Benzodiazepine use dropped by a quarter in a decade, but nurse practitioners now write twice as many
STUDY: Cruz N et al, American Journal of Psychiatry 2026
STUDY TYPE: Repeated cross-sectional study
FUNDING: Pew Charitable Trusts; Agency for Healthcare Research and Quality; National Institute on Drug Abuse
Background
Benzodiazepine prescribing climbed for two decades, then the FDA issued boxed warnings on combining them with opioids (2016) and on misuse and dependence (2020). This study looks at what happened next.
The Study
- 1.1 billion benzodiazepine fills from a national pharmacy database covering about 90% of US retail prescriptions, 2013 to 2024.
- Outcomes: the share of the population filling a benzodiazepine each year, fill counts by prescriber type, and dose per prescription.
Results
The share of Americans filling a benzodiazepine fell from 7.5% to 5.5%, a 27% drop. Adults 65 and older still had the highest rate (10.7% in 2024).
Young adults ages 18 to 29 saw the steepest decline (45%). Children ages 2 to 12 barely changed, because rising use of seizure drugs like clobazam offset declines in other benzodiazepines.
Prescriptions fell sharply among:
- Pain specialists: 63% fewer
- Primary care physicians: 44% fewer
- Psychiatrists: 38% fewer
Prescriptions from nurse practitioners and physician assistants doubled, rising from 12% to 32% of all fills.
The average dose per prescription fell 18%. Psychiatrists prescribed the highest doses.
Practice Implications
- The NP and PA workforce significantly increased during this study, and the authors acknowledge that may create the appearance of an increase in scripts when it was an increase in clinicians.
- The study leaves an open question: Did NP and PA behavior change, or did more patients switch to these clinicians after MDs reduced their benzodiazepines?
—Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
