An investigation into problem benzodiazepine use among individuals with a prescription

In recent years, problem use of classified prescription drugs in the United States has become a critical public health concern garnering increased attention and resources. Although the focus has primarily been on problem use of prescription drugs with the highest abuse potential, evidence of the increasing prevalence and growing burden of problem benzodiazepine use in the United States is mounting. Most epidemiological research on problem prescription drug use, including benzodiazepines, has focused on use among individuals without a prescription. However, problem use also includes use with a prescription, but in ways, or for reasons, not recommended by a doctor. Of particular importance are individuals with a benzodiazepine prescription who experience clinically significant impairment or distress as a result of using their prescription in problematic ways. Several prescription-related risk factors could increase the risk of problem benzodiazepine use among individuals prescribed benzodiazepines. These include characteristics of the benzodiazepines prescribed (including dosage and abuse liability of the prescribed benzodiazepine), the amount of benzodiazepine prescribed over time (including medication possession ratio [i.e. whether the benzodiazepine recipient has more medication than is medically necessary] and days supply of medication) and prescription contextual variables (including whether the prescription recipient also receives other controlled substances and utilizes psychotherapeutic services). In addition, characteristics of the benzodiazepine prescription recipient (including alcohol disorders, drug disorders, anxiety disorders and mood disorders) could also predict problem benzodiazepine use. This dissertation aims to consider the independent and joint roles of these factors in the risk of problem benzodiazepine use among individuals with a prescription. To this end, the current dissertation consists of three parts: a systematic literature review and two analytic research papers investigating risk factors for the development of problem benzodiazepine use, using prospective individual-level medical and pharmacy claims information in the 2003-2004 Thompson Reuters MarketScan® Commercial Claims Databases. Modifiable variables including prescription characteristics, the amount of benzodiazepine prescribed over time and prescription contextual factors independently increased the risk of problem benzodiazepine use among individuals with a prescription. Psychiatric disorders, for which benzodiazepines are indicated (alcohol and anxiety disorders), or used off-label (drug and mood disorders), independently increased the risk of problem benzodiazepine use among individuals with a prescription. Further, psychotherapy and opioid prescriptions modified the increased risk of problem benzodiazepine use conferred by an anxiety disorder. This information can be used to develop specifically targeted prevention and treatment interventions, such as surveillance systems, to address the burden of problem benzodiazepine use in the U.S