Use of benzodiazepines and z-drugs not compliant with guidelines and associated factors: a population-based study
Abstract
Benzodiazepines and z-drugs are primarily indicated for the treatment of sleep disorders and anxiety symptoms. Their frequent long-term use contrasts with the international guidelines that limit treatment duration to a maximum of 4 weeks. The objective of this study was to assess the frequency of their use that was not in accordance with guidelines in the French general population between 2007 and 2012 and associated characteristics. A cohort of 67,550 benzodiazepine new users was set up in an exhaustive database for health-care reimbursements and representative of the French population. Benzodiazepine use not in accordance with guidelines was defined as the concomitant dispensation of several benzodiazepines, the dispensation of treatment over a period longer than recommended, or a new dispensing within the 2 months following the end of a previous treatment of maximum recommended duration, considering that French recommendations distinguish between hypnotic (4 weeks) and anxiolytic benzodiazepines (12 weeks). Benzodiazepine use not in accordance with guidelines was high, in about 30% of new hypnotic users and 20% of new anxiolytic users. Its frequency was stable over the study period. Associated characteristics were similar for new hypnotic or anxiolytic users, i.e.. older age, treatment initiation by a psychiatrist, presence of a chronic disease, hospitalization, or another psychotropic treatment. These findings provide a solid basis for establishing a public health policy to reduce benzodiazepine use not compliant with guidelines. They should be further explored in patients most at risk in the present study, e.g., patients treated by a psychiatrist.
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Real-world use of BZDs and Z-drugs often exceeds guideline-recommended durations, with up to 30% of new hypnotic users continuing treatment beyond 4 weeks.
“Additionally, real-world use of BZDs and Z-drugs often exceeds guideline-recommended durations, with up to 30% of new hypnotic users continuing treatment beyond 4 weeks.”
From Z-drug abuse and dependence: Clinical guideline of the Brazilian Academy of Neurology for diagnosis and management (2025) · cites this paper as [27]
Younger age, white race, chronic pain, and psychiatric comorbidities are associated with general substance misuse, while older age is linked to sedative misuse.
“Younger age, white race, chronic pain, and psychiatric comorbidities are associated with general substance misuse, while older age is linked to sedative misuse.”
From Z-drug abuse and dependence: Clinical guideline of the Brazilian Academy of Neurology for diagnosis and management (2025) · cites this paper as [27]
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Stelzer, F. G., Bacelar, A., Éckeli, A. L., Negrão, A. B., Almeida, C. M. O., Franco, C. M. R., Pires, G. N., Gitaí, L. L. G., Sobreira-Neto, M. A., Assis, M., et al. (2025) · Arquivos de Neuro-Psiquiatria · doi:10.1055/s-0045-1812323 · Cited by 1 · see citing works
“27 Evidence 9,28 suggests that zopiclone carries a potential for dependence.”
- Authors
- Panes, A., Pariente, A., Bénard-Laribière, A., Lassalle, R., Dureau-Pournin, C., Lorrain, S., Tournier, M., & Fourrier-Réglat, A.
- Affiliations
- Université de Bordeaux (FR)
- Centre d'Investigation Clinique Plurithématique de Bordeaux (FR)
- Corresponding author
- Panes, Arnaud
- Venue
- European Archives of Psychiatry and Clinical Neuroscience
- Published
- 2018-12-11
- Volume
- 270
- Issue
- 1
- Pages
- 3-10
- ISSN
- 0003-9373 (ISSN-L)
- 0940-1334
- 1433-8491
- OpenAlex
- W2904964518
- Cited by
- 50
- References
- 22
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 9 · 2023: 9 · 2022: 4 · 2021: 8 · 2020: 6 · 2019: 2 · 2017: 1
- FWCI
- 2.22
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- European Archives of Psychiatry and Clinical Neuroscience (publishedVersion)
- PubMed (publishedVersion)
- HAL (submittedVersion)
- Oskar-Bordeaux (Universite de Bordeaux) (submittedVersion)
- Funders
- Agence Nationale de Sécurité du Médicament et des Produits de Santé (2013-S081)
- Topics
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- benzodiazepines, Z-drugs, guideline adherence, long-term benzodiazepine use, treatment duration, sleep disorders, anxiety disorders, prescribing patterns, public health policy
- MeSH terms
- Zolpidem, Adolescent, Adult, Age Factors, Aged, Aged, 80 and over, Benzodiazepines, Female, France, Humans, Hypnotics and Sedatives, Male, Middle Aged, National Health Programs, Piperazines, Drug Prescriptions, Sex Factors, Anti-Anxiety Agents, Cohort Studies, Guideline Adherence, Azabicyclo Compounds, Young Adult
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