- Design
- Population-level observational study of national prescribing and adverse reaction data
- Population
- Primary care prescribing of 14 benzodiazepines in England, 2020–2025
- Primary outcome
- Prescribing trends, costs and reported adverse reaction fatality ratios
- Effect
- Prescribing −4.3% per year (−4.5 to −4.0); fatality ratio 4.5 per 100 reports overall
This population-level study analysed national prescribing, cost and adverse reaction data for 14 benzodiazepines in England from 2020 to 2025.
Prescribing fell from about 15,560 to 12,280 items per 100,000 people, a mean fall of 4.3% a year, driven by diazepam, temazepam and chlordiazepoxide. Clobazam, mainly a specialist antiseizure drug, rose by about 6% a year. Ethnicity shaped how deprivation related to prescribing. Among spontaneous adverse reaction reports, the fatality ratio averaged 4.5 deaths per 100 reports, highest for oxazepam (17.9), lorazepam (9.1) and alprazolam (8.6).
The trend shows sustained deprescribing can work at scale. The fatality ratios come from spontaneous reports and reflect what was reported, not the risk per prescription, so they cannot rank the drugs' true lethality. In India, where alprazolam and clonazepam are widely prescribed and available, the deprescribing message applies at least as strongly.
- Review every long-term benzodiazepine prescription for a planned, gradual taper.
- Avoid starting benzodiazepines for chronic insomnia or anxiety where alternatives exist.
- Treat the high fatality ratios for oxazepam, lorazepam and alprazolam as a signal to be cautious, not a ranking of risk.
- Warn about combining benzodiazepines with opioids, alcohol or gabapentinoids.
Why it matters
It shows national deprescribing can reduce use steadily without a single dramatic intervention.
Don't overread it
Fatality ratios from spontaneous reports do not measure risk per prescription.
The statistics, in plain English
A fatality ratio is the share of reported adverse reactions that ended in death. It depends on what gets reported — serious events are reported more — so it is useful for spotting signals, not for comparing how dangerous each drug is.
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