Benzodiazepines use in primary care England: Prescribing patterns and adverse consequences.

AIMS: Benzodiazepines (BZDs) are commonly prescribed for anxiety and insomnia but carry risks such as dependence, adverse drug reactions (ADRs) and mortality. Despite deprescribing efforts, the influence of recent prescribing trends, COVID-19 and adverse outcomes on prescribing patterns in England remains uncertain. This study evaluates trends in BZD prescribing, costs, and safety outcomes and explores their socioeconomic associations.

METHODS

This population-level observational study analysed prescribing, cost and ADR data for 14 BZDs using national datasets. Prescribing rates were standardized per 100 000 population, fatality ratios were calculated, and regression models assessed yearly changes by drug, region, and pandemic phase. Socioeconomic influences on prescribing were analysed using a generalized additive model.

RESULTS

Total BZD prescribing decreased from 15562.34 items per 100 000 population in 2020 to 12284.01 in 2025, a mean annual change of -4.3% (95% CI: -4.5% to -4.03%), largely because of reduced prescribing of diazepam, temazepam and chlordiazepoxide. Conversely, specialist-use agents increased, including clobazam (6.36% per year, 95% CI: 0.34% to 12.39%) and midazolam (1.03% per year, 95% CI: -1.30% to 3.37%). Ethnicity influenced deprivation-related prescribing patterns, indicating disparities beyond socioeconomic status. The average lifetime fatality ratio across all BZDs was 4.5 deaths per 100 reported cases, with oxazepam the highest (17.9), followed by lorazepam (9.1) and alprazolam (8.6).

CONCLUSIONS

Benzodiazepine prescribing in England continues to decline, reflecting successful deprescribing policies. However, increasing specialist use, persistent inequities, and drug-specific safety and cost concerns highlight the need for cautious prescribing, enhanced pharmacovigilance and equitable access.