Benzodiazepine Overprescribing Remains a Problem Post-Stroke

TOPLINE:

About 5% of people older than 65 years in the United States are prescribed benzodiazepine after acute ischemic stroke (AIS) despite warnings of potential side effects in older adults, a new study shows. Although the findings indicate a slight decrease in benzodiazepine use for post-stroke anxiety (PSA) over the past decade, investigators say overdiagnosis remains a problem.

METHODOLOGY:

• Researchers analyzed a sample of US Medicare claims from April 2013 to September 2021.
• A total of 126,050 beneficiaries (mean age, 78 years; 54% women; 82% White) discharged alive following an AIS were included.
• Patients previously prescribed benzodiazepine and those with self-discharge or discharge to skilled nursing facilities were excluded.
• Researchers assessed the demographics and comorbidities of patients, initial prescription lengths, cumulative incidence of first fills of benzodiazepine within 90 days post-discharge, and geographic and yearly trends.

TAKEAWAY:

• Within 90 days of discharge, 5% of stroke survivors were initiated on benzodiazepine, with lorazepam (40%) and alprazolam (33%) prescribed most often.
• Most (76%) of first-time benzodiazepine prescriptions had a supply of > 7 days, with 55% covering 15-30 days.
• Women had higher initiation rates than men (6% vs 4%), and Hispanic adults had a higher cumulative incidence (6%) than adults of other ethnicities.
• Prescription rates were the highest in the Southeast (5%) and lowest in the Midwest (4%), with a slight countrywide decline (cumulative incidence difference, 1.6%) during the study period.

IN PRACTICE:

“Despite declining trends in benzodiazepine prescriptions, it is necessary to note that use remains alarming in the United States as it represents the third most used illicit or prescription drug in the country,” the authors wrote.

Authors of an accompanying editorial noted that ideally, patients with stroke would be screened for PSA at discharge to allow for early diagnosis and appropriate treatment. “Unfortunately, access to mental health services after stroke can be limited, and not all hospitals or clinics will have these types of resources available,” the authors wrote. “These limitations require stroke physicians to often become the first line of treatment for PSA and sometimes are the only option available.”

SOURCES:

This study was led by Victor Lomachinsky Torres, MD, and Julianne D. Brooks, MPH, both at Massachusetts General Hospital, Boston. The editorial was authored by Justin J. MacKenzie, PhD, of Southern Utah Psychological Consultants, St. George, Utah. Both were published online on October 17 in Stroke.

LIMITATIONS:

This study’s findings may not be generalizable to other groups. Misclassification of race and ethnicity in Medicare’s administrative data may also have affected the accuracy of the findings. Further limitations of the study included a potential selection bias, missing data on prescription indications, and reliance on supplied total daily dose of benzodiazepine as a measure of intake.

DISCLOSURES:

This study was funded by the National Institutes of Health. Three authors disclosed receiving funding from various institutions, while one reported being the director of the National Committee for Quality Assurance. Detailed disclosures for study and editorial authors are provided in the original article. No conflicts of interest were reported.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.