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Benzodiazepines: risk of persistent use even after brief treatment

Occasional benzodiazepine use is often followed by repeated use, and there is a risk of addiction. When a benzodiazepine is justified, it is important to plan its withdrawal, together with the patient, as soon as treatment starts.

A cohort study published in 2021 identified 2.5 million adults in a US health insurance database who had undergone surgery between 2009 and 2017 and had not been prescribed a benzodiazepine during the year before their operation (excluding the month before the operation). The commonest operations were cataract surgery, cholecystectomy and hysterectomy.

Perioperative benzodiazepine use was observed in 64 000 (2.6%) of these patients, with half of them receiving more than 10 days' supply of the drug. Diazepam (e.g. Valium°) was the most frequently used benzodiazepine (32% of patients), followed by alprazolam (e.g. Xanax°) at 29%. 19.5% of the patients who had been prescribed a benzodiazepine around the time of surgery continued taking it afterwards. Among the patients who received another prescription for a benzodiazepine between 90 days and 180 days after the operation, 56% received one prescription and 44% received two or more prescriptions.

The factors shown to be associated with persistent benzodiazepine use in this study were: being 70 years of age or older, female gender, the number of comorbidities, or a history of anxiety, depression, insomnia or substance abuse.

In practice, occasional benzodiazepine use is commonly followed by repeated or persistent use, and the risk of addiction is real. When a benzodiazepine is justified, it is important to plan its withdrawal, together with the patient, as soon as treatment starts.

©Prescrire 1 March 2022

Source: "Perioperative benzodiazepines: a risk factor for persistent use" Prescrire International 2022; 31 (235): 78. Subscribers only.

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