Benzodiazepine Use Declines Across the U.S., Led by Reductions in Older Adults

Benzodiazepine treatment declined among U.S. adults between 2018 and 2022, with the steepest drop among adults ages 56 and older, according to a new study by researchers at the Columbia University Mailman School of Public Health and Columbia University Irving Medical Center. Despite the overall decrease, co-prescribing with other central nervous system (CNS) depressants—including opioids—remains common, particularly among adults in poor health or experiencing serious psychological distress. The findings are published in the Journal of Clinical Psychiatry.

“Considerable controversy has surrounded the appropriate role of benzodiazepines in clinical practice because of their withdrawal symptoms and risks, including falls, motor vehicle crashes, cognitive impairment, and overdose,” said Mark Olfson, MD, MPH, professor of Epidemiology at Columbia Mailman School and professor of Psychiatry at Vagelos College of Physicians and Surgeons.

As patients age, they become more sensitive to the adverse effects of these medications. The American Geriatrics Society recommends avoiding benzodiazepines in older adults when possible, especially in combination with opioids or other CNS depressants. Between 1990 and 2016, the percentage of U.S. office-based visits that included prescriptions for both benzodiazepines and opioids or other CNS depressants tripled, highlighting the potential for harmful drug–drug interactions, Olfson noted.

The researchers analyzed data from 104,231 adults ages 18 and older who participated in the 2018–2022 Medical Expenditure Panel Survey, a nationally representative survey of the civilian, noninstitutionalized U.S. population. They examined age-specific trends in benzodiazepine use and the extent of concurrent treatment with other CNS depressants.

Annual benzodiazepine use declined from 4.7 percent of adults in 2018 to 3.4 percent in 2022. The decrease was most pronounced among adults 56 and older (7.0 percent to 4.7 percent), compared with adults ages 36–55 (4.4 percent to 3.4 percent) and ages 18–35 (2.1 percent to 1.8 percent).

However, 41.6 percent of adults who used benzodiazepines also received another CNS depressant during the same year. Co-prescribing was more common among adults ages 36–55 (44.6 percent) and 56 and older (43 percent) than among younger adults ages 18–35 (30 percent). Among benzodiazepine-treated adults in fair or poor health, 72 percent also received another CNS depressant; the same was true for 63 percent of those with serious psychological distress.

“Although benzodiazepine use is declining in U.S. outpatient care, the high rate of co-prescribing with other CNS depressants underscores the need for careful monitoring,” Olfson said. “Before initiating a benzodiazepine, clinicians should review a patient’s full medication list to assess potential drug to drug interactions—particularly for patients in poor health or experiencing serious psychological distress.”

Co-authors include Chandler McClellan and Samuel Zuvekas of the Agency for Healthcare Research and Quality and Carlos Blanco of the National Institute on Drug Abuse.

The authors report no conflicts of interest.