Benzodiazepine Prescription for Anxiety Disorders Increase the Risk of Substance Use Disorders: A Retrospective Cohort Study
Introduction While the role of benzodiazepines (BZDs) has been well established for anxiety and related disorders, there are significant concerns about BZD dependence, withdrawal, and tolerance. There is a lot of ambiguity regarding the potential long-term effects of BZDs on mental health. However,...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Cambridge University Press
2023-03-01
|
| Series: | European Psychiatry |
| Online Access: | https://www.cambridge.org/core/product/identifier/S0924933823007162/type/journal_article |
| _version_ | 1827753438726848512 |
|---|---|
| author | C.-F. Sun Y. Lin A. S. Pola A. S. Kablinger R. L. Trestman |
| author_facet | C.-F. Sun Y. Lin A. S. Pola A. S. Kablinger R. L. Trestman |
| author_sort | C.-F. Sun |
| collection | DOAJ |
| description |
Introduction
While the role of benzodiazepines (BZDs) has been well established for anxiety and related disorders, there are significant concerns about BZD dependence, withdrawal, and tolerance. There is a lot of ambiguity regarding the potential long-term effects of BZDs on mental health. However, the risk of developing subsequent other substance use disorders is in question.
Objectives
In this electronic medical record (EMR) based retrospective cohort study, the study cohort was defined as patients between the ages of 18 and 65 with anxiety disorders (ICD-10-CM: F40-F48) prescribed with at least one BZD; the control cohort was defined as patients between the ages of 18 and 65 with anxiety disorders (ICD-10-CM: F40-F48) with no BZD prescription during the five-year timeframe examined. We excluded patients with pre-existing substance use disorders (ICD-10-CM: F10-F19), et al.
Methods
We collected data from TriNetX Research database, a real-time international EMR network, from September 2017 to September 2022. Patients in the two cohorts were matched by gender, age, race, ethnicity, and common medical conditions at a 1:1 ratio by propensity scoring and then underwent Kaplan–Meier analysis and association analysis.
Results
A total of 626,754 patients were identified and matched for analysis. Patients in the study cohort were more likely to be female (67.6% vs. 66.7%, p < 0.001), non-Hispanic (65.8% vs. 62.5%, p < 0.001) and white (72.8% vs. 69.1%, p < 0.001). Kaplan–Meier analysis showed the survival probability at the end of the time window was 94.1% for the control cohort and 89.5% for the study cohort (Hazard ratio, 2.20; 95% CI, 2.16-2.25; P < 0.001) in all type of substance use disorders. (Table 1)
Table 1.
Hazard ratio of substance use disorders difference in BZD cohort versus the control cohort.
BZD Cohortn (risk%)
Control Cohortn (risk%)
Hazard Ratio(95% Cl)
P value
Substance Use Disorders*
26,569 (4.2)
11,976 (1.9)
2.20 (2.16-
2.25)
<0.001
Sedative/hypnotic/anxiolytic related disorders
656 (0.1)
152 (0.0)
4.26 (3.57- 5.09)
<0.001
Alcohol Related Disorder
5,749 (0.9)
2,064 (0.3)
2.74 (2.61-2.88)
<0.001
Opioid Related Disorder
2,807 (0.4)
815 (0.1)
3.38 (3.13-3.66)
<0.001
Stimulant Related Disorder
1,658 (0.3)
551 (0.1)
2.94 (2.67- 3.24)
<0.001
Cannabis Related Disorder
3,376 (0.5)
970 (0.2)
3.41 (3.17- 3.66)
<0.001
*
Substance use disorders was defined as Mental and behavioral disorders due to psychoactive substance use (ICD-10-CM: F10-F19).
Conclusions
Patients with an anxiety disorder who were prescribed BZDs are at higher risk of not only BZD dependence but all types of substance use disorders than a matched cohort not prescribed BZDs. Given this notable association, clinicians should be cautious while prescribing BZDs and inform the patient about the risks associated with their utilization.
Disclosure of Interest
None Declared |
| first_indexed | 2024-03-11T07:36:12Z |
| format | Article |
| id | doaj.art-b3e73eb6cffc42808bb6b33032edd643 |
| institution | Directory Open Access Journal |
| issn | 0924-9338 1778-3585 |
| language | English |
| last_indexed | 2024-03-11T07:36:12Z |
| publishDate | 2023-03-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | European Psychiatry |
| spelling | doaj.art-b3e73eb6cffc42808bb6b33032edd6432023-11-17T05:09:49ZengCambridge University PressEuropean Psychiatry0924-93381778-35852023-03-0166S324S32410.1192/j.eurpsy.2023.716Benzodiazepine Prescription for Anxiety Disorders Increase the Risk of Substance Use Disorders: A Retrospective Cohort StudyC.-F. Sun0Y. Lin1A. S. Pola2A. S. Kablinger3R. L. Trestman41Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion Clinic School of Medicine, Roanoke, United States1Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion Clinic School of Medicine, Roanoke, United States 2Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, Tongji University 3Department of Psychiatry, Shanghai East Hospital, School of Medicine, Shanghai, China1Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion Clinic School of Medicine, Roanoke, United States1Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion Clinic School of Medicine, Roanoke, United States1Department of Psychiatry and Behavioral Medicine, Virginia Tech Carilion Clinic School of Medicine, Roanoke, United States Introduction While the role of benzodiazepines (BZDs) has been well established for anxiety and related disorders, there are significant concerns about BZD dependence, withdrawal, and tolerance. There is a lot of ambiguity regarding the potential long-term effects of BZDs on mental health. However, the risk of developing subsequent other substance use disorders is in question. Objectives In this electronic medical record (EMR) based retrospective cohort study, the study cohort was defined as patients between the ages of 18 and 65 with anxiety disorders (ICD-10-CM: F40-F48) prescribed with at least one BZD; the control cohort was defined as patients between the ages of 18 and 65 with anxiety disorders (ICD-10-CM: F40-F48) with no BZD prescription during the five-year timeframe examined. We excluded patients with pre-existing substance use disorders (ICD-10-CM: F10-F19), et al. Methods We collected data from TriNetX Research database, a real-time international EMR network, from September 2017 to September 2022. Patients in the two cohorts were matched by gender, age, race, ethnicity, and common medical conditions at a 1:1 ratio by propensity scoring and then underwent Kaplan–Meier analysis and association analysis. Results A total of 626,754 patients were identified and matched for analysis. Patients in the study cohort were more likely to be female (67.6% vs. 66.7%, p < 0.001), non-Hispanic (65.8% vs. 62.5%, p < 0.001) and white (72.8% vs. 69.1%, p < 0.001). Kaplan–Meier analysis showed the survival probability at the end of the time window was 94.1% for the control cohort and 89.5% for the study cohort (Hazard ratio, 2.20; 95% CI, 2.16-2.25; P < 0.001) in all type of substance use disorders. (Table 1) Table 1. Hazard ratio of substance use disorders difference in BZD cohort versus the control cohort. BZD Cohortn (risk%) Control Cohortn (risk%) Hazard Ratio(95% Cl) P value Substance Use Disorders* 26,569 (4.2) 11,976 (1.9) 2.20 (2.16- 2.25) <0.001 Sedative/hypnotic/anxiolytic related disorders 656 (0.1) 152 (0.0) 4.26 (3.57- 5.09) <0.001 Alcohol Related Disorder 5,749 (0.9) 2,064 (0.3) 2.74 (2.61-2.88) <0.001 Opioid Related Disorder 2,807 (0.4) 815 (0.1) 3.38 (3.13-3.66) <0.001 Stimulant Related Disorder 1,658 (0.3) 551 (0.1) 2.94 (2.67- 3.24) <0.001 Cannabis Related Disorder 3,376 (0.5) 970 (0.2) 3.41 (3.17- 3.66) <0.001 * Substance use disorders was defined as Mental and behavioral disorders due to psychoactive substance use (ICD-10-CM: F10-F19). Conclusions Patients with an anxiety disorder who were prescribed BZDs are at higher risk of not only BZD dependence but all types of substance use disorders than a matched cohort not prescribed BZDs. Given this notable association, clinicians should be cautious while prescribing BZDs and inform the patient about the risks associated with their utilization. Disclosure of Interest None Declaredhttps://www.cambridge.org/core/product/identifier/S0924933823007162/type/journal_article |
| spellingShingle | C.-F. Sun Y. Lin A. S. Pola A. S. Kablinger R. L. Trestman Benzodiazepine Prescription for Anxiety Disorders Increase the Risk of Substance Use Disorders: A Retrospective Cohort Study European Psychiatry |
| title | Benzodiazepine Prescription for Anxiety Disorders Increase the Risk of Substance Use Disorders: A Retrospective Cohort Study |
| title_full | Benzodiazepine Prescription for Anxiety Disorders Increase the Risk of Substance Use Disorders: A Retrospective Cohort Study |
| title_fullStr | Benzodiazepine Prescription for Anxiety Disorders Increase the Risk of Substance Use Disorders: A Retrospective Cohort Study |
| title_full_unstemmed | Benzodiazepine Prescription for Anxiety Disorders Increase the Risk of Substance Use Disorders: A Retrospective Cohort Study |
| title_short | Benzodiazepine Prescription for Anxiety Disorders Increase the Risk of Substance Use Disorders: A Retrospective Cohort Study |
| title_sort | benzodiazepine prescription for anxiety disorders increase the risk of substance use disorders a retrospective cohort study |
| url | https://www.cambridge.org/core/product/identifier/S0924933823007162/type/journal_article |
| work_keys_str_mv | AT cfsun benzodiazepineprescriptionforanxietydisordersincreasetheriskofsubstanceusedisordersaretrospectivecohortstudy AT ylin benzodiazepineprescriptionforanxietydisordersincreasetheriskofsubstanceusedisordersaretrospectivecohortstudy AT aspola benzodiazepineprescriptionforanxietydisordersincreasetheriskofsubstanceusedisordersaretrospectivecohortstudy AT askablinger benzodiazepineprescriptionforanxietydisordersincreasetheriskofsubstanceusedisordersaretrospectivecohortstudy AT rltrestman benzodiazepineprescriptionforanxietydisordersincreasetheriskofsubstanceusedisordersaretrospectivecohortstudy |