The epidemiology of benzodiazepine misuse: A systematic review*

Votaw, Victoria R.; Geyer, Rachel; Rieselbach, Maya M.; McHugh, R. Kathryn

doi:10.1016/j.drugalcdep.2019.02.033

Cited by 479Opioid Use Disorder TreatmentSubstance Abuse Treatment and OutcomesPharmaceutical Practices and Patient Outcomes

The epidemiology of benzodiazepine misuse: A systematic review*

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Votaw, Victoria R., Geyer, Rachel, Rieselbach, Maya M., McHugh, R. Kathryn·2019·Drug and Alcohol Dependence

DOI 10.1016/j.drugalcdep.2019.02.033PMC PMC6639084

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Abstract

Background: Benzodiazepine misuse is a growing public health problem, with increases in benzodiazepine-related overdose deaths and emergency room visits in recent years. However, relatively little attention has been paid to this emergent problem. We systematically reviewed epidemiological studies on benzodiazepine misuse to identify key findings, limitations, and future directions for research. Methods: PubMed and PsychINFO databases were searched through February 2019 for peer-reviewed publications on benzodiazepine misuse (e.g., use without a prescription; at a higher frequency or dose than prescribed). Eligibility criteria included human studies that focused on the prevalence, trends, correlates, motives, patterns, sources, and consequences of benzodiazepine misuse. Results: The search identified 1,970 publications, and 351 articles were eligible for data extraction and inclusion. In 2017, benzodiazepines and other tranquilizers were the third most commonly used illicit or prescription drug in the U.S. (approximately 2.2% of the population). Worldwide rates of misuse appear to be similar to those reported in the U.S. Factors associated with misuse include other substance use, receipt of a benzodiazepine prescription, and psychiatric symptoms and disorders. Benzodiazepine misuse encompasses heterogeneous presentations of motives, patterns, and sources. Moreover, misuse is associated with myriad poor outcomes, including mortality, HIV/HCV risk behaviors, poor self-reported quality of life, criminality, and continued substance use during treatment. Conclusions: Benzodiazepine misuse is a worldwide public health concern that is associated with a number of concerning consequences. Findings from the present review have implications for identifying subgroups who could benefit from prevention and treatment efforts, critical points for intervention, and treatment targets.

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Benzodiazepine misuse is reported in approximately 2% of the general adult population.
“BZD misuse is reported in approximately 2% of the general adult population [10,11].”
From Cognitive behavioral therapy and acceptance and commitment therapy for the discontinuation of long-term benzodiazepine use in insomnia and anxiety disorders (2021) · cites this paper as [10]
The Results, under Prevalence and Trends (page unavailable), report approximately 2.2% past-year tranquilizer misuse in the U.S. population aged 12 and older. They also report rates near 2% in several international general-population samples. These figures support the approximate prevalence, but the U.S. figure is not restricted to adults or to benzodiazepines alone. (LLM, conf=0.86)
Experimental — accuracy not yet measured
Benzodiazepines are commonly prescribed for anxiety and insomnia but are often misused for their sedative effects.
“Benzodiazepines are commonly prescribed for anxiety and insomnia but are often misused for their sedative effects [64, 65].”
From Prevalence and patterns of substance use in West Africa: A systematic review and meta-analysis (2024) · cites this paper as [65]
Patients diagnosed with substance use disorder have increased tendencies to misuse BZD compared to the general population.
“It has been shown that patients diagnosed with substance use disorder have increased tendencies to misuse BZD compared to the general population [31].”
From Benzodiazepines: Uses, Dangers, and Clinical Considerations (2021) · cites this paper as [31]
There is evidence that other substance use disorders are highly prevalent among those with benzodiazepine misuse and that benzodiazepine misuse is associated with poorer substance use disorder treatment outcomes.
“However, there is evidence that other substance use disorders are highly prevalent among those with benzodiazepine misuse (9), and that benzodiazepine misuse is associated with poorer substance use disorder treatment outcomes (14).”
From Prevalence and correlates of the misuse of z-drugs and benzodiazepines in the National Survey on Drug Use and Health (2023) · cites this paper as [14]
Even in studies outside of the NSDUH, investigators commonly assess the use and misuse of drugs producing anxiolytic and/or hypnotic effects as one category.
“Similarly, even in studies outside of the NSDUH, investigators commonly assess the use and misuse of drugs producing anxiolytic and/or hypnotic effects as one category (14).”
From Prevalence and correlates of the misuse of z-drugs and benzodiazepines in the National Survey on Drug Use and Health (2023) · cites this paper as [14]

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Research works printed but not linked: 1

Substance Abuse and Mental Health Services Administration, 2012 Comparing and evaluating youth substance use estimates from the National Survey on Drug Use and Health and other surveys. HHS Publication, Rockville, MD https://www.samhsa.gov/data/sites/default/files/NSDUH-M9-Youth-2012/NSDUH-M9-Youth-2012.pdf 30480921

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Benzodiazepines: Uses, Dangers, and Clinical Considerations
Edinoff, A. N., Nix, C. A., Hollier, J., Sagrera, C. E., Delacroix, B. M., Abubakar, T., Cornett, E. M., Kaye, A. M., & Kaye, A. D. (2021) · Neurology International · doi:10.3390/neurolint13040059 · Cited by 340 · see citing works
“It has been shown that patients diagnosed with substance use disorder have increased tendencies to misuse BZD compared to the general population [31].”
Background
Cognitive behavioral therapy and acceptance and commitment therapy for the discontinuation of long-term benzodiazepine use in insomnia and anxiety disorders
Chapoutot, M., Peter-Derex, L., Bastuji, H., Leslie, W., Schoendorff, B., Heinzer, R., Siclari, F., Nicolas, A., Lemoine, P., Higgins, S., et al. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph181910222 · Cited by 59 · see citing works
“BZD misuse is reported in approximately 2% of the general adult population [10,11].”
Background
Sex differences in benzodiazepine misuse among adults with substance use disorders
McHugh, R. K., Geyer, R. B., Chase, A. R., Griffin, M. L., Bogunovic, O., & Weiss, R. D. (2021) · Addictive Behaviors · doi:10.1016/j.addbeh.2020.106608 · Cited by 51 · see citing works
Self-citation
Prevalence and correlates of the misuse of z-drugs and benzodiazepines in the National Survey on Drug Use and Health
McHugh, R. K., Votaw, V. R., Trapani, E. W., & McCarthy, M. D. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1129447 · Cited by 38 · see citing works
Self-citation
Benzodiazepine Misuse among Adults Receiving Psychiatric Treatment
McHugh, R. K., Peckham, A. D., Björgvinsson, T., Korte, F. M., & Beard, C. (2020) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2020.05.020 · Cited by 25 · see citing works
Self-citation
Prevalence and patterns of substance use in West Africa: A systematic review and meta-analysis
Emmanuel, G. O., Akinsolu, F. T., Abodunrin, O. R., & Ezechi, O. C. (2024) · PLOS Global Public Health · doi:10.1371/journal.pgph.0004019 · Cited by 24 · see citing works

Authors: Votaw, V. R., Geyer, R., Rieselbach, M. M., & McHugh, R. K.
Affiliations: University of New Mexico (US)
McLean Hospital (US)
Harvard University (US)
Corresponding author: Votaw, Victoria R.
ORCID: Votaw, Victoria R.
Geyer, Rachel
Rieselbach, Maya M.
McHugh, R. Kathryn
Venue: Drug and Alcohol Dependence
Publisher: Elsevier BV
Published: 2019-07
Volume: 200
Pages: 95-114
ISSN: 0376-8716 (ISSN-L)
DOI: 10.1016/j.drugalcdep.2019.02.033
PMC: PMC6639084
OpenAlex: W2944251535
Semantic Scholar: 4dd8153a9249ac387cb03d106faa14427882aee8
Cited by: 479
References: 332
Citations by year: 2026: 45 · 2025: 65 · 2024: 74 · 2023: 119 · 2022: 61 · 2021: 60 · 2020: 46 · 2019: 8
FWCI: 7.15
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
Locations: Drug and Alcohol Dependence (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: National Institute on Alcohol Abuse and Alcoholism
McLean Hospital
National Institute on Drug Abuse
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
Keywords: benzodiazepine misuse, prescription drug misuse, prevalence, benzodiazepine overdose, substance use comorbidity, mental illness, illicit drug use, quality of life, criminality, prevention and treatment
MeSH terms: Benzodiazepines, Humans, Public Health, Quality of Life, Prevalence, Substance-Related Disorders, Prescription Drugs, Drug Overdose, Prescription Drug Misuse

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The epidemiology of benzodiazepine misuse: A systematic review*

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