The DOI matches its Crossref record; 331 of the 331 references it cites were found in a registry or an index.
The epidemiology of benzodiazepine misuse: A systematic review*
Open accessAbstract
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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“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]
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“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]
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“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]
In the citing paper
“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]
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“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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“It has been thoroughly documented that simultaneous use of other substances, particularly opioids, is common among those who misuse benzodiazepines (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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Cites
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“…sedative/tranquilizer misuse and use disorder have remained relatively stable among both adolescents and adults in the U.S. (CBHSQ, 2015a, 2018b; Johnston et al., 2018; Palamar et al., 2019), including among those with opioid misuse (Boggis et al., 2019) (see Supplementary Materials for data on…”
BackgroundInfluentialConway, K. P., Compton, W., Stinson, F. S., & Grant, B. F. (2006) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v67n0211 · Cited by 934 · cited 1×
“found that the association between anxiety disorders and SHA use disorder was stronger among women relative to men; however, the association between panic disorder without agoraphobia and sedative dependence was higher among men (Conway et al., 2006).”
ResultHan, B., Compton, W. M., Blanco, C., Crane, E., Lee, J., & Jones, C. M. (2017) · Annals of Internal Medicine · doi:10.7326/m17-0865 · Cited by 873
Johnston, L. D., Miech, R., O'Malley, P., Bachman, J., Schulenberg, J., & Patrick, M. E. (2015) · doi:10.3998/2027.42/150621 · Cited by 850
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Polydrug abuse: a review of opioid and benzodiazepine combination use
Jones, J. D., Mogali, S., & Comer, S. D. (2012) · Drug and Alcohol Dependence · doi:10.1016/j.drugalcdep.2012.07.004 · Cited by 703
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Increasing Benzodiazepine Prescriptions and Overdose Mortality in the United States, 1996–2013
Bachhuber, M. A., Hennessy, S., Cunningham, C. O., & Starrels, J. L. (2016) · American Journal of Public Health · doi:10.2105/ajph.2016.303061 · Cited by 531
Research works printed but not linked: 1
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Cited by
Sorted by citations
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
“It has been shown that patients diagnosed with substance use disorder have increased tendencies to misuse BZD compared to the general population [31].”
BackgroundChapoutot, 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
“BZD misuse is reported in approximately 2% of the general adult population [10,11].”
BackgroundSex 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
Self-citationMcHugh, R. K., Votaw, V. R., Trapani, E. W., & McCarthy, M. D. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1129447 · Cited by 38
Self-citationBenzodiazepine 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
Self-citationPrevalence 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
Montégut, L., Rousseau, A., Ungolo, C., Derosa, L., Fidelle, M., Alves Costa Silva, C., Routy, B., Zitvogel, L., Besse, B., Pasolli, E., et al. (2025) · OncoImmunology · doi:10.1080/2162402x.2025.2528955 · Cited by 8
Metadata
- 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.
- Venue
- Drug and Alcohol Dependence
- Publisher
- Elsevier BV
- Published
- 2019-07
- Volume
- 200
- Pages
- 95-114
- ISSN
- 0376-8716 (ISSN-L)
- PMC
- PMC6639084
- OpenAlex
- W2944251535
- Semantic Scholar
- 4dd8153a9249ac387cb03d106faa14427882aee8
- Cited by
- 479
- References
- 331
- 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
- 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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