[Benzodiazepines and Z-Drugs - Analyses of Ambulatory Prescriptions from 2006 to 2015]. / Benzodiazepine und Z-Substanzen ­ Analyse der kassenärztlichen Verschreibungen von 2006 bis 2015.

OBJECTIVE: The majority of medication-dependent persons uses sedatives and hypnotics for many years. In this study we describe trends of benzodiazepine and z-drug prescriptions over a 10-years period. METHODS: Prescriptions from 2006 to 2015 (based on German statutory health insurances) from the North German Pharmacy Computing Centre (NARZ) were analysed for the Federal states Schleswig-Holstein, Hamburg, Lower Saxony and Bremen. Data were classified as appropriate (in accordance with the guideline) or inappropriate/risky prescription patterns. RESULTS: In a 10-years period 1.64 Million patients received benzodiazepine and/or z-drug prescriptions. Two thirds were women (65.3 %). More than half were 60 years or older. The percentage of patients with appropriate prescriptions (less than 2 months) increased from 51.7 % in 2006 to 60.2 % in 2015. The rate of inappropriate or risky prescription patterns which can be indicative of misuse or dependence dropped from 34.8 % in 2006 to 27.1 % in 2015. CONCLUSION: Over the past years the amount of inappropriate or risky benzodiazepine and z-drug prescriptions (which are not in accordance with the guideline) among patients with statutory health insurance is steadily decreasing. However, two fifths of the patients still received prescriptions for long-term intake or in higher doses. It remains unclear to what extent private prescriptions are used for inappropriate or long-term prescriptions of benzodiazepines and z-drugs.

Problematic Medication With Benzodiazepines, "Z-drugs", and Opioid Analgesics.

BACKGROUND: An estimated 1.4 to 2.6 million people in German suffer from drug dependence. Most of them are long-term users of benzodiazepines (BZD), Z drugs (ZD), or opioid analgesics (OA). METHODS: This analysis is based on prescription data from patients of the national statutory health insurance system in the German federal states of Schleswig-Holstein, Hamburg, Bremen, and Lower Saxony. Drug-taking trends, duration, dosage, and long-term use of BZD, ZD, and OA in the years 2006 to 2015 are analyzed; prevalences are estimated for the years 2006 to 2016. RESULTS: In 2006, 7.7% of patients received at least one prescription for a BZD, ZD, or OA; in 2016, 7.0% did. Over the period of analysis, a marked drop was seen in prescriptions of BZD and a slight fall in prescriptions of ZD (2006: BZD 3.5%, ZS 1.1%; 2016: BZD 2.0%, ZS 0.8%), but there was also an increase in prescriptions of OA, from 4.2% to 4.9%. The number of defined daily doses (DDD) prescribed per year fell for both BZD and ZD. For OA, the number of DDD prescribed per year rose from 2006 to 2009 and decreased by a small amount in subsequent years. The proportions of BZD and ZD patients who had long-term prescriptions fell over time, while the corresponding percentage of OA patients rose. CONCLUSION: Nearly one-fifth of all prescriptions for BZD were long-term prescriptions for an entire year, in violation of the relevant guidelines. The rising prevalence of OA use was in the expected range in view of the aging population, but the number of prescriptions rose among younger patients as well. This trend toward more common treatment with opioid analgesics should be critically examined.