- Design
- Population-level observational study of national datasets
- Population
- Benzodiazepine prescribing and adverse reaction reports in England, 2020–2025
- Primary outcome
- Prescribing trends, costs and fatality ratios
- Effect
- Prescribing −4.3% per year (95% CI −4.5 to −4.0); clobazam +6.4% per year
This population-level study used national prescribing, cost and adverse drug reaction data for 14 benzodiazepines in English primary care.
Total prescribing fell from about 15,560 to 12,280 items per 100,000 population between 2020 and 2025, an average fall of 4.3% a year, driven by diazepam, temazepam and chlordiazepoxide. Specialist agents moved the other way: clobazam rose about 6% a year. Prescribing patterns varied by ethnicity as well as deprivation. In spontaneous reports, the fatality ratio averaged 4.5 deaths per 100 reported cases, highest for oxazepam (17.9), lorazepam (9.1) and alprazolam (8.6).
Deprescribing policy appears to be working. The fatality ratios come from spontaneous reports, which over-represent serious cases, so they flag drugs to watch rather than measure risk. Alprazolam, often prescribed in India, sits near the top of that list.
- Review every long-term benzodiazepine prescription for a continuing indication.
- Taper gradually when deprescribing; abrupt withdrawal risks seizures.
- Be cautious with alprazolam and lorazepam, which had high reported fatality ratios.
- Check for co-prescribed opioids, gabapentinoids or alcohol use, which compound risk.
- Offer non-drug treatments for insomnia and anxiety before starting a benzodiazepine.
Why it matters
Overall decline can hide rising use of particular agents and persistent inequities.
Don't overread it
Spontaneous-report fatality ratios are not true mortality risks.
The statistics, in plain English
A fatality ratio from spontaneous reports is deaths divided by reported cases, not by people taking the drug. Because serious events are more likely to be reported, these ratios cannot tell you how often a patient will die; they show which drugs feature in fatal reports.
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