US benzodiazepine dispensing fell 27% in a decade

Design

Repeated cross-sectional analysis of national prescription data

Population

1,100,233,787 US benzodiazepine fills, 2013 to 2024

Primary outcome

Annual prevalence of benzodiazepine dispensing

Effect

7.5% to 5.5% (relative -26.7%); ages 18 to 29 -44.8%

A repeated cross-sectional analysis in the American Journal of Psychiatry (30 September) used a national US prescription database covering 1.1 billion benzodiazepine fills from 2013 to 2024. The share of the population dispensed a benzodiazepine each year fell from 7.5% to 5.5%, a relative drop of 26.7%. The steepest fall was in young adults aged 18 to 29 (-44.8%).

Primary care physicians still wrote the most prescriptions, but their volume fell 44.3%, psychiatrists' by 38.3% and pain specialists' by 62.5%. Prescriptions from advanced practice providers, by contrast, roughly doubled (+101.5%). The mean total dose per prescription fell across every age group and prescriber type.

The decline fits the FDA's 2020 boxed warning on misuse and dependence and wider caution about combining benzodiazepines with opioids, though a dispensing study cannot prove cause. For prescribers, the message is that shorter, smaller supplies are now the norm, and the growth in prescribing by non-physician clinicians is where review and support are most needed.

• Prescribe benzodiazepines for the shortest period and smallest supply that meets the clinical need.
• Review every long-term benzodiazepine prescription at least yearly for continued indication and dose.
• Check for concurrent opioids, gabapentinoids or alcohol before starting or renewing a benzodiazepine.
• Support nurse practitioners and other non-physician prescribers in your service with clear benzodiazepine prescribing guidance.
• Offer an evidence-based alternative, such as an SSRI or CBT, for anxiety disorders before reaching for a benzodiazepine.

Why it matters

Prescribing is shifting towards clinicians who have had the least benzodiazepine stewardship focus, even as overall use falls.

Don't overread it

Dispensing data show what was filled, not whether prescribing was appropriate or patients were harmed.

The statistics, in plain English

A fall from 7.5% to 5.5% of the population is a 2 percentage-point absolute drop, which is 26.7% in relative terms. The 101.5% rise among advanced practice providers means their prescription volume about doubled, but from a smaller base.

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