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Predictors of Benzodiazepine Re-Prescription Among U.S. Veterans with a History of Chronic Benzodiazepine Use
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  • Aryan Esmaeili,
  • Christine Timko,
  • Katherine Hoggatt J,
  • Eleanor Lewis,
  • Kathryn S. Macia,
  • Mai Chee Lor,
  • Andrea Nevedal L
Aryan Esmaeili
VA Palo Alto Health Care System Menlo Park Division

Corresponding Author:[email protected]

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Christine Timko
VA Palo Alto Health Care System Menlo Park Division
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Katherine Hoggatt J
San Francisco VA Health Care System
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Eleanor Lewis
VA Palo Alto Health Care System Menlo Park Division
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Kathryn S. Macia
VA Palo Alto Health Care System Menlo Park Division
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Mai Chee Lor
VA Palo Alto Health Care System Menlo Park Division
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Andrea Nevedal L
VA Ann Arbor Healthcare System
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Abstract

Objective: Given difficulty in discontinuing prescribed benzodiazepines and potential harms to people from chronic benzodiazepine use, it is important to understand medical and mental health conditions associated with re-prescription. This study sought to estimate benzodiazepine re-prescription incidence rates among Veterans in the United States Veterans Health Administration (VHA) and identify predictors of re-prescription among Veterans who discontinued benzodiazepines. Methods: This longitudinal study used VHA administrative data from patients’ electronic health records in Fiscal Year 2019. Patients with chronic (>30 days) benzodiazepine prescriptions who were not prescribed benzodiazepines continuously for the entire year were identified based on pharmacy records (n=151,777). We used Kaplan-Meier methods and a Cox proportional hazards model to estimate benzodiazepine re-prescription incidence rates. Unadjusted and adjusted hazard ratios were used to examine demographic and clinical characteristics as predictors of benzodiazepine re-prescription. Results: Among 151,777 patients who did not refill a benzodiazepine prescription for ≥30 days, 50% were re-prescribed benzodiazepines within 2.5 months. Benzodiazepine re-prescription was associated with mental health conditions (e.g., anxiety, PTSD). Patients were less likely to be re-prescribed benzodiazepines if they had a history of an alcohol or drug use disorder, neurological disorder other than paralysis, chronic heart failure, dementia, and hospice care. Conclusions: The short gap between benzodiazepine prescriptions ending and being re-prescribed suggests patients have difficulty discontinuing prescribed benzodiazepines. More investigations are needed on the medical necessity of chronic benzodiazepines and strategies for increasing guideline concordant care.
28 Jul 2023Submitted to Pharmacoepidemiology and Drug Safety
04 Aug 2023Assigned to Editor
04 Aug 2023Submission Checks Completed
04 Aug 2023Review(s) Completed, Editorial Evaluation Pending
08 Aug 2023Reviewer(s) Assigned