From Prescription to Dependence? Retrospective Cohort Study of Long-term Benzodiazepine and Z-drug Use
D. Kubek, M. Mišuth, M. Selvek, L. Kováčová, B. Saal, R. Mužik, D. BreznoščákováIntroduction
Benzodiazepines and Z-drugs (BZDR) are commonly prescribed for anxiety and insomnia, yet their long-term use is discouraged due to risks of dependence and adverse outcomes. Evidence on long-term BZDR use in Slovakia remains scarce.
Objectives
We aimed to describe BZDR prescription in Slovakia using administrative data from a health insurance company, focusing on long-term use, patient characteristics and differences between specialist and general practitioners (GP) prescription patterns.
Methods
We conducted a retrospective cohort study using administrative data from a Slovak health insurance company covering approximately one-third of the Slovak population (1.7 million insurees in 2024). The study included all prescriptions with ATC codes N05BA, N05CD and N05CF (N = 5 144 826) between 2015 and 2024 for 343 280 patients insured at least 6 months before first prescription. Long-term use was defined as at least 3 consecutive prescriptions with gap of maximum 60 days in between and covering at least 90 daily doses. Statistical methods including linear regression and chi-square tests were applied.
Results
The mean age at time of treatment initiation was 52.5 years, women represented 63.0% of the cohort. Criteria for long-term BZDR use were met by 82 553 (24.0%) patients at least once during the study period. Long-term users were older at time of treatment initiation (mean age 58.0 years), with slightly higher proportion of women (64.4%, p < 0.001). There was no significant linear trend in ratio of long-term users over the study period (p = 0.151).
GPs were responsible for initiating BZDR treatment in 63.9 % cases (219 349 patients). Among specialists, psychiatrists initiated treatment in most cases (51 985, 15.1%). The difference in ratio of long-term users across treatment initiating specialties was significantly different (p < 0.001): GPs (25.1%), psychiatrists (34.9%) and other specialties (13.0%).
Conclusions
Long-term BZDR use is a prevalent phenomenon, affecting nearly one in four patients. Initiation of treatment by psychiatrists lead to long-term use more often compared to GPs and other specialties. Older patients and women showed increased susceptibility to long-term use of BZDR. These findings highlight the importance of monitoring treatment duration and developing strategies to prevent unnecessary long-term exposure to BZDR.
Disclosure of Interest
None Declared