Use Of Z-drugs Research Articles

Incident Benzodiazepine and Z-Drug Use and Subsequent Risk of Serious Infections.

Animal studies have suggested a link between benzodiazepine and related Z-drug (BZDR) use and immune dysfunction. Corresponding evidence in humans is limited and focuses mainly on pneumonia. This study aimed to assess the association of incident BZDR use with subsequent development of serious infections. This Swedish register-based study included a population-based demographically matched cohort, a co-twin control cohort, and an active comparator cohort. Out of 7,362,979 individuals aged below 65 years who were BZDR naïve by 2007, 713,896 BZDR recipients with incident dispensation of any BZDRs between 2007 and 2019 were 1:1 matched to 713,896 nonrecipients from the general population; 9197 BZDR recipients were compared with their 9298 unexposed co-twins/co-multiples; and 434,900 BZDR recipients were compared with 428,074 incident selective serotonin reuptake inhibitor (SSRI) recipients. The outcomes were identified by the first inpatient or specialist outpatient diagnosis of serious infections in the National Patient Register, or death from any infections recorded as the underlying cause in the Cause of Death Register. Cox proportional hazards regression models were fitted and controlled for multiple confounders, including familial confounding and confounding by indication. To study a possible dose-response association, the cumulative dosage of BZDRs dispensed during the follow-up was estimated for each BZDR recipient and modeled as a time-varying exposure with dose categories in tertiles [≤ 20 defined daily doses (DDDs), > 20 DDDs ≤ 65, and > 65 DDDs). The risk of infections was assessed in BZDR recipients within each category of the cumulative BZDR dosage compared to their demographically matched nonrecipients. In the demographically matched cohort (average age at incident BZDR use 42.8 years, 56.9% female), the crude incidence rate of any serious infections in BZDR recipients and matched nonrecipients during 1-year follow-up was 4.18 [95% confidence intervals (CI) 4.13-4.23] and 1.86 (95% CI 1.83-1.89) per 100 person-years, respectively. After controlling for demographic, socioeconomic, clinical, and pharmacological confounders, BZDR use was associated with 83% relative increase in risk of any infections [hazard ratio (HR) 1.83, 95% CI 1.79-1.89]. The risk remained increased, although attenuated, in the co-twin cohort (HR 1.55, 95% CI 1.23-1.97) and active comparator cohort (HR 1.33, 95% CI 1.30-1.35). The observed risks were similar across different types of initial BZDRs and across individual BZDRs, and the risks increased with age at BZDR initiation. We also observed a dose-response association between cumulative BZDR dosage and risk of serious infections. BZDR initiation was associated with increased risks of serious infections,even when considering unmeasured familial confounding and confounding by indication. The exact pathways through which BZDRs may affect immune function, however, remain unclear. Further studies are needed to explore the neurobiological mechanisms underlying the association between BZDR use and serious infections, as it can lead to safer therapeutic strategies for patients requiring BZDR.

Clinical course and demographic insights into suicide by self-poisoning: patterns of substance use and socio-economic factors.

To analyze whether sociodemographic characteristics influence the substance choice and preclinical and clinical course of suicidal poisoning. This was a retrospective single-center study in patients hospitalized due to suicidal poisoning and who received at least one psychiatric exploration during their inpatient stay. Patients' sociodemographic, anamnestic, preclinical, and clinical parameters were analyzed with respect to sex and age. 1090 patients were included, 727 (67%) were females, median age was 39 years (min-max: 13-91) with 603 (55%) aged 18-44 years. 595 patients (54.8%) ingested a single substance for self-poisoning, 609 (59.5%) used their own long-term medication. Comparing to males, females preferred antidepressants (n = 223, 30.7%, vsn = 85, 23.4%; p = 0.013) and benzodiazepines (n = 202, 27.8%, vsn = 65, 17.9%; p < 0.001); males more often used cardiovascular drugs (n = 33, 9.1%, vsn = 34, 4.7%; p = 0.005) and carbon monoxide (n = 18, 5.0%, vsn = 2, 0.3%; p < 0.001). Use of Z-drugs (n = 1, 1.7%, to n = 37, 33.3%; p < 0.001) and benzodiazepines (n = 4, 6.9%, to n = 33, 29.7%; p = 0.003) increased with age (< 18 to > 64 years), while use of non-opioid analgesics (n = 23, 39.7%, to n = 20, 18.0%; p < 0.001) decreased. Average dose of substance in patients > 64 years was 12.9 ± 18.4 times higher than recommended maximum daily dose (compared to 8.7 ± 15.2 higher in those aged < 18 years; p < 0.001). Males more often required intensive care (n = 150, 41.3%, vsn = 205 females, 28.2%; p < 0.001). These results underline the complexity of (para-)suicidal poisonings and identify potential measures for their prevention, such as restricting access and better oversight over the use of certain substances.

Fall Outcomes in Older Adults Following Benzodiazepine/Z-Drug Discontinuation: A Retrospective Cohort Study in an Academic Health System.

Benzodiazepines and z-drugs increase the fall risk in older adults. There is a lack of real-world data examining the association between falls and deprescribing medications. In a retrospective cohort study of older adults with chronic benzodiazepine or z-drug use receiving care at an academic health system from January 2017 to December 2020, we explored the association between medication discontinuation and falls. Chronic use was defined as ≥ 3 medication dispensings and cumulative days' supply ≥ 45 days within 100 days in 2018. Discontinuation was defined as a dispensing gap of ≥ 180 days within 1 year of chronic use eligibility, with a secondary definition requiring a gap of ≥ 90 days. Non-discontinuers (n = 524) were matched 4:1 to discontinuers (n = 131) if they had a fill in the same month as the matched discontinuation index date. The association between discontinuation and a fall during 2.25-year follow-up was assessed using Cox proportional hazards models. The analysis was repeated using a gap of ≥ 90 days (n = 279 discontinuers; 1116 matched non-discontinuers). The cumulative incidence of falls-related acute visits was 6.9% for discontinuers and 9.7% for non-discontinuers [adjusted hazard ratio (HR) 0.65, 95% confidence interval (CI) 0.31-1.31]. Using the 90-day-gap definition, the cumulative incidence was 9.3% for discontinuers and 8.5% for non-discontinuers (HR 1.12, 95% CI 0.70-1.77). Benzodiazepine/z-drug discontinuation was not associated with reduced risk of falls. However, the relationship between discontinuation and falls varies depending on the definitions used. It is essential to examine different discontinuation definitions in larger studies while considering other relevant clinical outcomes.

Development and Validation of a Sonication-Assisted Dispersive Liquid-Liquid Microextraction Procedure and an HPLC-PDA Method for Quantitative Determination of Zolpidem in Human Plasma and Its Application to Forensic Samples.

The use of z-drugs has increased worldwide since its introduction. Although the prescribing patterns of hypnotics differ among countries, zolpidem is the most widely used z-drug in the world. Zolpidem may be involved in poisoning and deaths. A simple and fast HPLC-PDA method was developed and validated. Zolpidem and the internal standard chloramphenicol were extracted from plasma using a sonication-assisted dispersive liquid-liquid microextraction procedure. The method was validated including selectivity, linearity, precision, accuracy, and recovery. The calibration range (0.15-0.6 µg/mL) covers therapeutic and toxic levels of zolpidem in plasma. The limit of quantification was set at 0.15 µg/mL. Intra- and interday accuracy and precision values were lower than 15% at the concentration levels studied. Excellent recovery results were obtained for all concentrations. The proposed method was successfully applied to ten real postmortem plasma samples. In our series, multiple substances (alcohol and/or other drugs) were detected in most cases of death involving zolpidem. Our analytical method is suitable for routine toxicological analysis.

Z-Drug Use and Benzodiazepine Use and Misuse Among LGB Populations: The Role of Psychological Distress.

Z-drugs (hypnotics such as zolpidem, zopiclone, and zaleplon) and benzodiazepines (BZDs) are sedative medications with misuse liability. The goals of this study are to report the (1) prevalence of past-year any Z-drug use, any BZD use, and any BZD misuse by sexual identity category and psychological distress; (2) associations among these 3 categories between sexual identity and past-year psychological distress; (3) associations among these 3 categories with sexual identity by past-year psychological distress status. Data were collected from the National Survey on Drug Use and Health (years 2015-2019 [n = 210,392]), a yearly representative national household survey of the American population. We report prevalences of any Z-drug use, any BZD use, and any BZD misuse by sexual identity and past-year psychological distress status. We ran logistic regressions with complex survey design with the 3 dichotomous variables described above as the dependent variables, stratified and not-stratified by psychological distress. Prevalence of any Z-drug an BZD use and any BZD misuse were higher among LGB (lesbian/gay/bisexual) populations, especially gay men and bisexual women. Psychological distress was positively associated with any Z-drug and BZD use and any BZD misuse. Women were at higher risk of Z-drug (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.18-1.37) and BZD use (OR, 1.64; 95% CI, 1.55-1.73), but lower risk of BZD misuse (OR, 0.82; 95% CI, 0.76-0.88). When stratifying by psychological distress, differences between LGB and heterosexuals were more pronounced among those without past-year psychological distress, especially gay men and bisexual women. The presence of psychological distress attenuates the disparities between LGB and heterosexual individuals in Z-drug use and BZD use and misuse.

Patient-GP-Pharmacist cooperation towards individualized tapering schemes for long term benzodiazepine users

Long-term use of benzodiazepines and Z-drugs is associated with multiple side effects, such as increased sedation, fall risk, and an elevated risk of dependency and abuse. Avoiding initiation of treatment, or stopping treatment after a few weeks, is definitely the best-case scenario. But for patients that are already using benzodiazepines for more than 3 months (up to 20 years or more), a deprescribing methodology should be deployed. Abrupt withdrawal, particularly if the individual has been taking the drug in high doses, can result in severe symptoms, including psychotic reactions. The recommendation is for slow withdrawal, tapering the dosage gradually over a period of several months.&#x0D; Pharmacy compounding of capsules has been a possibility for many years, and allows to prepare and dispense individualized dosages to patients. Medical practitioners such as GP’s have always had the possibility to prescribe dose reduction schemes for patients motivated to taper off. Unfortunately, as benzodiazepines are not reimbursed in Belgium, this came at a high cost for patients.&#x0D; In 2022, pharmacy associations together with health insurance funds and the National Institute for Health and Disability Insurance (NIHDI) worked on a reimbursement scheme that allowed tapering off benzodiazepines. The patient-GP-pharmacist triangle is at the core of the scheme:&#x0D; -Pharmacists raise awareness when dispensing prescribed benzodiazepines, and prepare and dispense individualized doses&#x0D; -GP’s motivate patients to consider tapering and prescribe the programme&#x0D; -Patients engage in a tapering path and are intensively followed by the GP and the pharmacist&#x0D; Apart from the roles and responsibilities of the 3 parties, there are some rules set out to increase the change of successful tapering whilst keeping expenditure under control. For instance, a maximum daily consumption of 3 DDD set out, there is choice between 3 tapering schemes (5, 7 or 10 steps), and the total duration of the programme should not exceed 360 days.&#x0D; Critical success factors of these programs are: intrinsic motivation of the patient, therapeutic contract with 3 parties concerned, absence of financial penalty for patients, and smooth communication between prescriber and preparer/dispenser.&#x0D;

Benzodiazepines and z-drugs - between treatment effectiveness and the risk of addiction

Benzodiazepines (BZDs) and Z-drugs are commonly prescribed medications for anxiety and sleep disorders. This review examines their efficacy, associated risks, and alternative treatment options. BZDs enhance the activity of gamma-aminobutyric acid (GABA), reducing anxiety, while Z-drugs selectively target GABA-A receptors' alpha-1 subunits for sedative effects. Despite their effectiveness, both drug classes carry the risk of addiction, physical and psychological dependence, and withdrawal symptoms. Side effects, such as drowsiness, dizziness, and cognitive impairment, are also associated with their use. Recent studies indicate that chronic use of BZDs and Z-drugs may lead to cognitive impairment and an increased risk of dementia in older adults. Furthermore, individual factors, dosage, duration of use, and drug interactions can affect their efficacy. Prescribing trends show a decline in benzodiazepine prescriptions and an increase in Z-drug use due to perceived safety advantages. However, evidence suggests that Z-drugs carry similar risks of adverse effects and addiction potential as benzodiazepines. Healthcare professionals should carefully assess patients before prescribing these drugs and monitor their use to prevent dependence and addiction. Brief interventions, patient education, drug withdrawal support, and cognitive behavioral therapy have shown effectiveness in reducing long-term benzodiazepine and Z-drug use. Alternative treatments, including cognitive behavioral therapy and relaxation techniques, should be considered, particularly for patients with a history of addiction or those at high risk of addiction. In conclusion, the risk of addiction, withdrawal symptoms, and adverse effects associated with benzodiazepines and Z-drugs necessitates cautious prescribing and the exploration of alternative treatment options.

Retracted: Short- and Long-Term Influences of Benzodiazepine and Z-Drug Use in Patients with Bipolar Disorder Combined Sleep Disturbance during Affective Period: A Nine-Month Follow-Up Analysis.

[This retracts the article DOI: 10.1155/2022/6799898.].

Factors associated with long-term benzodiazepine and Z-drug use across the lifespan and 5-year temporal trajectories among incident users: a Swedish nationwide register-based study

PurposeDespite being discouraged by guidelines, long-term use of benzodiazepines and related Z-drugs (BZDR) remains frequent in the real-world. An improved understanding of factors associated with the transition from new to long-term BZDR use and of temporal BZDR use trajectories is needed. We aimed to assess the proportion of long-term BZDR use (> 6 months) in incident BZDR-recipients across the lifespan; identify 5-year BZDR use trajectories; and explore individual characteristics (demographic, socioeconomic and clinical) and prescribing-related factors (pharmacological properties of the initial BZDR, prescriber’s healthcare level, and concurrent dispensing of other medications) associated with long-term BZDR use and distinct trajectories.MethodsOur nationwide register-based cohort included all BZDR-recipients in Sweden with first dispensation in 2007–2013. Trajectories of BZDR use days per year were built using group-based trajectory modelling. Cox regression and multinomial logistic regression were fitted to assess the predictors of long-term BZDR use and trajectories’ membership.ResultsIn 930,465 incident BZDR-recipients, long-term use increased with age (20.7%, 41.0%, and 57.4% in 0–17, 18–64, and ≥ 65-year-olds, respectively). Four BZDR use trajectories emerged, labelled ‘discontinued’, ‘decreasing’, ‘slow decreasing’ and ‘maintained’. The proportion of the ‘discontinued’ trajectory members was the largest in all ages, but reduced from 75.0% in the youths to 39.3% in the elderly, whereas the ‘maintained’ increased with age from 4.6% to 36.7%. Prescribing-related factors, in particular multiple BZDRs at initiation and concurrent dispensing of other medications, were associated with increased risks of long-term (vs short-term) BZDR use and developing other trajectories (vs ‘discontinued’) in all age groups.ConclusionsThe findings highlight the importance of raising awareness and providing support to prescribers to make evidence-based decisions on initiating and monitoring BZDR treatment across the lifespan.

High Prescribing and State-Level Variation in Z-Drug Use Among Medicare Patients.

Z-drugs are nonbenzodiazepine hypnotics used for sleep initiation and maintenance; these drugs increase the risk of fall-related injuries in older adults. The American Geriatrics Society's Beers criteria classifies Z-drugs as high-risk and strongly recommends avoiding prescribing Z-drugs to older adults due to adverse effects. The study objectives were to determine the prevalence of Z-drug prescribing among Medicare Part D patients and identify state or specialty-dependent prescribing differences. This study also aimed to determine prescribing patterns of Z-drugs to Medicare patients. Z-drug prescription data was extracted from the Centers for Medicare and Medicaid Services State Drug Utilization Data for 2018. For all 50 states, the number of prescriptions per 100 Medicare enrollees and days-supply per prescription was determined. The percentage of total prescriptions prescribed by each specialty and the average number of prescriptions per provider within each specialty was also determined. Zolpidem was the most prescribed Z-drug (95.0%). Prescriptions per 100 enrollees were significantly high in Utah (28.2) and Arkansas (26.7) and significantly low in Hawaii (9.3) relative to the national average (17.5). Family medicine (32.1%), internal medicine (31.4%), and psychiatry (11.7%) made up the largest percentages of total prescriptions. The number of prescriptions per provider was significantly high among psychiatrists. Contrary to the Beers criteria, Z-drugs are prescribed to older adults at high rates.

Legislation alone is not enough to reduce prescriptions of benzodiazepines

Psychiatry and Clinical NeurosciencesVolume 77, Issue 5 p. 251-251 Editorial Legislation alone is not enough to reduce prescriptions of benzodiazepines Takashi Tsuboi MD, PhD, Corresponding Author Takashi Tsuboi MD, PhD [email protected] orcid.org/0000-0002-8253-8888 Department of Neuropsychiatry, Kyorin University School of Medicine, Mitaka, Japan Correspondence: Email: [email protected]Search for more papers by this author Takashi Tsuboi MD, PhD, Corresponding Author Takashi Tsuboi MD, PhD [email protected] orcid.org/0000-0002-8253-8888 Department of Neuropsychiatry, Kyorin University School of Medicine, Mitaka, Japan Correspondence: Email: [email protected]Search for more papers by this author First published: 02 May 2023 https://doi.org/10.1111/pcn.13536Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. References 1Takeshima M, Yoshizawa K, Enomoto M et al. Effects of Japanese policies and novel hypnotics on long-term prescriptions of hypnotics. Psychiatry Clin. Neurosci. 2023; 77: 264– 272. 2Olfson M, King M, Schoenbaum M. Benzodiazepine use in the United States. JAMA Psychiat. 2015; 72: 136– 142. 3Panes A, Pariente A, Bénard-Laribière A et al. Use of benzodiazepines and z-drugs not compliant with guidelines and associated factors: A population-based study. Eur. Arch. Psychiatry Clin. Neurosci. 2020; 270: 3– 10. 4 The International Narcotics Control Board. Psychotropic Substances 2021. https://www.incb.org/incb/en/psychotropics/technical-report.html Volume77, Issue5May 2023Pages 251-251 ReferencesRelatedInformation

Global trends in the consumption of benzodiazepines and Z-drugs in 67 countries and regions from 2008-2018: a sales data analysis.

To investigate the trends in the consumption of benzodiazepines (BZDs) and Z-drugs at global, regional, and national levels from 2008 to 2018, across 67 countries and regions. This cross-sectional descriptive study investigated the consumption of BZDs and Z-drugs analysed by global pharmaceutical sales data from the IQVIA-Multinational Integrated Data Analysis System database between 2008 and 2018. Consumption was measured in defined daily dose per 1,000 inhabitants per day (DDD/TID). The global, regional, and national trends were estimated using linear mixed models. Additional analyses were conducted by grouping countries by income levels. The association between consumption and Gross Domestic Product (GDP) and the prevalence of different medical conditions was explored in univariable linear models. BZD consumption decreased annually by -1.88% (95% CI: -2.27%, -1.48%), and Z-drugs increased by +3.28% (+2.55%, +4.01%). In 2008, the top ten countries for BZD and Z-drug consumption were all European, ranging from 63.69 to 128.24 DDD/TID. Very low levels were found in Russia, Kuwait, United Arab Emirates, Saudi Arabia, French West Africa, and the Philippines, with DDD/TID <1. The consumption in high-income countries was much higher than in middle-income countries. The results showed that increased consumption of BZDs and Z-drugs was statistically associated (P<0.05) with higher GDP and increased prevalence of anxiety, self-harm, neurological disorders, chronic respiratory diseases, cardiovascular diseases and cancers. Distinct differences in consumption and trends of BZDs and Z-drugs were found across different countries and regions. Further exploration is needed to understand the association and safety of the use of BZDs and Z-drugs in patients with comorbidities.

A Comparison between Perceptions of Psychiatric Outpatients and Psychiatrists Regarding Benzodiazepine Use and Decision Making for Its Discontinuation: A Cross-Sectional Survey in Japan

Although long-term use of benzodiazepines and z-drugs (BZDs) is not recommended, little is known about the stakeholders' perceptions. This study aimed to assess and compare the perceptions of BZD use and decision making regarding its discontinuation between psychiatric outpatients and psychiatrists. A cross-sectional survey was conducted. Of 104 outpatients, 92% were taking hypnotics and 96% were taking anxiolytics for ≥a year, while 49% were willing to taper hypnotic/anxiolytics within a year of starting. Most psychiatrists felt that "patient and psychiatrist make the decision together on an equal basis" compared to patients (p < 0.001), while more patients felt that "the decision is (was) made considering the psychiatrists' opinion" compared to psychiatrists (p < 0.001). Of 543 psychiatrists, 79% reported "patients were not willing to discontinue hypnotic/anxiolytic" whereas a certain number of patients conveyed "psychiatrists did not explain in enough detail about hypnotic/anxiolytic discontinuation such as procedure (18.3%), timing (19.2%), and appropriate condition (14.4%)". The results suggest that the majority of psychiatric outpatients were taking hypnotic/anxiolytics for a long time against their will. There might be a difference in perceptions toward hypnotic/anxiolytic use and decision making for its discontinuation between psychiatric outpatients and psychiatrists. Further research is necessary to fill this gap.

Maternal Benzodiazepines and Z-Drugs Use during Pregnancy and Adverse Birth and Neurodevelopmental Outcomes in Offspring: A Population-Based Cohort Study

Introduction: The use of benzodiazepines and/or z-drugs in women of childbearing age has increased. Objective: The aim of the study was to evaluate whether gestational benzodiazepine and/or z-drug exposure is associated with adverse birth and neurodevelopmental outcomes. Methods: A population-based cohort including mother-child pairs from 2001 to 2018 in Hong Kong was analysed to compare gestationally exposed and nonexposed children on the risk of preterm birth, small for gestational age, autism spectrum disorder (ASD), and attention-deficit/hyperactivity disorder (ADHD) through logistic/Cox proportional hazards regression with a 95% confidence interval (CI). Sibling-matched analyses and negative control analyses were applied. Results: When comparing gestationally exposed with gestationally nonexposed children, the weighted odds ratio (wOR) was 1.10 (95% CI = 0.97–1.25) for preterm birth and 1.03 (95% CI = 0.76–1.39) for small for gestational age, while the weighted hazard ratio (wHR) was 1.40 (95% CI = 1.13–1.73) for ASD and 1.15 (95% CI = 0.94–1.40) for ADHD. Sibling-matched analyses showed no association between gestationally exposed children and their gestationally nonexposed siblings for all outcomes (preterm birth: wOR = 0.84, 95% CI = 0.66–1.06; small for gestational age: wOR = 1.02, 95% CI = 0.50–2.09; ASD: wHR = 1.10, 95% CI = 0.70–1.72; ADHD: wHR = 1.04, 95% CI = 0.57–1.90). Similarly, no significant differences were observed when comparing children whose mothers took benzodiazepines and/or z-drugs during pregnancy to children whose mothers took benzodiazepines and/or z-drugs before but not during pregnancy for all outcomes. Conclusions: The findings do not support a causal relationship between gestational benzodiazepines and/or z-drugs exposure and preterm birth, small for gestational age, ASD, or ADHD. Clinicians and pregnant women should carefully balance the known risks of benzodiazepines and/or z-drugs use against those of untreated anxiety and sleep problems.

Sedative drug-use in Denmark, 2000 to 2019: a nationwide drug utilization study.

To describe trends in and characteristics of sedative drug use from 2000 through 2019 in relation to the introduction of central regulations and new drugs. In this descriptive study, we used individual prescription data on the entire Danish population from the Danish National Prescription Registry to calculate yearly incidence and prevalence of use of benzodiazepines, benzodiazepine-related drugs (Z-drugs), melatonin, olanzapine, low-dose quetiapine, mianserin/mirtazapine, pregabalin, and promethazine from 2000 through 2019. From the Danish National Patient Registry, we obtained data on drug users' psychiatric and somatic comorbidity. The use of benzodiazepines and Z-drugs declined gradually from 2000 through 2019, whereas the newer alternatives, melatonin, low-dose quetiapine, pregabalin and promethazine, increased in use, while the use of olanzapine and mianserin/mirtazapine was relatively stable. This development was seen in both men and women and across all age groups except for hypnotic benzodiazepines which showed a steep increase in the oldest age group from 2010. For all sedative drugs depression, anxiety, alcohol and misuse disorder, pain and cancer were the most prevalent comorbidities. During our study period, the number of individuals without any of the selected diagnoses increased. In Denmark different central regulations have influenced prescription practice toward more restrictive use of Z-drugs and benzodiazepines, except for hypnotic benzodiazepine prescriptions increased after the introduction of special palliative care. An increase in use of newer sedative drugs, however, indicates that the regulations do not remove the need for sedative drugs in the population.

Development and evaluation of an evidence-based health information on benzodiazepines and z-drugs

Abstract Background With approximately 1.1-1.4 million people in Germany taking benzodiazepines (BZDs) and z-drugs in a problematic or dependent manner, this is a relevant public health problem which needs to be adressed. However, it is well known that affected individuals do not receive the counseling or treatment they need. One possible solution is preventive education of affected individuals and medical practioners using evidence-based and target-group-health information (HI).The project EDER-MIA aimed to develop and evaluate evidence-based and target-group-related HI. Methods With the help of three different focus groups (18-40-years; women: 40-60-years; &amp;gt; 60-year-olds), the information needs of affected individuals were assessed. Based on the results, we developed the HI and received feedback from health experts. The HI was implemented online (http://www.psychenet.de) and evaluated with the ‘Usefulness Scale of Patient Information’ (USE): An assessment was made on 3 subscales with a 10-point scale from ‘1=disagree at all’ to ‘10=agree completely'. By forming a sum score (range: 0-90), an overall assessment was calculated. Results The results of the focus group study revealed the persons taking BZDs or z-drugs were in need about informations about sleep problems, the risk of taking BZDs and z-drugs and a better orientation regarding help services. The evaluation of the health information achieved medium acceptance rates of usefulness for affected persons (N = 192, 68.2% female; mean= 54.3, sd = 15.4). A somewhat higher usefulness was recognised by the medical staff (N = 58, 69.0% female, mean=64.7, sd = 17.2). Conclusions The development of target group-specific HI with the participation of affected individuals and experts is suitable for topics that are associated with possible experiences of shame and stigma. In addition to providing information about the risks of taking BZDs and z-drugs, screening of problematic BZD and z-drug use is also a matter of concern. Key messages • BZDs and z-drug use is a relevant public health concern which needs to be adressed. • Target-group specific health information for BZD and z-drug use accompanied by a screening-test can encourage affected individuals to seek medical advice.

Continuing Medical Education Questions: December 2022.

Article Title: Use of Benzodiazepines and Z-Drugs in Inflammatory Bowel Disease.

Use of Benzodiazepines and Z-Drugs in Inflammatory Bowel Disease.

We estimated the incidence and prevalence of benzodiazepine and Z-drug (separately and jointly as BZD) use in the inflammatory bowel disease (IBD) population compared with matched controls without IBD and examined the association of mood/anxiety disorders (M/ADs) with the use of BZD from 1997 to 2017. Using administrative data from Manitoba, Canada, we identified 5,741 persons with incident IBD who were matched in a 1:5 ratio to controls on sex, birth year, and region. Validated case definitions were used to identify M/AD. Dispensations of BZD were identified. Multivariable generalized linear models were used to assess the association between IBD, M/AD, and BZD use. In 2016, the incident age/sex-standardized benzodiazepine use rates per 1,000 were 28.06 (95% confidence interval [CI] 26.41-29.81) in the IBD cohort and 16.83 (95% CI 16.28-17.39) in controls (adjusted rate ratio = 1.69 [95% CI 1.56-1.79]). Benzodiazepine incidence rates were higher for women with IBD than men, but the RR between cases and controls were similar for men and women. The incident age/sex-standardized Z-drug use rate per 1,000 was 21.07 (95% CI 19.69-22.41) in the IBD cohort. This was 1.87-fold higher than in controls (95% CI 1.73-2.01). In 2017, approximately 20% of persons with IBD used benzodiazepines and 20% used Z-drugs. There was a subadditive effect of both benzodiazepine and Z-drug uses between IBD and M/AD after adjusting for covariates. The use of BZD is more common in people with IBD than in population controls. Strategies to reduce the use of BZDs in persons with IBD and to offer alternative management strategies for M/ADs, sleep disorders, and other symptomatic concerns are needed.

Insomnia in primary care: a survey conducted on Italian patients older than 50 years—results from the “Sonno e Salute” study

Insomnia affects one-third of the adult population and is associated with multiple medical conditions. We conducted an observational epidemiological survey to assess (1) the prevalence of insomnia in an Italian group of patients aged over 50 years, presenting directly to the general physician (GP); (2) the association of insomnia with sleepiness and comorbidities; and (3) the pharmacological treatment. The study was carried out by GPs. Each GP was asked to enroll the first patient over 50 years old spontaneously presenting for any medical problems for 5 consecutive days. The Italian version of the Sleep Condition Indicator (SCI) was administered; daytime sleepiness was evaluated by a visual analogic scale (VAS). For every patient, GPs collected information regarding comorbidities and pharmacological treatment for insomnia and evaluated the severity of insomnia using the Clinical Global Impression Severity (CGI-S) scale. A total of 748 patients (mean age 65.12 ± 9.45 years) were enrolled by 149 GPs. Prevalence of insomnia was 55.3%. SCI, VAS, and CGI-S scores were highly correlated between each other (p < 0.0001). At general linear model analysis, the comorbidities more associated with the presence of insomnia were anxiety-depressive disorder (p < 0.001), other psychiatric disorders (p = 0.017), cardiovascular disorders (p = 0.006), and dementia (p = 0.027). A statistically significant correlation was found between SCI score and the use of benzodiazepines (p < 0.001), z-drugs (p = 0.012), antidepressants (p < 0.001), and melatonin-prolonged release (p < 0.001). Insomnia affects half of Italian primary care patients over 50 years and is frequently associated with different medical conditions, sleepiness, and use of multiple—often off-label—drugs.

Use of hypnotic drugs among Scandinavian children, adolescents, and young adults

IntroductionHypnotic drug use in children and adolescents is widely debated.ObjectivesTo describe use of hypnotic drugs (melatonin, z-drugs and sedating antihistamines) among 5-24-year-old Scandinavians during 2012 to 2018.MethodsAggregate-level data from public data sources in Sweden, Norway and Denmark. We calculated annual prevalence (users/1000 inhabitants) stratified by sex, age group and country. Quantity of use (Defined Daily Dose (DDD)/user/day) was estimated for Norway and Denmark.ResultsMelatonin was most frequently used, with an increase from 2012 to 2018 in all countries. Sweden presented the highest rise (7 to 25/1,000) compared to Denmark (6 to 12/1,000) and Norway (10 to 20/1,000). The increase was strongest for females and 15-24-year-olds. Melatonin use was twice as common for males under age 15 years, and slightly more common for females thereafter. The annual prevalence of sedating antihistamine use doubled from 7 to 13/1,000 in Sweden, whereas it was more stable in Norway and Denmark, reaching 8/1,000 and 3/1,000, respectively. Z-drug use decreased in all countries, lowering to 4/1,000 in Sweden and Norway in 2018 and 2/1,000 in Denmark. The quantity of hypnotic use in Norway and Denmark was 1 DDD/user/day for melatonin, as compared to 0.1-0.3 for z-drugs and antihistamines.ConclusionsThere is an increasing use of melatonin and sedating antihistamines among Scandinavian children, adolescents and young adults. The increase is more pronounced in Sweden compared to Norway and Denmark. This Scandinavian discrepancy could reflect variation in frequency of sleep problems or national variation in clinical practice or health care access.DisclosureNo significant relationships.