16 Oct 2024 Changes in Sedative Use in British Columbia, Canada from 2012 to 2021: A Drug Utilization Study
Authors: Wade Thompson, Jason D. Kim, Greg Carney, Jessica Otte, Colin Dormuth.
Published: 16 October 2024.
https://link.springer.com/article/10.1007/s11606-024-09065-2
Abstract
Background: Benzodiazepines (BZDs) are sedating drugs and have long been associated with harms. Prescribers may seek alternatives such as Z-drugs, or low-doses of quetiapine, trazodone, or mirtazapine, which have their own safety concerns. Data from up to 2019 in Ontario suggested declining BZD use, offset by increasing quetiapine and trazodone use. As differences in sedative use may exist across provinces, we assessed recent data on sedative use in British Columbia, Canada.
Objective: Our aim was to describe patterns of sedating medication use in British Columbia (BC), Canada from 2012 to 2021.
Methods: We used PharmaNet, a database of medications dispensed from BC community pharmacies. This study was approved by UBC Research Ethics Board (H22-03213). We included BC residents ≥ 13 years old. We excluded persons with schizophrenia or bipolar disorder. Sedating medications included Z drugs (zopiclone, eszopiclone, zolpidem), benzodiazepines (BZDs commonly used for insomnia: temazepam, lorazepam and oxazepam), and low doses of quetiapine (≤ 100 mg/day), trazodone (≤ 100 mg/day), and mirtazapine (≤ 15 mg/day).
We investigated 1) prevalence (calculated monthly): the number of people dispensed the medication that month or who had existing prescription with a duration extending into the month, per 1000 persons; and 2) incidence rate (calculated over 6-month periods): the number of people with a new dispensing event for that medication (and none in the preceding five years) per 1000 person-years.
Individuals could be an incident or prevalent user of multiple medications of interest. We calculated the overall prevalence and incidence combined for all sedatives. We also evaluated prevalence and incidence in the subgroup age ≥ 65 years.
Results: Z drugs had the highest prevalence of use, but prevalence fell from 23 per 1000 persons in early 2012 to 14 per 1000 persons in late 2021. BZD prevalence fell from 17 per 1000 persons to 7.2 per 1000 persons in the same period. In contrast, the prevalence of quetiapine use rose from 5.7 per 1000 persons in early 2012 to 8.7 per 1000 persons in late 2021 and the prevalence of trazodone use rose from 6.8 to 10 per 1000 persons. Overall prevalence of any sedative fell from 53 per 1000 persons in early 2012 to 45 in late 2021. Prevalence patterns were similar in the subgroup of older adults.
New use of BZDs and Z drugs also fell. The incidence rate of BZDs was 21 per 1000 person-years in early 2012 and was 15 per 1000 person-years in late 2021. For Z drugs, the incidence rate fell from 16 to 6.7 per 1000 person-years. Mirtazapine, trazodone, and quetiapine incidence rates increased over the study period. The quetiapine incidence rate rose from 5.3 per 1000 person-years in early 2012 to 6.4 per 1000 person-years in late 2021 while trazodone incidence rate increased from 7.0 to 8.1 per 1000 person-years. The overall incidence of any sedative use fell from 52 per 1000 person-years in early 2012 to 41 in late 2021. Incidence patterns among older adults mirrored the general population.
Citation
Thompson W, Kim JD, Carney G, Otte J, Dormuth C. Changes in Sedative Use in British Columbia, Canada from 2012 to 2021: A Drug Utilization Study. J Gen Intern Med. 2025 Mar; 40(4):980-983. DOI: 10.1007/s11606-024-09065-2. Epub 2024 Oct 16. PMID: 39414735 PMCID: PMC11914706.
No Comments