One in four patients who begins treatment with anxiolytics ends up using them for a long time

One in four people treated in primary care with a prescription for anxiolytic drugs (benzodiazepines) ends up using them for a long time and far beyond what is recommended by medical guidelines, according to a new study conducted in Catalonia and led by a specialist from Parc Sanitari SJD and the SJD Research Institute.

The Challenge of long-term benzodiazepine use in primary care: insights from a real-world cohort study in Catalonia report was led by Dr Ignacio Aznar from the Health Technology Assessment in Primary Care and Mental Health (PRISMA) research group at the Sant Joan de Déu Research Institute (IRSJD) and Parc Sanitari Sant Joan de Déu. The research, funded by CIBERESP and published in the journal Family Medicine and Community Health, analysed real data for more than 100,000 patients from the public health system of Catalonia gathered between July 2021 and July 2022.

These data show that one in ten adults in Catalonia took benzodiazepines. Sixty-two percent of these prescriptions were new, 27.1% were still being filled three months later and 14.5% continued at six months. These figures stand in contrast to clinical recommendations which advise restricting the use of benzodiazepines to at most four weeks in cases of insomnia and up to twelve weeks in treatment for anxiety.

Widespread use in spite of the risks

Benzodiazepines act on the central nervous system and are commonly used to treat conditions such as anxiety, insomnia, seizures and muscle tension along with sedation prior to medical procedures. Notwithstanding their short-term efficacy, the study authors caution that prolonged use may carry serious health risks including dependence, cognitive impairment, increased risk of falls and fractures, traffic accidents, drug tolerance and even a potential increase in mortality.

In Catalonia, more than 10% of people receiving primary care are prescribed benzodiazepines each year, with a prevalence almost twice as high in women as in men and particularly common in the elderly.

"Our results show that a significant proportion of patients who start treatment with benzodiazepines end up becoming long-term users if they do not receive appropriate clinical supervision," says Maite Peñarrubia, a research collaborator at the PSSJD and IRSJD and one of the authors of the study. "More effective strategies need to be put in place to monitor and, where needed, curb the prolonged use of these drugs."

Factors which increase the risk of becoming a chronic user include advanced age, being female, having a history of mental disorders, previous use of these drugs, living in a rural area and seeing a doctor online rather than in person.

The results have been examined from a gender perspective and reveal a general similarity in risk factors between both sexes. The study also found that patients seen by practitioners with low prescription quality standards are more likely to prolong their use.

 

Encouraging safer use

This is the first study of its kind in Spain using real data and a large population sample. Its results furnish a robust basis for devising training strategies for healthcare professionals and fostering more personalised, face-to-face follow-up of patients prescribed benzodiazepines to mitigate the risks associated with unnecessarily lengthy use of these drugs.

 

Professional recognition for Dr Maite Peñarrubia

Alongside the publication of the study, Dr Maite Peñarrubia's scientific career has recently been recognised in primary care. On 29 January, the board of the Barcelona Medical Association in el Baix Llobregat awarded her the prize for the best publication in primary care in the Southern Metropolitan Area for this research on prolonged use of benzodiazepines. This accolade reflects not only the quality of her study but also her role in enhancing clinical practice and patient safety in healthcare provision in the region.