Long-Term Benzodiazepine Use Strongly Associated With Race, Study Finds

When we think of someone who takes a lot of Xanax, Valium, or Klonopin, we may conjure up the image of a rapper with face tattoos, but it’s not just young people who use and abuse these sedatives that belong to the class known as benzodiazepines, new research shows.

In fact, far more adults over 35 years old use benzodiazepines, which are typically prescribed to treat anxiety or insomnia, than younger adults or teens. These drugs are only meant for short-term use, as they can be addictive and possibly even deadly, but a new study points to a surprising number of older adults who may be taking them for long periods of time.

In a paper published Monday in JAMA Internal Medicine, a team of doctors present evidence that about one in four older adults who were prescribed benzodiazepines ended up taking them for much longer than necessary. By surveying a group of 576 adults — average age of 78.4 years — without a recent history of benzodiazepine use who had just been prescribed benzodiazepines, and then following up with them after a year, the researchers found that over 26 percent of the patients were prescribed benzodiazepines for an average of almost eight months.

They also found that poor sleep quality was the only medical factor that contributed to longer periods of prescription. Remarkably, two non-medical factors were also strongly associated with long-term benzodiazepine use: how large the initial prescription was, and whether the patient was white. In the study authors’ analysis of the data, the patient being white actually had a slightly stronger association with benzodiazepine prescribing than their quality of sleep.

National trends in benzodiazepine prescriptions, as well as the concern for the well-being of the individual patients who are receiving these prescriptions, highlight the gravity of this study’s findings. The National Institute on Drug Abuse notes that the number of benzodiazepine prescriptions in the United States increased by 67 percent from 1996 to 2013, from 8.1 million to 13.5 million. The NIDA also notes that benzodiazepines are involved in about one in three opioid overdoses.

Given the growing public health threat posed by benzodiazepines, perhaps the most concerning finding in this study is not that people are taking benzodiazepines for a long time, but that many benzodiazepine prescriptions don’t seem to be medically necessary. And in fact, even though these drugs are psychiatric medications, all the prescriptions in the study were written by nonpsychiatric doctors.

This research adds to the knowledge that older white people in the US are more frequently dying from suicide, drugs, and alcohol than they used to. As NPR reported in 2017, substance use and abuse among older white Americans without college degrees is often driven by lack of economic opportunities. These so-called “deaths of despair” are not limited to any specific drug, though benzodiazepines, along with opioid painkillers, figure prominently.

In 2016, The Washington Post reported on the story of Karen Franklin, a Bakersfield, California woman who took more than a dozen different prescriptions a day. “There’s a purple morphine tablet for chronic back pain, a blue Xanax for anxiety and a white probiotic for her stomach, which aches from all the other pills,” the story’s authors write. The Post story also reported on the fate of Bonnie Jean Marshall, who overdosed in 2012 after mixing a cocktail of Xanax, a benzodiazepine; Vicodin, an opioid; and alcohol. The headline was simple and stark: “Opioids and anti-anxiety medication are killing white American women.”

“It is a cause for concern that these nonclinical factors are associated with benzodiazepine prescribing, which suggests that approaches to reduce prescribing of this drug that focus on specific clinical populations may have limited success,” write the study’s authors, led by Lauren Gerlach, D.O, a clinical lecturer at the University of Michigan’s department of psychiatry.

In other words, since long-term benzodiazepine use is associated just as much with the patients’ race as it is with actual medical concerns, it’s not clear how doctors should approach the issue from a medical perspective. After all, these data suggest that the upward trend in benzodiazepine prescribing is not driven by medical factors.

As such, the study’s authors recommend that doctors explore non-drug treatments for anxiety and insomnia.

“In light of the continued growth of psychotropic prescribing to older adults by nonpsychiatric clinicians,” they write, “it is critical to improve access to and education regarding nonpharmacologic treatment so clinicians feel they have treatment alternatives to offer.”