to also include questions about addictive prescription drug use. When clinicians receive a positive response to questions on the use of such prescription drugs there is reason to ask follow-up questions, as they would for a positive response to questions on drinking or depression. Benzodiazepine users are often co-medicated with other prescription drugs, such as other hypnotics and opioids 4-8. As co-occurring use is common, this might suggest that mothers who use hypnotics or opioids should receive the same attention from clinicians trying to identify at-risk families as do mothers using benzodiazepines. Further studies on the effects of various patterns of benzodiazepine use in different life periods are warranted. Raitasalo et al. point out that previous research is inconsistent with regard to whether or not in-utero exposure to benzodiazepines increases the risk of negative birth outcomes 1, 9-11. Clearly, this should be given further attention. While randomized controlled trials are the gold standard with which to study outcomes from prescription drug use, pregnant women are often excluded from clinical trials. The large, prospective observational data available in nation-wide registers may therefore be the most effective way to investigate possible teratogenic effects from prescription drugs 12. The sharp increase in benzodiazepine use during the years after childbirth is cause for concern, as parental prescription drug use is associated with prescription drug use in their children as adults 13. For instance, repeated use of both benzodiazepines and opioids among mothers is associated with the increased risk that their children also become repeated users of benzodiazepines and opioids, respectively 14. The study by Raitasalo et al. 1 underscores some of the opportunities offered by nation-wide registers. One advantage is the inclusion of whole populations; a second advantage is that registry data allow for large samples, well suited to study rare outcomes: for instance, short- and long-term outcomes in children exposed to benzodiazepines in utero. A third advantage is that when personal identification numbers are assigned to all residents, such as in Nordic countries, this enables the matching of person-level data from several registers. This allows for controlling for important confounding variables such as education, employment and marital status, children, mental and physical health, and allows for data matching for parents and children. Another advantage is that as the registers are established and in use and data are available, they represent a relatively cost- and time-effective way of conducting large-scale prospective studies. Registry studies such as the one by Raitasalo and colleagues are important, because they provide both a complete description of drug use that might be problematic and needing further research attention, and as a background from which to enable clinicians to identify families at risk of different factors and behaviours. None.

Benzodiazepine use in the United States.

Although concern exists regarding the rate of benzodiazepine use, especially long-term use by older adults, little information is available concerning patterns of benzodiazepine use in the United States. To describe benzodiazepine prescription patterns in the United States focusing on patient age and duration of use. A retrospective descriptive analysis of benzodiazepine prescriptions was performed with the 2008 LifeLink LRx Longitudinal Prescription database (IMS Health Inc), which includes approximately 60% of all retail pharmacies in the United States. Denominators were adjusted to generalize estimates to the US population. The percentage of adults filling 1 or more benzodiazepine prescriptions during the study year by sex and age group (18-35 years, 36-50 years, 51-64 years, and 65-80 years) and among individuals receiving benzodiazepines, the corresponding percentages with long-term (≥120 days) benzodiazepine use, prescription of a long-acting benzodiazepine, and benzodiazepine prescriptions from a psychiatrist. In 2008, approximately 5.2% of US adults aged 18 to 80 years used benzodiazepines. The percentage who used benzodiazepines increased with age from 2.6% (18-35 years) to 5.4% (36-50 years) to 7.4% (51-64 years) to 8.7% (65-80 years). Benzodiazepine use was nearly twice as prevalent in women as men. The proportion of benzodiazepine use that was long term increased with age from 14.7% (18-35 years) to 31.4% (65-80 years), while the proportion that received a benzodiazepine prescription from a psychiatrist decreased with age from 15.0% (18-35 years) to 5.7% (65-80 years). In all age groups, roughly one-quarter of individuals receiving benzodiazepine involved long-acting benzodiazepine use. Despite cautions concerning risks associated with long-term benzodiazepine use, especially in older patients, long-term benzodiazepine use remains common in this age group. More vigorous clinical interventions supporting judicious benzodiazepine use may be needed to decrease rates of long-term benzodiazepine use in older adults.

The effect of the Medicare Part D benzodiazepine exclusion on the utilization patterns of benzodiazepines and substitute medications

Although the benzodiazepine exclusion policy in the U.S. Medicare Part D drug coverage program has been studied, little information is available on individual use and switching patterns between benzodiazepines and substitute medications. Patients voluntarily were continuing or stopping benzodiazepines or switching to substitute medications. These individual-level outcomes can provide information beneficial to providers and policymakers to better understand the intended and unintended consequences of exclusion policies. The objective was to determine the effect of the Medicare Part D benzodiazepine exclusion on the utilization patterns of benzodiazepines and substitute medications by a select group of Medicare beneficiaries for a year following implementation of the exclusion. This research focused on the examination of the within-person patterns of benzodiazepine use and factors associated with these patterns. A quasi-experimental, comparative study was used to analyze prescription patterns and multinomial regression models were applied to investigate factors predicting different benzodiazepine use patterns. Pharmacy dispensing data for continuously eligible Medicare beneficiaries with at least one benzodiazepine fill in 2005 were reduced to a comparison group of 216 individuals with continual coverage and an intervention group of 250 individuals who lost coverage for benzodiazepines. Four individual patients' drug use patterns, continuation, switch, fluid movement, and cessation were identified by sorting and arraying pharmacy dispensing data to apply systematic drug file review. Multinomial regression models were used to examine the impact of coverage, demographic, medical, economic, and pharmaceutical factors. Significantly more Medicare seniors who lost benzodiazepine coverage switched to potential substitute medications than those who continued to have coverage. Interestingly, 12 percent of affected seniors and 6 percent of unaffected seniors switched from and back to benzodiazepines (fluid movement). Zolpidem was the most popular substitute agent despite being an expensive brand-name drug. Regression models revealed that affected individuals had nearly two times the odds of engaging in switch-related patterns than those who had continuous coverage. Also, women were twice as likely to discontinue benzodiazepines as men. More seniors who lost benzodiazepine coverage engaged in medication switching, and women were more likely to stop benzodiazepines after the implementation of the exclusion policy.

Treatment or “high”: Benzodiazepine use in patients on injectable heroin or oral opioids

Benzodiazepine (BZD) use is widespread among opioid-maintained patients worldwide. We conducted a cross-sectional survey to investigate motives and patterns of BZD use and psychiatric comorbidity in a convenience sample of patients (n=193) maintained on oral opioid agonists or diacetylmorphine (DAM). Prolonged BZD use and high-risk behaviors like parenteral use were common. After principal component analysis, motives were divided into those related to negative affect regulation, positive affect regulation (i.e. reward-seeking) and somato-medical problems. Negative affect regulation and somato-medical motives were associated with prolonged use. Psychiatric comorbidity was associated with several self-therapeutic motives, most importantly to lose anxiety. Patients maintained on DAM were more likely to be ex-users of BZD and report high positive affect regulation. Therefore, patients maintained on different agonists may have deviating motives for BZD use, which could be of importance when addressing this issue. Treatment of psychiatric comorbidity, in particular anxiety, depressive and sleeping disorders, may be helpful in reducing BZD use, particularly in patients maintained on oral opioids.

Socio-demographic, lifestyle and psychological predictors of benzodiazepine and z-hypnotic use patterns

Aims: Risk and demographic factors for benzodiazepine and z-hypnotic use are incompletely understood. The aim of the paper was therefore to investigate socio-demographic, lifestyle and psychological factors predicting onset and differential pattern of prescribed benzodiazepine and z-hypnotic use in a Norwegian population sample. Methods: This retrospective cohort study obtained socio-demographic, psychological and lifestyle variables from the Nord-Trøndelag Health Study. Information about benzodiazepine prescriptions from the Norwegian prescription database were linked to epidemiological questionnaire data. Benzodiazepine use was classified into single-period, intermittent and chronic use, and high dose use was defined as being prescribed a yearly average above 180 daily defined doses. Results: Older age, sleep difficulties and smoking were positively associated with all patterns of benzodiazepine use. Male gender was related to a reduced risk of all patterns of use, whereas educational achievement was negatively associated with single-period use. Alcohol consumption, anxiety and tension were positively related to intermittent and chronic use, while exercise was negatively related to chronic use. Smoking, sleep difficulties and old age were positively associated with prescriptions of high benzodiazepine doses, while exercise was associated with lower doses. Conclusions: Patterns of prescribed benzodiazepine use are linked to demographic, lifestyle and clinical variables. Non-pharmacological treatment for sleep difficulties and smoking cessation may reduce the risk of chronic benzodiazepine use.

Benzodiazepine Use among Older Adults with Chronic Obstructive Pulmonary Disease

Patients with chronic obstructive pulmonary disease (COPD) may receive benzodiazepines for a variety of reasons, including as treatment for insomnia, as treatment for depression and anxiety, and to help relieve refractory dyspnoea. However, benzodiazepines have been linked to adverse physiological respiratory outcomes in individuals with COPD. The potential adverse respiratory effects of benzodiazepines in COPD may also be heightened in older adults given their altered pharmacokinetics that increase benzodiazepine half-life. There is minimal information on the scope and nature of benzodiazepine use in the older adult COPD population. The purpose of this study was to describe patterns of benzodiazepine use among older adults with COPD. A validated algorithm was applied to Ontario healthcare administrative data to identify older adults with COPD. Incident oral benzodiazepine receipt between 1 April 2004 and 31 March 2009, defined as no benzodiazepines dispensed in the year prior to incident prescription, was examined. Regression techniques were used to identify patient characteristics associated with new benzodiazepine use. Descriptive statistics were performed to describe benzodiazepine use among new users. The analysis was stratified by COPD severity defined by COPD exacerbation frequency (less severe COPD: 0 exacerbations in the year prior; more severe COPD: 1 or more exacerbations in the year prior). Among 111,445 older adults with COPD, 35,311 (31.7%) received a new benzodiazepine. New benzodiazepine receipt was higher among individuals with more severe COPD (adjusted odds ratio 1.43, 95% CI 1.38-1.48). Among new benzodiazepine users, there was a relatively high frequency of receipt of long-acting agents (14.6%), dispensations for greater than 30days (32.6%), second dispensations (22.0% or 30.6% for occurrence within 120% or 200% days of the index prescription, respectively), early refills (11.6%), and benzodiazepine receipt during COPD exacerbations (9.0%). Among individuals with more severe COPD, 35.4% of incident use occurred during a COPD exacerbation. Almost one-third of older individuals with COPD received a new benzodiazepine, and rates were higher among those with more severe COPD. Important safety and quality of care issues are potentially raised by the degree and pattern of benzodiazepine use in this older and respiratory-vulnerable population.

Extent of Use and Concordance of Self-report and Urinalysis of Benzodiazepine Abuse

ObjectivesTo study the extent and pattern of benzodiazepine use in patients with alcohol and opioid dependence and to examine the concordance between self-reported benzodiazepine use and urinalysis results.MethodsFifty-one consecutive male patients of opioid and alcohol dependence each were included

Benzodiazepine Use Among Patients With Schizophrenia in Taiwan: A Nationwide Population-Based Survey

Benzodiazepine Use Among Patients With Schizophrenia in Taiwan: A Nationwide Population-Based Survey

Five-Year Trajectories of Long-Term Benzodiazepine Use by Adolescents: Patient, Provider, and Medication Factors

Five-Year Trajectories of Long-Term Benzodiazepine Use by Adolescents: Patient, Provider, and Medication Factors

Benzodiazepine Use Among Patients With Schizophrenia in Taiwan: A Nationwide Population-Based Survey

This study aimed to describe the pattern of benzodiazepine use in a representative sample of patients with schizophrenia in Taiwan. Data from the National Health Insurance Research Database in Taiwan were used to examine the prevalence and indices of benzodiazepine use in 2005. Demographic and clinical characteristics associated with long-term benzodiazepine use (more than 180 days of cumulated prescription in one year) were further explored by multivariate logistic regression analysis. Among the 3,690 patients with schizophrenia, the one-year prevalence rate of benzodiazepine use was 79.2% (N=2,923). Among those who used benzodiazepines, 1,840 (62.9%) were long-term users. Use of benzodiazepines was associated with having a comorbid psychiatric disorder, use of concomitant psychotropic agents, and antipsychotic polypharmacy. Among benzodiazepine users, older age, longer duration of illness, and use of concomitant psychotropic agents were associated with significantly higher odds of being a long-term user. The study showed that benzodiazepine use was highly prevalent among patients with schizophrenia in Taiwan and that a substantial proportion of users (62.9%) were long-term users. Because long-term use was associated with longer duration of illness and with use of concomitant psychotropic medications, long-term users may be at higher risk of neurocognitive side effects caused by benzodiazepines and interactions with other psychotropic medications. Therefore, this group should be closely monitored for drug-drug interactions and the benefits and risks of benzodiazepine use.

Patterns in the use of benzodiazepines in British Columbia: Examining the impact of increasing research and guideline cautions against long-term use

We examined changes in patterns of benzodiazepine use in British Columbia over a period of increasing evidence of harms associated with long-term use. Using linked administrative databases for the years 1996 and 2006, we performed logistic regression to examine how socio-economic and health factors affect the likelihood of benzodiazepine use and long-term use, and to test for changes in rates of use and long-term use over time. In 2006, 8.4% of British Columbians used benzodiazepines, 3.5% long-term. Use was positively related with being female, lower income, older, and of poorer health status. Long-term use was positively associated with being in the lowest income quintile, of poorest health, and over the age of 65. While the rate of long-term use decreased from 1996 to 2006 for those over age 70, it increased in middle-aged populations. Our results suggest, despite increased awareness of and cautions regarding risks associated with long-term use of benzodiazepines, rates of potentially inappropriate use have changed very little over a decade. Given that early use of benzodiazepines is positively associated with later long-term use, policies targeting populations younger than conventionally studied (i.e. those under age 65) may be needed to decrease rates of long-term use.

Patterns of benzodiazepine use in a Canadian population sample

The objective of this study was to identify clinical and demographic factors that may be associated with benzodiazepine treatment, to describe the reported reasons for use of these medications and to appraise the pattern of use in relation to standard guidelines in a general population sample. Telephone survey methods were employed to select a sample of 3345 people between the ages of 18 and 64. A computer assisted telephone interview, including the Mini Neuropsychiatric Diagnostic Interview (MINI), was administered. Estimates were weighted for design features and population demographics. The overall prevalence of benzodiazepines use was 3.3% (95% confidence interval [CI] 2.6 to 4.1%). There was a higher frequency of medication use in women than men, among respondents who were widowed, separated or divorced, and those with lower levels of education. In relation to MINI diagnosis, diagnoses of Panic Disorder and Major Depression increased the probability of taking benzodiazepines. The reported main reason for use was "Sleep disorders" (68.9%), "Anxiety" (35.8%), "Depression" (27.8%) and "Pain management" (21.2%). More than 80% of subjects were taking benzodiazepines for more than one year. When compared to previous estimates, the lower frequency of benzodiazepines use suggests that there has been improvement in their evidence-based use at a population level. However our results once more confirm the difficulty stopping the use of these medications once they have been started. Further randomized control studies may help clinicians in having a better practical approach to rational benzodiazepine use.

Pattern of benzodiazepine use in psychiatric outpatients in Pakistan: a cross-sectional survey

BackgroundBenzodiazepines (BDZ) are the largest-selling drug group in the world. The potential of dependence with BDZ has been known for almost three decades now. In countries like Pakistan where laws against unlicensed sale of BDZ are not implemented vigorously the risk of misuse of and dependence on these drugs is even higher. Previous studies have shown that BDZ prevalence among patients/visitors to general outpatient clinics in Pakistan may be as high as 30%. However, no research has been carried out on the prevalence of BDZ use in psychiatric patients in Pakistan.MethodsWe carried out a cross-sectional survey over 3 months in psychiatry outpatient clinics of two tertiary care hospitals in Karachi and Lahore. Besides basic socio-demographic data the participants were asked if they were taking a BDZ at present and if yes, the frequency, route and dosage of the drug, who had initiated the drug and why it had been prescribed. We used chi-square test and t-test to find out which socio-demographic or clinical factors were associated with an increased risk of BDZ use. We used Logistic Regression to find out which variable(s) best predicted the increased likelihood of BDZ use.ResultsOut of a total of 419 participants 187 (45%) of the participants had been currently using at least one BDZ. Seventy-three percent of the users had been using the drug for 4 weeks or longer and 87% were taking it every day. In 90% of cases the BDZ had been initiated by a doctor, who was a psychiatrist in 70% of the cases. Female gender, increasing age, living in Lahore, and having seen a psychiatrist before, were associated with an increased likelihood of using BDZ.ConclusionThe study shows how high BDZ use is in psychiatric outpatients in Pakistan. Most of the users were taking it for a duration and with a frequency which puts them at risk of becoming dependent on BDZ. In most of the cases it had been initiated by a doctor. Both patients and doctors need to be made aware of the risk of dependence associated with the use of BDZ.

Benzodiazepine Dependence in Singapore

The study, conducted in 2003–2005, was aimed at investigating the pattern of benzodiazepine (BZD) use and the attitudes and perceptions of doctors' prescribing practices by a hundred BZD-dependent patients in Singapore. Data on patients' demographic characteristics, psychiatric profiles, patterns of BZD use, and perceptions about doctors' prescribing practices were collected. A benzodiazepine dependence self-report questionnaire (Bendep-SRQ) was also administered. The mean age of the study participants was 39.4 years (SD = 9.7); 88% were Chinese, 58% were males, 46% were married, 48% had received secondary school education, and 48% were unemployed. BZD abuse in Singapore is contributed to by both doctor-shopping behavior and doctors' prescribing practices. Doctors need training on the assessment and management of BZD dependence. The study's limitations were noted. This project was supported by an institutional block grant received from the National Medical Research Council, Singapore.

Long-term use of benzodiazepines in participants with comorbid anxiety and alcohol use disorders.

Although the only widely accepted role for benzodiazepines in alcohol dependence is the treatment of withdrawal syndromes, they are frequently prescribed outside of this clinical setting. There is little empirical evidence to guide the rational use of benzodiazepines in the common clinical situation where anxiety disorders are comorbid with alcohol use disorders (AUD). Since January 1989, the Harvard Anxiety Research Program has naturalistically monitored the prospective clinical course of people with anxiety disorders, some of whom had a history of AUD. Earlier research showed that the use of benzodiazepines was not significantly associated with the presence or absence of a history of an AUD over the first year of follow-up. This report extends that investigation. Using standard parametric analytic methods, patterns of benzodiazepine use (routinely prescribed medication and as-needed [PRN] use) among participants receiving benzodiazepine treatment was prospectively examined over the course of 12 years. Differences in benzodiazepine usage patterns were examined in each year of follow-up between participants who did (n=120) and did not (n=425) have a new episode of AUD. Using proportional hazards regression analysis, benzodiazepine usage levels were examined as predictors of recovery and recurrence of AUD. Additionally, random-effects regression analyses were used to examine the patterns of benzodiazepine use before and after the onset of a prospectively observed episode of AUD. Benzodiazepine usage levels remained stable for the full sample over the course of the 12 years. Benzodiazepine use did not distinguish participants who had a new AUD from those who did not. Over the 12 years of follow-up, participants who had an AUD used more PRN medication in years five to eight. This difference reached statistical significance but was not clinically significant. Benzodiazepine usage levels did not predict recovery or recurrence in AUD subjects. Neither the total dose nor the PRN usage of benzodiazepines was significantly associated with the onset of AUD, but when combined into a measure of any benzodiazepine use, a relationship between increased use and the onset of AUD emerged. For participants in the Harvard Anxiety Research Program with comorbid alcohol dependence and anxiety disorders, there was little association between the use of benzodiazepines and the occurrence of a new AUD. Neither was there a temporal relationship between the use of benzodiazepines and the onset of a new AUD. Whether or not this finding extends to a broader patient population or a group of people who present to addictions treatment awaits further investigation.