An Analysis of Benzodiazepine Prescribing to Primary Care Patients in a Large Healthcare System from 2019-2020

ABSTRACT

We sought to quantify benzodiazepine prescribing by primary care providers from 2019 to 2020 and identify correlates of prescribing. We hypothesized prescribing would increase post-COVID-19 lockdown. We conducted a retrospective cohort study of adult patients with primary care visits in 2019 or 2020 in a large Ohio healthcare system. Demographics, diagnosis codes, and receipt of benzodiazepine prescriptions were collected. Using multivariable logistic regression, we examined factors associated with benzodiazepine prescription receipt during the whole study period and post-lockdown. 455,537 adult patients had 1,643,473 visits. Benzodiazepines were prescribed in 3.2% (53,049/1,643,473) of visits. Effect sizes for positive associations with benzodiazepine prescription were largest for anxiety disorders. For negative associations, they were largest for Black patients and patients with cocaine use disorder. Benzodiazepine prescribing was positively associated with multiple groups having contraindications, though effect sizes were small. Contrary to our hypothesis, odds of receiving a prescription were 8.8% lower post-lockdown. Benzodiazepine prescribing rates in our system compared favorably to national rates. Year over year odds of receiving a prescription were slightly lower post-lockdown. Racial disparities were present and deserve further study. Strategies to reduce benzodiazepine prescribing to patients with anxiety may yield the largest reductions for benzodiazepine prescribing in primary care settings.

KEYWORDS:

• Benzodiazepines
• Epidemiology
• Psychiatric comorbidities
• Risk
• Adverse events
• COVID-19

Disclosure statement

Dr. Barnett reports receiving stock options from CB Therapeutics for compensation of consulting services. He also receives monetary compensation for his work as a topic editor on substance use disorders for DynaMed Plus (EBSCO Industries, Inc.) and as a consultant for Cerebral. The other authors report no financial relationships with commercial interests.

Data availability statement

The data that support the findings of this study are available from BSB, upon reasonable request.

Additional information

Funding

BB received a non-monetary internal grant for biostatistical support for this study from the Cleveland Clinic Neurological Institute Center for Outcomes Research & Evaluation (NICORE).