Long Term Benzo Use Rarer Than Thought

And no, the doses don’t keep rising

STUDY: Rosenqvist TW et al, Am J Psychiatry 2024;181:246–254

STUDY TYPE: Register-based cohort study

FUNDING: University Hospital Copenhagen, Bispebjerg and Frederiksberg

Background

Benzodiazepines and Z-drugs carry FDA boxed warnings about addiction and dose escalation, but how often do these problems actually occur under real-world prescribing conditions? This large Danish study put the question to the data.

The Study

Nearly one million incident users of benzodiazepines and Z-drugs were followed for up to 20 years using Denmark’s national prescription registry. Researchers tracked how many became long-term users (more than 1 year or more than 7 years) and how many escalated to doses above recommended levels.

Only 15% used these medications for more than 1 year, and just 3% continued beyond 7 years. Z-drugs had the highest rates of persistent use (17.8% at 1 year, 4% at 7 years). Among patients with at least 3 years of continuous use, the median dose actually declined over time — and only 7% escalated to doses above recommended thresholds.

Psychiatric comorbidity, especially substance use disorder, was the strongest predictor of both long-term use and dose escalation.

Limitations: Denmark is a country with stricter prescribing regulations and active monitoring of physician prescribing patterns, so these rates may not translate directly to U.S. practice.

Practice Implications

1. For most disorders, benzodiazepines are intended for short-term only, and this study tells us that’s possible.