Increasing Benzodiazepine Prescriptions and Overdose Mortality in the United States, 1996–2013


Increasing Benzodiazepine Prescriptions and Overdose Mortality in the United States, 1996–2013


Marcus A. Bachhuber, MD, MSHP, Sean Hennessy, PharmD, PhD, Chinazo O. Cunningham, MD, MS, and Joanna L. Starrels, MD, MS

Marcus A. Bachhuber, Chinazo O. Cunningham, and Joanna L. Starrels are with Division of General Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY. Sean Hennessy is with Center for Clinical Epidemiology and Biostatistics and Center for Pharmacoepidemiology Research and  Training, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.


Correspondence should be sent to Marcus A. Bachhuber, MD, MSHP, 111 E 210 St, Bronx, NY 10467 (e-mail: ). Reprints can be ordered at by clicking the “Reprints” link.




All authors acquired, analyzed, or interpreted the data and critically revised the brief for important intellectual content. M. A. Bachhuber drafted the brief and had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. M. A. Bachhuber and S. Hennessy conceptualized and designed the study and performed statistical analysis. S. Hennessy, C. O. Cunningham, and J. L. Starrels supervised the study.




Objectives. To describe trends in benzodiazepine prescriptions and overdose mortality involving benzodiazepines among US adults.

Methods. We examined data from the Medical Expenditure Panel Survey and multiple-cause-of-death data from the Centers for Disease Control and Prevention.
Results. Between 1996 and 2013, the percentage of adults filling a benzodiazepine prescription increased from 4.1% (95% confidence interval [CI] = 3.8%, 4.5%) to 5.6% (95% CI = 5.2%, 6.1%), with an annual percent change of 2.5% (95% CI = 2.1%, 3.0%). The quantity of benzodiazepines filled increased from 1.1 (95% CI = 0.9, 1.2) to 3.6 (95% CI = 3.0, 4.2) kilogram lorazepam equivalents per 100 000 adults (annual percent change = 9.0%; 95% CI = 7.6%, 10.3%). The overdose death rate increased from 0.58 (95% CI = 0.55, 0.62) to 3.07 (95% CI = 2.99, 3.14) per 100 000 adults, with a plateau seen after 2010.

Conclusions. Benzodiazepine prescriptions and overdose mortality have increased considerably. Fatal overdoses involving benzodiazepines have plateaued overall; however, no evidence of decreases was found in any group. Interventions to reduce the use of benzodiazepines or improve their safety are needed. (Am J Public Health. Published online ahead of print February 18, 2016: e1–e3. doi:10.2105/AJPH.2016.303061)