Study Shows Decreased Use of Benzodiazepines among Veterans with PTSD
The number of Veterans seeking care for PTSD has increased dramatically in the past decade, thus the safe and effective treatment of this condition is of great importance to VA. Joint VA/DoD clinical guidelines caution against the use of benzodiazepines among Veterans with PTSD due to insufficient evidence for efficacy and emerging safety concerns. While benzodiazepines can bring rapid, short-term relief of some symptoms (e.g., insomnia and anxiety), there is mounting evidence that long-term harms (e.g., dependence) outweigh short-term benefits. Moreover, two common comorbidities among Veterans with PTSD include substance use disorder and traumatic brain injury, both of which are contraindications to benzodiazepine use. This study examined trends in benzodiazepine prescribing among Veterans with PTSD. Investigators analyzed VA inpatient and outpatient data, as well as pharmacy records, for Veterans treated for PTSD from October 1998 through September 2009. Over this 11-year time period, the number of Veterans who received VA care for PTSD increased nearly three-fold - from 170,685 to 498,081.
Findings show that the overall proportion of Veterans receiving a benzodiazepine decreased from 37% in 1999 to 31% in 2009. In addition, the proportion of long-term users (>90 days) decreased from 69% to 64%, and the mean daily dose declined by nearly 15%. The likelihood of receiving benzodiazepines was influenced by time since first VA PTSD diagnosis. For example, in 2009, patients newly diagnosed with PTSD were the least likely to receive a benzodiazepine (21%) compared to patients with a history of three or more years of treatment (36%). Clonazepam was the most commonly prescribed benzodiazepine across all study years.
Despite decreasing frequency of use, the absolute number of Veterans with PTSD who received benzodiazepines increased nearly 250% due to the increasing numbers of Veterans receiving care for PTSD in the VA healthcare system. Therefore, the authors suggest that minimizing benzodiazepine exposure will remain a vital policy issue.
Lund B, Bernardy N, Alexander B, and Friedman M. Declining benzodiazepine use in Veterans with post-traumatic stress disorder. Journal of Clinical Psychiatry November 29, 2011;e-pub ahead of print.
This study was funded by HSR&D and VA's National Center for PTSD at the White River Junction VAMC. Dr. Lund is part of HSR&D's Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City, IA.