Prevalence and trends of benzodiazepine use among Veterans Affairs patients with posttraumatic stress disorder, 2003-2010
Prevalence and trends of benzodiazepine use among Veterans Affairs patients with posttraumatic stress disorder, 2003-2010
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DOI：
10.1016/j.drugalcdep.2012.01.003
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发表时间：
2012-07-01
影响因子：
4.2
通讯作者：
Kivlahan, Daniel R.
中科院分区：
文献类型：
--
作者：
Hawkins, Eric J.;Malte, Carol A.;Kivlahan, Daniel R.
背景：尽管退伍军人事务部和国防部(VA/DoD)创伤后应激障碍(PTSD)的临床指南建议不要常规使用苯二氮卓类药物，但自2004年这些指南发布以来，人们对苯二氮类药物的使用趋势、临床和处方概况知之甚少。方法：这项回顾性研究包括2003-2010年间退伍军人综合服务网络(VISN 20)中64,872名被诊断为PTSD的患者。任何使用的年度流行率被定义为苯二氮卓类药物的任何处方，长期使用被定义为一年中90天的供应量。结果：年龄调整后的苯二氮卓类药物使用趋势男性从25.0%上升到26.8%，女性从31.2%上升到38.8%。男性和女性的长期使用分别从15.4%和18.0%增加到16.4%和22.7%。精神和酒精使用障碍(AUD)与长期使用苯二氮卓类药物的增加有关。2010年，61%的苯二氮卓类药物使用者获得了90天的药物供应。在长期服用苯二氮卓类药物的患者中，11%患有AUD，47%同时长期服用阿片类药物。结论：尽管VA/DoD临床指南建议不要常规使用苯二氮卓类药物治疗创伤后应激障碍，但在VISN 20中，调整后的长期使用苯二氮卓类药物的患病率有所增加。苯二氮卓类药物和阿片类药物的广泛同时使用表明，需要建立风险管理系统，并对这些药物的有效性和安全性进行研究。爱思唯尔爱尔兰有限公司出版。
Background: Although the Veterans Affairs and Department of Defense (VA/DoD) clinical guidelines for management of posttraumatic stress disorder (PTSD) recommend against routine benzodiazepine use, little is known about the trends and clinical and prescription profiles of benzodiazepine use since these guidelines were released in 2004.Methods: This retrospective study included 64,872 patients with a PTSD diagnosis received from care at facilities in VA Northwest Veterans Integrated Service Network (VISN 20) during 2003-2010. Annual prevalence of any use was defined as any prescription for benzodiazepines, and long-term use was defined as >90 days' supply, in a year. Gender-specific logistic regressions were fit to estimate any and long-term benzodiazepine use, test for linear trends over 8-years and explore factors associated with trends.Results: The trend of age-adjusted benzodiazepine use over 8-years rose significantly from 25.0 to 26.8% among men and 31.2 to 38.8% among women. Long-term use in men and women increased from 15.4 to 16.4% and 18.0 to 22.7%, respectively. Comorbid psychiatric and alcohol use disorders (AUD) were associated with a greater increase in long-term use of benzodiazepines. In 2010, 61% of benzodiazepine users received >90 days' supply. Among those prescribed benzodiazepines long-term, 11% had AUD and 47% were also prescribed opioids long-term.Conclusion: Despite VA/DoD clinical guidelines recommending against routine use of benzodiazepines for PTSD, the adjusted prevalence of long-term use increased among men and women with PTSD in VISN 20. Widespread concomitant use of benzodiazepines and opioids suggests risk management systems and research on the efficacy and safety of these medications are needed. Published by Elsevier Ireland Ltd.