Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Psychiatry
Published in: BMC Psychiatry 1/2016

Open Access 01-12-2016 | Research article

Benzodiazepine prescription for patients in treatment for drug use disorders: a nationwide cohort study in Denmark, 2000–2010

Published in: BMC Psychiatry | Issue 1/2016

Login to get access

Abstract

Background

Benzodiazepines are frequently prescribed to patients with drug use disorders. However, it has previously been difficult to distinguish whether this frequent prescribing was due to underlying psychiatric disorders or inappropriate prescribing. In a nationwide cohort study, we investigated the prescribing of benzodiazepines to patients with drug use disorders in connection with treatment admission.

Methods

Benzodiazepine prescriptions to patients (N = 33203) aged 18 to 67 years admitting for outpatient treatment for drug use disorders in Denmark, 2000 to 2010, were studied by using linked data from nationwide health registries. Factors associated with increasing amounts of benzodiazepine use within the first year after admission were assessed by multinomial logistic regression. Proportions of very long-term benzodiazepine prescription were calculated.

Results

During the first year after admission to treatment, 26.2 % of patients were prescribed benzodiazepines. Of these, 35.5 % were prescribed benzodiazepines at dose levels that might indicate inappropriate use (>365 Defined Daily Dose per year), and 34.6 % were prescribed more than one type of benzodiazepines. Diazepam was the most commonly prescribed type. Among patients with opioid use, 43.2 % were prescribed benzodiazepines which were three times higher than for patients with cannabis (12.2 %) or central stimulating drugs (13.8 %) as their primary drug use. Admitting to treatment for a drug use disorder did not increase the specialized psychiatric treatment coverage of this patient group, disregarding use of prescribed benzodiazepines. 29.5 % were new users of prescribed benzodiazepines, and of these, 27.5 % continued into very long-term use (≥4 years after admission) during the study period.

Conclusions

Benzodiazepines were commonly prescribed to patients admitting to treatment for drug use disorders, and included prescription of multiple and non-optimal types, high doses, and very long-term prescriptions. These findings point towards inappropriate prescribing of benzodiazepines in many cases more than treatment for psychiatric disorders.
Literature
1.
Degenhardt L, Whiteford HA, Ferrari AJ, Baxter AJ, Charlson FJ, Hall WD, et al. Global burden of disease attributable to illicit drug use and dependence: findings from the Global Burden of Disease Study 2010. Lancet. 2013;382(9904):1564–74.CrossRefPubMed
2.
Denis C, Lavie E, Fatseas M, Auriacombe M. Psychotherapeutic interventions for cannabis abuse and/or dependence in outpatient settings. Cochrane Database Syst Rev. 2006;3:Cd005336.PubMed
3.
Knapp WP, Soares BG, Farrel M, Lima MS. Psychosocial interventions for cocaine and psychostimulant amphetamines related disorders. Cochrane Database Syst Rev. 2007;3:Cd003023.PubMed
4.
Gibson A, Degenhardt L, Mattick RP, Ali R, White J, O'Brien S. Exposure to opioid maintenance treatment reduces long-term mortality. Addiction (Abingdon, England). 2008;103(3):462–8.CrossRef
5.
Mattick RP, Breen C, Kimber J, Davoli M. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev. 2014;2:Cd002207.PubMed
6.
7.
Ashton H. Guidelines for the rational use of benzodiazepines. When and what to use. Drugs. 1994;48(1):25–40.CrossRefPubMed
8.
Brunette MF, Noordsy DL, Xie H, Drake RE. Benzodiazepine use and abuse among patients with severe mental illness and co-occurring substance use disorders. Psychiatric services (Washington, DC). 2003;54(10):1395–401.CrossRef
9.
Bramness JG, Kornor H. Benzodiazepine prescription for patients in opioid maintenance treatment in Norway. Drug Alcohol Depend. 2007;90(2–3):203–9.CrossRefPubMed
10.
Grant BF, Stinson FS, Dawson DA, Chou SP, Dufour MC, Compton W, et al. Prevalence and co-occurrence of substance use disorders and independent mood and anxiety disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry. 2004;61(8):807–16.CrossRefPubMed
11.
Clark RE, Xie H, Brunette MF. Benzodiazepine prescription practices and substance abuse in persons with severe mental illness. J Clin Psychiatry. 2004;65(2):151–5.CrossRefPubMed
12.
Chen KW, Banducci AN, Guller L, Macatee RJ, Lavelle A, Daughters SB, et al. An examination of psychiatric comorbidities as a function of gender and substance type within an inpatient substance use treatment program. Drug Alcohol Depend. 2011;118(2–3):92–9.CrossRefPubMedPubMedCentral
13.
Griffiths RR, Weerts EM. Benzodiazepine self-administration in humans and laboratory animals--implications for problems of long-term use and abuse. Psychopharmacology (Berl). 1997;134(1):1–37.CrossRef
14.
Backmund M, Meyer K, Henkel C, Soyka M, Reimer J, Schutz CG. Co-consumption of benzodiazepines in heroin users, methadone-substituted and codeine-substituted patients. J Addict Dis. 2005;24(4):17–29.CrossRefPubMed
15.
Taylor S, McCracken CF, Wilson KC, Copeland JR. Extent and appropriateness of benzodiazepine use. Results from an elderly urban community. Br J Psychiatry J Ment Sci. 1998;173:433–8.CrossRef
16.
Buffett-Jerrott SE, Stewart SH. Cognitive and sedative effects of benzodiazepine use. Curr Pharm Des. 2002;8(1):45–58.CrossRefPubMed
17.
O'Brien CP. Benzodiazepine use, abuse, and dependence. J Clin Psychiatry. 2005;66 Suppl 2:28–33.PubMed
18.
Voshaar RC, Couvee JE, van Balkom AJ, Mulder PG, Zitman FG. Strategies for discontinuing long-term benzodiazepine use: meta-analysis. Br J Psychiatry J Ment Sci. 2006;189:213–20.CrossRef
19.
Malcolm R, Brady KT, Johnston AL, Cunningham M. Types of benzodiazepines abused by chemically dependent inpatients. J Psychoactive Drugs. 1993;25(4):315–9.CrossRefPubMed
20.
Pradel V, Delga C, Rouby F, Micallef J, Lapeyre-Mestre M. Assessment of abuse potential of benzodiazepines from a prescription database using 'doctor shopping' as an indicator. CNS Drugs. 2010;24(7):611–20.CrossRefPubMed
21.
22.
23.
24.
Eriksen SI, Bjerrum L. Reducing Prescriptions of Long-Acting Benzodiazepine Drugs in Denmark: A Descriptive Analysis of Nationwide Prescriptions during a 10-Year Period. Basic Clin Pharmacol Toxicol. 2015;116(6):499–502.CrossRefPubMed
25.
Holm E, Fosbol E, Pedersen H, Jensen TB, Nielsen M, Weeke P, et al. Benzodiazepine use in Denmark 1997–2008. European Geriatric Medicine. 2012;3(5):299–303.CrossRef
26.
The National Board of Health and Welfare. Stofmisbrugsdatabasen (Register of Individuals in Treatment for Substance Use Disorders): The National Board of Health and Welfare, Copenhagen; 2015 [Available at: http://​www.​stofmisbrugsdata​basen.​dk].
27.
Kildemoes HW, Sorensen HT, Hallas J. The Danish National Prescription Registry. Scand J Public Health. 2011;39(7 Suppl):38–41.CrossRefPubMed
28.
Mors O, Perto GP, Mortensen PB. The Danish Psychiatric Central Research Register. Scand J Public Health. 2011;39(7 Suppl):54–7.CrossRefPubMed
29.
30.
WHO Collaborating Centre for Drug Statistics Methodology. Guidelines for ATC Classification and DDD Assignment. Oslo, Norway: Norwegian Institute of Public Health; 2007.
31.
Hausken AM, Furu K, Skurtveit S, Engeland A, Bramness JG. Starting insomnia treatment: the use of benzodiazepines versus z-hypnotics. A prescription database study of predictors. Eur J Clin Pharmacol. 2009;65(3):295–301.CrossRefPubMed
32.
Wei HT, Chen MH, Wong WW, Chou YH, Liou YJ, Su TP, et al. Benzodiazepines and Z-drug use among HIV-infected patients in Taiwan: a 13-year nationwide cohort study. BioMed Res Int. 2015;2015:465726.PubMedPubMedCentral
33.
Gronnerud L, Mahic M, Bramness JG. Bruk av benzodiazepiner og z-hypnotika blant pasienter i LAR. Norsk Farmaceutisk Tidsskrift. 2014;10:53–7.
34.
Naja WJ, Pelissolo A, Haddad RS, Baddoura R, Baddoura C. A general population survey on patterns of benzodiazepine use and dependence in Lebanon. Acta Psychiatr Scand. 2000;102(6):429–31.CrossRefPubMed
35.
Isacson D. Long-term benzodiazepine use: factors of importance and the development of individual use patterns over time--a 13-year follow-up in a Swedish community. Soc Sci Med. 1997;44(12):1871–80.CrossRefPubMed
36.
Chen KW, Berger CC, Forde DP, D'Adamo C, Weintraub E, Gandhi D. Benzodiazepine use and misuse among patients in a methadone program. BMC Psychiatry. 2011;11:90.CrossRefPubMedPubMedCentral
37.
Gelkopf M, Bleich A, Hayward R, Bodner G, Adelson M. Characteristics of benzodiazepine abuse in methadone maintenance treatment patients: a 1 year prospective study in an Israeli clinic. Drug Alcohol Depend. 1999;55(1–2):63–8.CrossRefPubMed
38.
Ashton H. The diagnosis and management of benzodiazepine dependence. Curr Opin Psychiatry. 2005;18(3):249–55.CrossRefPubMed
39.
European Monitoring Centre for Drug and Drug Addiction (EMCDDA). The misuse of benzodiazepines among high-risk opioid users in Europe Lisbon. Portugal: EMCDDA; 2015.
40.
Vogel M, Knopfli B, Schmid O, Prica M, Strasser J, Prieto L, et al. Treatment or "high": benzodiazepine use in patients on injectable heroin or oral opioids. Addict Behav. 2013;38(10):2477–84.CrossRefPubMed
41.
Orzack MH, Friedman L, Dessain E, Bird M, Beake B, McEachern J, et al. Comparative study of the abuse liability of alprazolam, lorazepam, diazepam, methaqualone, and placebo. Int J Addict. 1988;23(5):449–67.CrossRefPubMed
42.
Griffiths RR, Johnson MW. Relative abuse liability of hypnotic drugs: a conceptual framework and algorithm for differentiating among compounds. J Clin Psychiatry. 2005;66 Suppl 9:31–41.PubMed
43.
Manthey L, van Veen T, Giltay EJ, Stoop JE, Neven AK, Penninx BW, et al. Correlates of (inappropriate) benzodiazepine use: the Netherlands Study of Depression and Anxiety (NESDA). Br J Clin Pharmacol. 2011;71(2):263–72.CrossRefPubMedPubMedCentral
44.
Skretting A, Rosenqvist P. Shifting focus in substitution treatment in the Nordic countries. Nordic Studies on Alcohol and Drugs. 2010;27(6):581–97.
45.
Frank VA, Bjerge B, Houborg E. Shifts in opioid substitution treatment policy in Denmark from 2000–2011. Subst Use Misuse. 2013;48(11):997–1009.CrossRefPubMed
Metadata
Title
Benzodiazepine prescription for patients in treatment for drug use disorders: a nationwide cohort study in Denmark, 2000–2010
Publication date
01-12-2016
Published in
BMC Psychiatry / Issue 1/2016
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-016-0881-y

Other articles of this Issue 1/2016

BMC Psychiatry 1/2016 Go to the issue

Research article

Linear and non-linear analyses of Conner’s Continuous Performance Test-II discriminate adult patients with attention deficit hyperactivity disorder from patients with mood and anxiety disorders

Research article

The cost-effectiveness of family/family-based therapy for treatment of externalizing disorders, substance use disorders and delinquency: a systematic review

Research article

The epidemiology of adverse drug events and medication errors among psychiatric inpatients in Japan: the JADE study

Research article

Quality of care and its determinants in longer term mental health facilities across Europe; a cross-sectional analysis

Research article

Exposure to environmental factors increases connectivity between symptom domains in the psychopathology network

Research article

Validation of the Chinese version of the PHQ-15 in a tertiary hospital