Skip to main content

Advertisement

SpringerLink
Log in

Patterns and correlates of benzodiazepine use in the French general population

  • Pharmacoepidemiology and Prescription
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Mellinger GD, Balter MB, Uhlenhuth EH (1984) Prevalence and correlates of the long-term regular use of anxiolytics. JAMA 251(3):375–379

    Article  CAS  PubMed  Google Scholar 

  2. 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

    CAS  PubMed  Google Scholar 

  3. 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

    CAS  PubMed  Google Scholar 

  4. 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

    CAS  PubMed  Google Scholar 

  5. Olfson M, Pincus HA (1994) Use of benzodiazepines in the community. Arch Intern Med 154(11):1235–1240

    Article  CAS  PubMed  Google Scholar 

  6. 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

    Google Scholar 

  7. 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

    Article  CAS  PubMed  Google Scholar 

  8. Lader M (1984) Benzodiazepine dependence. Prog Neuropsychopharmacol Biol Psychiatry 8(1):85–95

    Article  CAS  PubMed  Google Scholar 

  9. Khan A, Hornblow AR, Walshe JW (1981) Benzodiazepine dependence: a general practice survey. N Z Med J 93(687):19–21

    CAS  PubMed  Google Scholar 

  10. 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

    Article  CAS  PubMed  Google Scholar 

  11. 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

    Google Scholar 

  12. 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

    Article  PubMed  Google Scholar 

  13. 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

    Article  CAS  PubMed  Google Scholar 

  14. 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

    Google Scholar 

  15. 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

    CAS  PubMed  Google Scholar 

  16. 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

    Article  CAS  PubMed  Google Scholar 

  17. Marks J (1980) The benzodiazepines—use and abuse. Arzneimittelforschung 30(5a):898–901

    CAS  PubMed  Google Scholar 

  18. 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

    CAS  PubMed  Google Scholar 

  19. Marks J (1983) The benzodiazepines an international perspective. J Psychoactive Drugs 15(1–2):137–149

    CAS  PubMed  Google Scholar 

  20. 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.

  21. Levy PS, Lemeshow S (1999) Sampling of populations. Wiley, New York, p 21

    Google Scholar 

  22. 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

    Google Scholar 

  23. 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

    Article  CAS  PubMed  Google Scholar 

  24. 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

    Google Scholar 

  25. Hosmer DW, Lemeshow S (1989) Applied logistic regression. Wiley, New York

    Google Scholar 

  26. Lepine JP, Lellouch J (1993) Etude épidémiologique des troubles dépressifs et anxieux dans une population générale. Ann Med Psychol 151:618–623

    Google Scholar 

  27. 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

    CAS  PubMed  Google Scholar 

  28. Ohayon MM, Caulet M (1996) Psychotropic medication and insomnia complaints in two epidemiological studies. Can J Psychiatry 41(7):457–464

    CAS  PubMed  Google Scholar 

  29. 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

    CAS  PubMed  Google Scholar 

  30. 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

    Google Scholar 

  31. 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

    PubMed  Google Scholar 

  32. 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

    Article  CAS  PubMed  Google Scholar 

  33. 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

    CAS  PubMed  Google Scholar 

  34. Ballenger JC (1990) Efficacy of benzodiazepines in panic disorder and agoraphobia. J Psychiatr Res 24[Suppl 2]:15–25

    Article  PubMed  Google Scholar 

  35. 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

    Google Scholar 

  36. 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

    CAS  PubMed  Google Scholar 

  37. 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

    CAS  PubMed  Google Scholar 

  38. 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

    CAS  PubMed  Google Scholar 

  39. Furukawa TA, Streiner DL, Young LT (2002) Antidepressant and benzodiazepine for major depression. Cochrane Database Syst Rev (1):CD001026

    Google Scholar 

  40. Gorman JM (2002) Treatment of generalized anxiety disorder. J Clin Psychiatry 63[Suppl 8]:17–23

    Google Scholar 

  41. Davidson JR (2001) Pharmacotherapy of generalized anxiety disorder. J Clin Psychiatry 62[Suppl 11]:46–50

    CAS  Google Scholar 

  42. Shorter E, Tyrer P (2003) Separation of anxiety and depressive disorders: blind alley in psychopharmacology and classification of disease. BMJ 327(7407):158–160

    Article  PubMed  Google Scholar 

  43. 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

    Article  CAS  PubMed  Google Scholar 

  44. 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

    CAS  PubMed  Google Scholar 

  45. 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

    Article  CAS  PubMed  Google Scholar 

  46. 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

    CAS  PubMed  Google Scholar 

  47. 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

    CAS  PubMed  Google Scholar 

  48. Koenig W, Ruther E, Filipiak B (1987) Psychotropic drug utilization patterns in a metropolitan population. Eur J Clin Pharmacol 32(1):43–51

    CAS  PubMed  Google Scholar 

  49. 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

    Article  PubMed  Google Scholar 

  50. 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

    CAS  PubMed  Google Scholar 

  51. 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

    CAS  PubMed  Google Scholar 

Download references

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

  1. Département de Pharmacologie, EA 3676, IFR 99, Université Victor Segalen, Bordeaux 2, 33076, Bordeaux cedex, France

    Rajaa Lagnaoui, Fanny Depont, Annie Fourrier, Abdelillah Abouelfath, Bernard Bégaud & Nicholas Moore

  2. ARME-Pharmacovigilance, 33076, Bordeaux, France

    Annie Fourrier

  3. Département de Psychiatrie Adulte, EA 3676, IFR 99, Université Victor Segalen, Bordeaux 2, Hôpital Charles Perrens, 33076, Bordeaux, France

    Hélène Verdoux

Authors
  1. Rajaa Lagnaoui
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Fanny Depont
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Annie Fourrier
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Abdelillah Abouelfath
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bernard Bégaud
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hélène Verdoux
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Nicholas Moore
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nicholas Moore.

Rights and permissions

Reprints 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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00228-004-0808-2

Keywords

Search

Navigation