Lauren B. Gerlach, D.O. Clinical Lecturer Department of Psychiatry University of Michigan

Larger Number of Benzodiazepine Pills in Initial Prescription Associated With Long Term Use Interview with:

Lauren B. Gerlach, D.O. Clinical Lecturer Department of Psychiatry University of Michigan

Dr. Gerlach

Lauren B. Gerlach, D.O.
Clinical Lecturer
Department of Psychiatry
University of Michigan What is the background for this study? 

Response: In this study we used data from the Supporting Seniors Receiving Treatment and Intervention or SUSTAIN program. The program provides a supplement to a Pennsylvania medication coverage program for low-income older adults. It provides behavioral health and case management services by phone across the state. This included detailed interviews to screen for mental health issues including anxiety, depression, sleep issues, and pain, as well as analysis of prescription records and other clinical data.

Among older adults prescribed a new benzodiazepine prescription by a non-psychiatric provider, we determined how many then went on to long-term use of the medication and what patient and clinical characteristics predicted long-term use over the following year.  What are the main findings?

Response: Despite evidence for many potential risks, our study found that 1 in 4 older adults newly prescribed a benzodiazepine went on to long-term use. Long-term use of these kinds of medications can place older adults in particular at risk for concerning side effects such as falls and cognitive impairment. We found that non-clinical factors such as patient race and the days’ supply in the initial prescription were strongly associated with conversion to long-term use. For just every 10 additional days of medication prescribed, a patient’s risk of long-term use nearly doubled over the next year. Of the clinical measures evaluated, which included measures of depression, anxiety, sleep, and pain, only poor sleep was associated with the likelihood of continued benzodiazepine use. This is despite the fact that benzodiazepines are not recommended for long-term use as sleep aids for older adults and may even worsen sleep outcomes the longer they are used. What should readers take away from your report? 

Response: The decision to prescribe and then continue a benzodiazepine—or any other medical treatment—should be driven by a clinical need. It is concerning that we found that non-clinical factors such patient race and supply of initial prescription were strongly associated with long-term use. Our and others findings that a larger number of pills provided in the initial prescription is associated with conversion to long-term use, suggests that providers should pause and think more cautiously when providing a new prescription for a benzodiazepine—such as considering a 14-day supply rather than a 30-day supply of medication. What recommendations do you have for future research as a result of this work?

Response: Further work is needed to better understand the variety of both patient and provider factors that drive prescribing practices. Additionally, more work is needed to improve access to and education surrounding effective non-pharmacologic treatment, such as cognitive behavioral therapy, and tapering strategies so that providers feel like they have treatment alternatives to offer patients. Is there anything else you would like to add?

Response: The results of our study show that we need to help providers start with the end in mind when prescribing a benzodiazepine, by beginning with a short-duration prescription and engaging patients in discussions of when to reevaluate their symptoms and begin tapering the patient off. Since chronic benzodiazepine use is rarely the goal when a new benzodiazepine is started, clinicians may decrease the likelihood of long-term use by limiting the amount of medication they provide in that initial prescription.

The authors have no disclosures. This study was supported by the Pharmaceutical Assistance Contract for the Elderly of the Commonwealth of Pennsylvania.


Gerlach LB, Maust DT, Leong SH, Mavandadi S, Oslin DW. Factors Associated With Long-term Benzodiazepine Use Among Older Adults. JAMA Intern Med. Published online September 10, 2018. doi:10.1001/jamainternmed.2018.2413 

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Last Updated on September 10, 2018 by Marie Benz MD FAAD