Benzodiazepine use declined before the COVID-19 pandemic, then plateaued

1. In this retrospective cohort study, benzodiazepine use among US adults aged 65 years or older declined from 2015 to 2019 before plateauing during and after the COVID-19 pandemic.

2. In contrast, benzodiazepine use increased after 2020 among adults aged 75 years or older and those receiving medications through long-term care (LTC) pharmacies.

Evidence Rating Level: 2 (Good)

Study Rundown: Benzodiazepines are commonly prescribed to older adults in the United States to treat anxiety and insomnia despite their association with falls, cognitive impairment, motor vehicle accidents, and other adverse events. Previous studies have described prescribing patterns in this population but have not examined trends during and after the COVID-19 pandemic. This study evaluated national trends in benzodiazepine prescribing among US adults aged 65 years or older between 2015 and 2024. Nearly 25 million older adults filled at least one benzodiazepine prescription during the study period. Prescribing by advanced practice clinicians increased over time, while prescribing by primary care physicians declined. Approximately one-third of older adults receiving benzodiazepines were long-term users. Overall, benzodiazepine use declined between 2015 and 2019 before stabilizing from 2020 to 2024. Adults aged 65–69 and 70–74 years experienced greater relative reductions in use than adults aged 75 years or older, whose benzodiazepine use decreased during the pandemic but increased after 2020. Long-term benzodiazepine use also declined overall, although dispensing through long-term care (LTC) pharmacies increased, particularly after 2020. The study was limited by its reliance on prescription dispensing data, which lacked information on prescribing indications, comorbidities, concomitant medications, adherence, and adverse outcomes. Nevertheless, these findings suggest that although benzodiazepine use among older adults has declined overall, prescribing has plateaued since the COVID-19 pandemic and increased among adults aged 75 years or older and LTC pharmacy users. Further research is needed to identify the factors driving these trends and inform safer management of anxiety and insomnia in these high-risk populations.

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Relevant Reading: Benzodiazepine Use and Misuse Among Adults in the United States

In-Depth [retrospective cohort]: This retrospective cohort study examined national trends in benzodiazepine prescribing among US adults aged 65 years or older from 2015 to 2024, with particular emphasis on changes before and after the onset of the COVID-19 pandemic. Data were obtained from the IQVIA Longitudinal Claims database (January 2015-December 2024). Adults who filled at least one benzodiazepine prescription were characterized by age, sex, treatment duration, pharmacy type, prescribing specialty, and geographic region. Annual rates per 100 adults were calculated for overall benzodiazepine use, long-term use (≥180 days/year), and LTC pharmacy dispensing. Trends were analyzed separately for the periods 2015-2019 and 2020-2024. Between 2015 and 2024, 24,909,430 older adults filled at least one benzodiazepine prescription, of whom 66.2%-67.3% were women. Prescribing by advanced practice clinicians increased from 14.3% to 30.1%, while prescribing by primary care physicians declined from 68.3% to 56.6%. Approximately 30.8%-34.8% of older adults receiving benzodiazepines were long-term users. Overall benzodiazepine use declined from 14.1 to 11.5 prescriptions per 100 adults. Rates decreased significantly from 2015 to 2019 (β = -0.53; 95% confidence interval [CI], -0.60 to -0.47) before plateauing from 2020 to 2024 (β = 0.00; 95% CI, -0.03 to 0.03). Use declined similarly among men (17.3%) and women (17.5%). Adults aged 65-69 and 70-74 years experienced larger relative declines (25.3% and 23.0%, respectively) than those aged 75 years or older (9.4%). Among adults aged 75 years or older, benzodiazepine use decreased before 2020 (β = -0.49; 95% CI, -0.58 to -0.41) but increased thereafter (β = 0.23; 95% CI, 0.17-0.29). Long-term benzodiazepine use also declined overall (β = -0.16; 95% CI, -0.17 to -0.15), whereas LTC pharmacy dispensing increased from 0.46 to 0.85 prescriptions per 100 adults, declining before 2020 but rising significantly afterward. Overall, benzodiazepine use declined before the pandemic and then plateaued through 2024.

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