Challenge of long-term benzodiazepine use in primary care: insights from a real-world cohort study in Catalonia

Introduction Long-term use of benzodiazepines (BZD) triggers health problems. Although Spain leads European use of BZD, the number of long-term users (LTUs) remains unknown. Objective The aim of the study is to estimate the proportion of primary care (PC) patients who initiate a BDZ prescription that subsequently become LTU and to identify its associated factors. Design Retrospective real-world data cohort. Setting and participant It included the population over 15 years with a new prescription of BZD in PC in Catalonia. Users were considered LTU if they had been dispensed at least three prescriptions within 3 months. Sociodemographic characteristics of patients and prescribers, pathologies, previous BZD use, number and type of visits, and prescription quality standard were considered. We estimated the proportion of LTU among patients with a new prescription, stratified by age and sex, and estimated risk factors by multivariate generalised linear models. Result 100 638 users with a new BZD prescription were included. 27.1% were LTU at 3 months and 14.5% at 6 months. LTU increases with age and is higher in women. Predictors of LTU are Spanish nationality, living in rural areas, having a mental illness, having used BZD, having virtual visits or not meeting pharmacy-therapeutic quality standards. Conclusion The number of patients who develop LTU is high, especially in the elderly. Exploring the causes of this phenomenon could contribute to the development of future interventions.