Australian doctors prescribing benzos for longer periods than recommended

Australian doctors are prescribing benzodiazepines and Z-drugs for longer periods than recommended, researchers from the University of Adelaide have found.

The large study, published in Pharmacology Research and Perspective, investigated medical records of more than 1.4 million patients who visited their GPs between 2011 and 2018 to identify long-term use of benzodiazepines and Z-drugs. 

The study found that in new benzodiazepines and Z-drugs users, prescribing lasts 11 months on average, which is 11 times longer than the current recommendation of no more than 4 weeks. 

“Long-term use of benzos and Z-drugs is concerning especially among elderly women and could potentially be linked to the increased prevalence of chronic mental health issues and use for insomnia management,’’Associate Professor David Gonzalez, from the University of Adelaide's Discipline of General Practice

Benzodiazepines, or benzos, are drugs prescribed mainly to manage anxiety and insomnia, while Z-drugs (zolpidem and zopiclone) are medications exclusively used for managing insomnia. 

In Australia, benzodiazepines and Z-drugs are available only with a prescription. They should not be used for more than four weeks due to their side effects and risk of dependency, addiction and overdose. 

Benzodiazepines and Z-drugs represent about 4-5% of all medications prescribed by GPs in Australia. In 2019–20, approximately 5.5 million benzodiazepine prescriptions were dispensed in Australia to 1.5 million people, meaning 1 in 20 Australians was treated with these drugs last year. 

Associate Professor David Gonzalez, from the University of Adelaide’s Discipline of General Practice, said benzos and Z-drugs are widely considered effective, but long-term use can also cause potential harms.

“Short-term use of these medications is usually safe and successful. However, long-term use can lead to dependence and adverse effects. Because they are very addictive medications, stopping them suddenly can cause anxiety, nausea, aches, hand tremors and other withdrawal symptoms,” Associate Professor Gonzalez said. 

The study also found that older people are six times more likely to be prescribed long-term benzos or Z-drugs than younger patients, and women and people living in disadvantaged areas were also more likely to receive long-term prescriptions. 

According to Associate Professor Gonzalez: “the higher rates of long-term prescription of benzos and Z-drugs in those groups are concerning and highlight the need for interventions that reduce their potential harms in vulnerable people”.

Patients who regularly use benzos or Z-drugs are more likely to suffer severe adverse effects such as falls and hip fractures, traffic accidents, problems with memory, physical dependence, and hospitalisations. The study results coincide with a substantial increase in benzos-related deaths in Australia. 

“Long-term use of benzos and Z-drugs is concerning especially among elderly women and could potentially be linked to the increased prevalence of chronic mental health issues and use for insomnia management,’’ said Associate Professor Gonzalez.

“There should be availability of non-pharmacological approaches to help avoid benzos and Z-drugs initiation, as well as access to programs to help with cessation of long-term use.”