Long-Term Benzodiazepine Prescribing in Massachusetts: A 10-Year Longitudinal Study

OBJECTIVES: Benzodiazepines are one of the most widely prescribed classes of medications in the United States. However, long-term benzodiazepine (LTB) prescribing may result in potential misuse and dependency. While standard definitions of LTB use are not uniformly applied in clinical settings, we examined LTB prescribing patterns in Massachusetts using a definition based on a review of the literature. METHODS: We conducted a descriptive analysis of Massachusetts Prescription Monitoring Program data from 2013 through 2023. We identified people with LTB use as any benzodiazepine-naïve individual (no prescription for 365 d prior) whose days' supply of benzodiazepines was ≥30% (109 d) during a full 365-day period, beginning from their initial prescription. We followed people with LTB use for subsequent 365-day cycles (follow-up years 1-10) through 2023. We reported and stratified the prevalence of LTB use by age and gender. RESULTS: The baseline group of benzodiazepine-naïve Massachusetts residents included 339 481 people. Females across all age groups comprised a larger part of the baseline group (63.8%; n = 216 751) than males. Overlap of benzodiazepine and opioid agonist days' supply among people with LTB use declined slightly from 32.8% in follow-up year 1 to 29.1% in follow-up year 10. In Massachusetts, 4.4% (n = 14 905) and 2.0% (n = 6621) of the baseline group continued to meet LTB criteria at 5 and 10 years, respectively. CONCLUSION: In Massachusetts, 2% of the baseline continued to receive benzodiazepines after 10 years. Defining LTB use and benzodiazepine equivalence could promote safer benzodiazepine prescribing.