Discontinuation of Chronic Benzodiazepine Use Among Adults in the United States

Abstract

Background: Guidelines recommend most benzodiazepine (BZD) treatment be short-term, though chronic BZD use is increasing. Objective: Determine the rate of BZD discontinuation among chronic users and identify patient- and provider-level factors associated with discontinuation. Design, Setting, and Participants: A retrospective cohort study using nationwide insurance claims data from 2014 to 2016 of US adults ≥ 18 years old with chronic BZD use (i.e., > 120 days) during the baseline year. Main Outcomes and Measures: The primary outcome was BZD discontinuation among chronic users after 1 year of follow-up. A series of multilevel logistic regression models examined the association of BZD discontinuation with patient and provider characteristics. Covariates included patient sociodemographics, medical and psychiatric comorbidity, co-prescribed opioids and other psychotropics, and characteristics of the prescribed BZD. Key Results: Of 141,008 chronic BZD users, 13.4% discontinued use after 1 year. Females had lower odds of discontinuation (AOR 0.83, 99% CI 0.79–0.87), while African-American patients had higher odds (AOR 1.12, 99% CI 1.03–1.22). Those prescribed a high-potency BZD had lower odds of discontinuation (AOR 0.51, 99% CI 0.47–0.54), as did those prescribed an opioid (AOR 0.94, 99% CI 0.89–0.99). After adjusting for patient- and provider-level factors, differences between providers accounted for 5.8% of variation in BZD discontinuation (p < 0.001). The median odds ratio for provider was 1.54, an association with discontinuation larger than almost all patient-level clinical variables. Conclusions: A small minority of patients prescribed chronic BZD in a given year are no longer prescribed BZDs 1 year later. There is significant variation in the likelihood of discontinuation accounted for by non-clinical factors such as race, geography, and a patient’s provider, which had a stronger association with the odds of discontinuation than almost every other patient-level variable. Provider-facing elements of interventions to reduce BZD prescribing may be critical.