Chronic hypnotic use at 10 years-does the brand matter?

PURPOSE: Chronic use of sedative-hypnotics is very common, although not guideline-endorsed. The incidence among new users is not well studied, and there are currently no recommendations favoring any specific agent. We quantified the risk for chronic use in first-time hypnotic users, and the association of the initial choice of hypnotic with later usage patterns.

METHODS

We used the computerized database of Israel's largest healthcare provider. All 236,597 new users of sedative-hypnotics between the years 2000-2005 were followed for 10 years. Filled prescriptions in the second, fifth, and tenth years were recorded. The association of the first hypnotic choice (benzodiazepine/Z-drug) with chronic consumption was assessed using multivariate logistic regression.

RESULTS

Average age on first use was 63.7 (SD ± 16.4) years. 58.6% were women. Benzodiazepines were initiated in 154,929 (65.5%) of the cases. Benzodiazepine users were older and of lower socioeconomic status, compared to Z-drug users (p < 0.001). On the tenth year, 103,912 (66.8%) of new users claimed ≤ 30 DDDs of hypnotics, 3,1724 (20.4%) were long-term users (≥ 180 DDD/year), and 828 (0.5%) used excessively (≥ 720 DDD/year). Z-drugs were associated with an increased risk of long-term use on the second year [17.3% vs. 12.4%, RR = 1.40 (1.37-1.43)] as well as on the fifth [21.9% vs. 13.9%, RR = 1.58 (1.55-1.61)] and tenth year [25.1% vs. 17.7%, RR = 1.42 (1.39-1.45)], p < 0.0001. Similar results were also observed for daily and excessive use (p < 0.001).

CONCLUSIONS

One in five new users of sedative-hypnotics will become a long-term user, but only 0.5% will become excessive users. Z-drugs were associated with an increased risk of chronic use.