National Trends in Benzodiazepine Prescribing by Provider Type in Children and Adults, 2013-2022

Background: Benzodiazepines (BZDs) are among the most commonly prescribed medications in the United States. Recent FDA black box warnings on the risks of BZD dependence/withdrawal, misuse/addiction, and co-prescribing with opioids highlight the importance of examining trends in BZD prescribing. Understanding which medical providers are prescribing BZDs, to what age groups, and for how many days they are supplied can inform prescribing practices to reduce adverse BZD-related health outcomes.

Objectives: To evaluate national trends in BZD prescriptions, including total prescriptions and days’ supply by provider type and patient age.

Methods: This observational study utilized IQVIA’s Longitudinal Prescription Claims (LRx) Dataset, which captures approximately 90% of outpatient prescriptions in the US across all ages and payer types. Monthly counts of BZD prescriptions from 1/2013 to 12/2022 were examined overall, by provider type (psychiatry, primary care, advanced practice, neurology, dentistry/oral surgeon, pain medicine, and other), and by patient age group (2-12, 13-17, 18-29, 30-44, 45-64, 65-80 years). Linear regression was used to estimate the average monthly change in BZD prescriptions from 2013 through 2022 overall, by provider type, and by age group. The monthly mean BZD prescription days’ supply values were estimated across the study period.

Results: The number of monthly BZD prescriptions in the US increased from 2013 to 2015, peaking at 5.7 million in November 2015, then steadily declined to 4.3 million in December 2022 (a 25% decline from peak). Across the study period, the rate of BZD prescriptions declined across all age groups, with the highest prescription rates consistently observed in adults aged 65-80 years followed by adults aged 45-64 years. BZD prescriptions declined across most provider types from 2013 to 2022, including primary care providers (-36.1%) and pain medicine providers (-54.3%), with an increase among advanced practice providers (72.7%). The mean days’ supply of BZD prescriptions declined from 2013 to 2022 across all age groups with variation by provider type. The largest reductions were in children aged 2-12 years (18.9 to 16.3) and 13-17 years (18.8 to 15.6 days). Substantial increases in days’ supply were observed at the onset of COVID-19 (3/2020 to 5/2020).

Conclusions: Declines in the number of BZD prescriptions from 2015 to 2022 alongside a reduction in BZD prescription days’ supply may indicate greater caution in BZD prescribing over the last decade. While the prescribing of other psychotropic medications has risen during this same time period, declines in BZD prescribing may have been influenced by increased awareness of BZD involvement in opioid-related overdoses and drug safety-related labeling changes.