Clinical Summary: Trends in Benzodiazepine Prescribing to Adults in the United States: Results From the Medical Expenditure Panel Survey
Benzodiazepines remain clinically useful for anxiety, insomnia, alcohol withdrawal, catatonia, and seizures, but their place in practice is increasingly shaped by concerns about falls, cognition, overdose, and co-prescribing with other CNS depressants. This study tracks how often US adults receive benzodiazepines, which patients are most likely to receive them, and how often these prescriptions overlap with other sedating medications that raise safety risk.
Key Findings
- Prescription benzodiazepine use among US adults significantly decreased from 4.7% in 2018 to 3.4% in 2022, with a larger decline in adults aged ≥56 years (7.2%–4.7%) than in those aged 36–55 years (4.4%–3.4%) or 18–35 years (2.1%–1.8%).
- Across 2018–2022, benzodiazepine use was highest in adults aged ≥56 years (5.9%), followed by adults aged 36–55 years (3.8%), and lowest in adults aged 18–35 years (1.8%).
- Approximately 4 in 10 (41.6%) adults treated with benzodiazepines also received other CNS depressants in the same year; the rate was 44.6% in adults aged 36–55 years and 42.9% in those aged ≥56 years versus 30.0% in those aged 18–35 years.
- Among adults with benzodiazepine use, most benzodiazepine treatment was for anxiety or stress, accounting for 78.6% in adults aged 18–35 years, 70.2% in those aged 36–55 years, and 56.8% in those aged ≥56 years, while insomnia or sleep disorders accounted for 18.5% of use in adults aged ≥55 years versus 7.7% in those aged 36–55 years and 4.4% in those aged 18–35 years.
- Among adults aged 56 and over with ≥1 annual benzodiazepine prescription, the mean number of prescriptions declined from 5.4 in 2018 to 4.3 in 2022 (difference, −1.0, 95% CI: −1.6 to −0.5).
Benzodiazepine prescribing to US adults declined from 2018 to 2022, driven mainly by reduced use in older adults, but co-prescribing with other CNS depressants remained common at 41.6%. In practice, the main safety priority is not only whether to prescribe a benzodiazepine, but whether the patient is also receiving opioids, hypnotics, gabapentinoids, muscle relaxants, or antipsychotics.
Practice Implications
- Review the full medication list before starting or continuing a benzodiazepine, because 41.6% of benzodiazepine-treated adults also received other CNS depressants in the same year.
- Use extra caution in adults aged 36–55 years and ≥56 years, who had higher same-year exposure to other CNS depressants than adults aged 18–35 years (44.6% and 42.9% vs 30.0%).
- Expect the treatment indication to vary by age: anxiety or stress accounted for 78.6% of benzodiazepine use in adults aged 18–35 years, while insomnia or sleep disorders accounted for 18.5% of use in older adults.
- Monitor especially closely in patients with serious psychological distress or poor general health, since 62.9% of benzodiazepine-treated adults with serious distress and 72.0% of those in fair/poor general health also received other CNS depressants.
