Psy-Q: Among which group has benzodiazepine prescribing declined the most: those enrolled in Medicare, commercial insurance, or the VA?

Donovan Maust, MD

Donovan Maust, MD

Answer: The VA showed the greatest decline in prescribing benzodiazepines (BZDs) during the period of 2013-2017, according to a new report by Maust et al published in the Journal of the American Geriatrics Society. Using prescribing data from Medicare, commercial insurance, and the VA, the authors found that BZD prescribing as well as BZD and opioid co-prescribing for older adults declined the most at the VA.

Psycom Pro discussed professional takeaways of the study with lead author Donovan Maust, MD, MS, an associate professor of psychiatry and associate director of the Geriatric Psychiatry Program at the University of Michigan. Dr. Maust also serves as a research scientist for the Center for Clinical Management Research at the VA Ann Arbor Healthcare System.

Psycom Pro: Why is it important to talk about reducing benzodiazepine prescribing in older adults?

Dr. Maust: We’ve known since some studies in the late 1980s that they are associated with an increased risk of fall-related injury in older adults and basically since then evidence of additional potential harms has accumulated. One particular concern is the increased risk of respiratory suppression and death when they are co-prescribed with opioids, which is common since many older adults have pain.

Also, benzodiazepines have an impact on cognition, which is obviously a concern for many older adults – and one that most clinicians would not want to actually worsen. For some people, benzodiazepines certainly are an appropriate part of their treatment – but on balance, given what is known about risks, the prevalence is probably higher than it should be.

Psycom Pro: Your study concludes that the declines in BZD prescribing in the VA could serve as an example to other systems that may learn from the VA’s strategies. How can non-VA clinicians use the lessons learned from the VA and apply them to their own practice?

Dr. Maust: I think there are probably a couple of key features at the VA that allow deprescribing. First, older adults in the VA have much better access to mental health providers, including psychiatrists, psychologists, and social workers – so they also then have better access to a variety of alternative treatment options. There is also better access to clinical pharmacists, who can help with the tapering process in a variety of different ways.

You might say that “it takes a village” to help deprescribe BZDs – for clinicians to successfully do this, they need help. Simply asking (or telling) clinicians to reduce use is unlikely to be successful and will leave both clinicians and their patients unhappy.

Psycom Pro: What else can prescribers take away from this study and apply to their practice?

Dr. Maust: That reducing the amount of BZD prescribing really is possible. I think there can be a lot of inertia, but the VA has demonstrated that, with concerted effort, prescribing to older patients can move into a more reasonable place.

 

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Last Updated: May 7, 2021