Long-Term Benzodiazepine Use in Posttraumatic Stress Disorder and Chronic Obstructive Pulmonary Disease

Abstract

Objective: Examine the national prevalence and variability in long-term benzodiazepine prescriptions for patients with two comorbidities placing them at high risk for benzodiazepine-related complications, posttraumatic stress disorder (PTSD) and chronic obstructive pulmonary disease (COPD). Methods: We identified Veterans with PTSD and COPD identified from electronic health records from Veterans Health Administration between 2010-2012. We used a mixed-effects logistic regression model with long-term benzodiazepine prescriptions (≥90 days) as the outcome to assess patient and center predictors. Results: Of 44,949 patients diagnosed with PTSD and COPD at 130 centers, 24.3% were prescribed benzodiazepines long-term. Patients with long-term prescriptions were more likely to be white (90.1 vs. 80.8%, p<0.001) and have other mental health comorbidities including generalized anxiety disorder (31.0 vs. 16.5%, p<0.001). Substantial heterogeneity among medical centers existed, and proportional use of long-term benzodiazepine ranged from 8.6 to 56.5%. This heterogeneity persisted after accounting for patient characteristics with a random effect by medical center of 0.33 (95% CI 0.28-0.39). Accounting for patient-level factors, southern centers were more likely than centers in the northeast to prescribe benzodiazepines long-term (OR 1.22, 95%CI 1.02-1.47), and centers with higher Veteran-reported access to mental health care were less likely to prescribe long-term benzodiazepines (OR 0.51, 95%CI 0.32-0.81). Conclusions: Long-term benzodiazepine prescribing is common among patients at high risk for complications, although this practice varies substantially from center to center. Poor access to mental health care is a potential driver of this guideline inconsistent use.