Abstract
Objective
To investigate the prevalence of current use of benzodiazepines (BZDs) and related drugs in the French general population and factors associated with this use.
Methods
National cross-sectional telephone survey conducted between 25 April 2001 and 8 May 2001 in a representative sample of non-institutionalized adults of BZD use and duration, prescriber specialty, socio-demographic data and mood and anxiety disorders, using a structured diagnostic interview.
Results
The prevalence of current use of BZD was 7.5%. It was higher among women (9.7%) than men (5.2%). It increased with age and was higher in the jobless (10.9). Duration of BZD use was more than 6 months in 75.9% of users and increased with age. Of the 711 (17.7%) subjects with at least one mood or anxiety disorder, 122 (17%) used BZD compared with180 (5.5%) of the 3296 subjects without mood or anxiety disorders. In multivariate analysis, factors associated with BZD use were age [odds ratio (OR): 3.6; 95% confidence interval (CI) 2.0–5.6], 6.5 (4.1–10.3) and 10.9 (6.9–17.1), respectively, for ages 35–44 years, 45–59 years and over 60 years compared with below 34 years, female gender (OR: 1.7; 95% CI 1.3–2.1), anxiety only (OR: 2.2; 95% CI 1.5–3.2), mood disorder only (OR: 4.4; 95% CI 2.7–7.1) or both mood and anxiety disorders (OR: 8.8; 95% CI 5.9–12.6).
Conclusion
Despite precautions, warnings and attempts to limit use, there remains a high proportion of long-term BZD users in the general French population, especially in the elderly. Our findings add to the weight of opinion that messages concerning proper use of BZDs certainly need to be clarified and amplified.
Similar content being viewed by others
References
Mellinger GD, Balter MB, Uhlenhuth EH (1984) Prevalence and correlates of the long-term regular use of anxiolytics. JAMA 251(3):375–379
Balter MB, Levine J, Manheimer DI (1974) Cross-national study of the extent of anti-anxiety-sedative drug use. N Engl J Med 290(14):769–774
Edwards C, Bushnell JL, Ashton CH, Rawlins MD (1991) Hospital prescribing and usage of hypnotics and anxiolytics. Br J Clin Pharmacol 31(2):190–192
Morgan K, Dallosso H, Ebrahim S, Arie T, Fentem PH (1988) Prevalence, frequency, and duration of hypnotic drug use among the elderly living at home. BMJ 296(6622):601–602
Olfson M, Pincus HA (1994) Use of benzodiazepines in the community. Arch Intern Med 154(11):1235–1240
Lecadet J, Vidal P, Baris B, Vallier N, Fender P, Allemand H (2003) Médicaments psychotropes: consommations et pratiques de prescription en France métropolitaine. I Données nationales, 2000. Rev Med Ass Maladie 34:75–84
Mattila-Evenden M, Bergman U, Franck J (2001) A study of benzodiazepine users claiming drug-induced psychiatric morbidity. Nord J Psychiatry 55(4):271–278
Lader M (1984) Benzodiazepine dependence. Prog Neuropsychopharmacol Biol Psychiatry 8(1):85–95
Khan A, Hornblow AR, Walshe JW (1981) Benzodiazepine dependence: a general practice survey. N Z Med J 93(687):19–21
Barbone F, McMahon AD, Davey PG, Morris AD, Reid IC, McDevitt DG et al (1998) Association of road-traffic accidents with benzodiazepine use. Lancet 352(9137):1331–1336
Herings RM, Stricker BH, de Boer A, Bakker A, Sturmans F (1995) Benzodiazepines and the risk of falling leading to femur fractures. Dosage more important than elimination half-life. Arch Intern Med 155(16):1801–1807
Lagnaoui R, Begaud B, Moore N, Chaslerie A, Fourrier A, Letenneur L et al (2002) Benzodiazepine use and risk of dementia: a nested case-control study. J Clin Epidemiol 55(3):314–318
Pierfitte C, Macouillard G, Thicoipe M, Chaslerie A, Pehourcq F, Aissou M et al (2001) Benzodiazepines and hip fractures in elderly people: case-control study. BMJ 322(7288):704–708
Ensrud KE, Blackwell T, Mangione CM, Bowman PJ, Bauer DC, Schwartz A et al (2003) Central nervous system active medications and risk for fractures in older women. Arch Intern Med 163(8):949–957
Wang PS, Bohn RL, Glynn RJ, Mogun H, Avorn J (2001) Hazardous benzodiazepine regimens in the elderly: effects of half-life, dosage, and duration on risk of hip fracture. Am J Psychiatry 158(6):892–898
Sgadari A, Lapane KL, Mor V, Landi F, Bernabei R, Gambassi G (2000) Oxidative and nonoxidative benzodiazepines and the risk of femur fracture. The Systematic Assessment of Geriatric Drug Use Via Epidemiology Study Group. J Clin Psychopharmacol 20(2):234–239
Marks J (1980) The benzodiazepines—use and abuse. Arzneimittelforschung 30(5a):898–901
Stewart RB, Marks RG, Padgett PD, Hale WE (1994) Benzodiazepine use in an ambulatory elderly population: a 14-year overview. Clin Ther 16(1):118–124
Marks J (1983) The benzodiazepines an international perspective. J Psychoactive Drugs 15(1–2):137–149
Duneton P (2001) Mise au point sur les troubles du comportement liées à l’utilisation des benzodiazépines et produits apparentés. http://www.afssaps.sante.fr/htm/10/filltrpsc/lp010901.htm; 2001.
Levy PS, Lemeshow S (1999) Sampling of populations. Wiley, New York, p 21
Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E et al (1998) The mini-international neuropsychiatric interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 59[Suppl 20]:22–33
Moore N, Pierfitte C, Pehourcq F, Lagnaoui R, Begaud B (2001) Comparison of patient questionnaires, medical records, and plasma assays in assessing exposure to benzodiazepines in elderly subjects. Clin Pharmacol Ther 69(6):445–450
Moore N, Masson H, Noblet C, Joannidès R (1993) What medicines do patients really take? A comparison of free form vs. oriented questionnaires. Post Marketing Surveillance 7:355–362
Hosmer DW, Lemeshow S (1989) Applied logistic regression. Wiley, New York
Lepine JP, Lellouch J (1993) Etude épidémiologique des troubles dépressifs et anxieux dans une population générale. Ann Med Psychol 151:618–623
Pariente P, Lepine JP, Lellouch J (1992) Self-reported psychotropic drug use and associated factors in a French community sample. Psychol Med 22(1): 181–190
Ohayon MM, Caulet M (1996) Psychotropic medication and insomnia complaints in two epidemiological studies. Can J Psychiatry 41(7):457–464
Ohayon M, Caulet M, Lemoine P (1996) The elderly, sleep habits and use of psychotropic drugs by the French population. Encephale 22(5):337–350
Guignon N, Mormiche P, Sermet C (1994) Epidemiological aspects of chronic use of psychotropic drugs. In: La consommation régulière de psychotropes. Institut National des Statistiques et des Etudes Economiques—INSEE Premiere, Paris, p 310
Ohayon MM, Lader MH (2002) Use of psychotropic medication in the general population of France, Germany, Italy, and the United Kingdom. J Clin Psychiatry 63(9):817–825
Johnell K, Merlo J, Lynch J, Blennow G (2004) Neighbourhood social participation and women’s use of anxiolytic-hypnotic drugs: a multilevel analysis. J Epidemiol Community Health 58(1):59–64
Ravaris CL, Friedman MJ, Hauri PJ, McHugo GJ (1991) A controlled study of alprazolam and propranolol in panic-disordered and agoraphobic outpatients. J Clin Psychopharmacol 11(6):344–350
Ballenger JC (1990) Efficacy of benzodiazepines in panic disorder and agoraphobia. J Psychiatr Res 24[Suppl 2]:15–25
Ballenger JC, Burrows GD, DuPont RL Jr, Lesser IM, Noyes R Jr, Pecknold JC et al (1988) Alprazolam in panic disorder and agoraphobia: results from a multicenter trial. I. Efficacy in short-term treatment. Arch Gen Psychiatry 45(5):413–422
Liebowitz MR, Fyer AJ, Gorman JM, Campeas R, Levin A, Davies SR et al (1986) Alprazolam in the treatment of panic disorders. J Clin Psychopharmacol 6(1):13–20
Moroz G, Rosenbaum JF (1999) Efficacy, safety, and gradual discontinuation of clonazepam in panic disorder: a placebo-controlled, multicenter study using optimized dosages. J Clin Psychiatry 60(9):604–612
Beauclair L, Fontaine R, Annable L, Holobow N, Chouinard G (1994) Clonazepam in the treatment of panic disorder: a double-blind, placebo-controlled trial investigating the correlation between clonazepam concentrations in plasma and clinical response. J Clin Psychopharmacol 14(2):111–118
Furukawa TA, Streiner DL, Young LT (2002) Antidepressant and benzodiazepine for major depression. Cochrane Database Syst Rev (1):CD001026
Gorman JM (2002) Treatment of generalized anxiety disorder. J Clin Psychiatry 63[Suppl 8]:17–23
Davidson JR (2001) Pharmacotherapy of generalized anxiety disorder. J Clin Psychiatry 62[Suppl 11]:46–50
Shorter E, Tyrer P (2003) Separation of anxiety and depressive disorders: blind alley in psychopharmacology and classification of disease. BMJ 327(7407):158–160
Fourrier A, Gasquet I, Allicar MP, Bouhassira M, Lepine JP, Begaud B (2000) Patterns of neuroleptic drug prescription: a national cross-sectional survey of a random sample of French psychiatrists. Br J Clin Pharmacol 49(1):80–86
Dunbar GC, Perera MH, Jenner FA (1989) Patterns of benzodiazepine use in Great Britain as measured by a general population survey. Br J Psychiatry 155:836–841
Ohayon MM, Caulet M, Priest RG, Guilleminault C (1998) Psychotropic medication consumption patterns in the UK general population. J Clin Epidemiol 51(3):273–283
Rayon P, Serrano-Castro M, del Barrio H, Alvarez C, Montero D, Madurga M et al (1996) Hypnotic drug use in Spain: a cross-sectional study based on a network of community pharmacies. Spanish Group for the Study of Hypnotic Drug Utilization. Ann Pharmacother 30(10):1092–1100
Mayer-Oakes SA, Kelman G, Beers MH, De Jong F, Matthias R, Atchison KA et al (1993) Benzodiazepine use in older, community-dwelling southern Californians: prevalence and clinical correlates. Ann Pharmacother 27(4):416–421
Koenig W, Ruther E, Filipiak B (1987) Psychotropic drug utilization patterns in a metropolitan population. Eur J Clin Pharmacol 32(1):43–51
van Hulten R, Isacson D, Bakker A, Leufkens HG (2003) Comparing patterns of long-term benzodiazepine use between a Dutch and a Swedish community. Pharmacoepidemiol Drug Saf 12(1):49–53
Zandstra SM, Furer JW, van de Lisdonk EH, Bor JH, Zitman FG, van Weel C (2002) Differences in health status between long-term and short-term benzodiazepine users. Br J Gen Pract 52(483):805–808
Cumming RG, Le Couteur DG (2003) Benzodiazepines and risk of hip fractures in older people: a review of the evidence. CNS Drugs 17(11):825–837
Acknowledgements
This study was funded by an unconditional grant from Merck & Co., USA. The authors gratefully thank the subjects who agreed to participate in this study. This study was done in accordance with all the laws and regulations governing such studies in France. All data were collected anonymously.
Conflict of interest and authorship statement: none of the authors or their families have any direct financial ties with any of the producers of any of the drugs cited in this study, or with Merck & Co., or own any shares in any of these companies. Several of them (mainly NM, HV and BB) have been invited to give lectures by pharmaceutical companies in this and other fields and have consulted for most pharmaceutical companies in the field of psychopharmacology and other fields of pharmacology, the proceeds going to the university or to non-profit organizations. RL, BB, HV, NM are employees of Université Victor Segalen, Bordeaux; FD and AA are employees of Naturalia & Biologia, a non-profit organization. Their salaries are financed by research contracts with pharmaceutical companies and public organisms. AF was at the time of the study. an employee of ARME-Pharmacovigilance, a non-profit research organization funded by equal donations from eleven pharmaceutical companies and by grants from the French Ministry of Health to conduct fundamental research on methods in pharmacovigilance. NM, HV, AF and BB had the original idea, RL, HV and FD designed the study and the study material and organized the survey, AA, AF, FD and RL did the data analysis. The first draft of the paper was written by RL and reviewed by all authors, who approved the final draft. NM is the guarantor of the study.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lagnaoui, R., Depont, F., Fourrier, A. et al. Patterns and correlates of benzodiazepine use in the French general population. Eur J Clin Pharmacol 60, 523–529 (2004). https://doi.org/10.1007/s00228-004-0808-2
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00228-004-0808-2