Predictors of Benzodiazepine Re-Prescription Among U.S. Veterans with a
History of Chronic Benzodiazepine Use
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.