Predictors of Benzodiazepine Re-Prescription Among U.S. Veterans with a History of Chronic Benzodiazepine Use

Objective: Given difficulty in discontinuing prescribed benzodiazepines and potential harms to people from chronic benzodiazepine use, it is important to understand medical and mental health conditions associated with re-prescription. This study sought to estimate benzodiazepine re-prescription incidence rates among Veterans in the United States Veterans Health Administration (VHA) and identify predictors of re-prescription among Veterans who discontinued benzodiazepines. Methods: This longitudinal study used VHA administrative data from patients’ electronic health records in Fiscal Year 2019. Patients with chronic (>30 days) benzodiazepine prescriptions who were not prescribed benzodiazepines continuously for the entire year were identified based on pharmacy records (n=151,777). We used Kaplan-Meier methods and a Cox proportional hazards model to estimate benzodiazepine re-prescription incidence rates. Unadjusted and adjusted hazard ratios were used to examine demographic and clinical characteristics as predictors of benzodiazepine re-prescription. Results: Among 151,777 patients who did not refill a benzodiazepine prescription for ≥30 days, 50% were re-prescribed benzodiazepines within 2.5 months. Benzodiazepine re-prescription was associated with mental health conditions (e.g., anxiety, PTSD). Patients were less likely to be re-prescribed benzodiazepines if they had a history of an alcohol or drug use disorder, neurological disorder other than paralysis, chronic heart failure, dementia, and hospice care. Conclusions: The short gap between benzodiazepine prescriptions ending and being re-prescribed suggests patients have difficulty discontinuing prescribed benzodiazepines. More investigations are needed on the medical necessity of chronic benzodiazepines and strategies for increasing guideline concordant care.