Drug and Alcohol Dependence 124 (2012) 154–161 Contents lists available at SciVerse ScienceDirect Drug and Alcohol Dependence j ourna l ho me pag e: www.elsevier.com/locate/drugalcdep Prevalence and trends of benzodiazepine use among Veterans Affairs patients with posttraumatic stress disorder, 2003–2010 Eric J. Hawkins a,b,d,* , Carol A. Malte a,b , Zac E. Imel e , Andrew J. Saxon b,c , Daniel R. Kivlahan a,b,d a Health Services Research and Development, VA Puget Sound Health Care System, Seattle, WA, United States b Center of Excellence in Substance Abuse Treatment and Education, VA Puget Sound Health Care System, Seattle, WA, United States c Department of Psychology, University of Washington, Seattle, WA, United States d Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States e Department of Educational Psychology, University of Utah, Salt Lake City, UT, United States a r t i c l e i n f o Article history: Received 30 September 2011 Received in revised form 4 January 2012 Accepted 7 January 2012 Available online 2 February 2012 Keywords: Trends in benzodiazepine use Posttraumatic stress disorder Opioid analgesics use a b s t r a c t Background: Although the Veterans Affairs and Department of Defense (VA/DoD) clinical guidelines for management of posttraumatic stress disorder (PTSD) recommend against routine benzodiazepine use, little is known about the trends and clinical and prescription profiles of benzodiazepine use since these guidelines were released in 2004. Methods: This retrospective study included 64,872 patients with a PTSD diagnosis received from care at facilities in VA Northwest Veterans Integrated Service Network (VISN 20) during 2003–2010. Annual prevalence of any use was defined as any prescription for benzodiazepines, and long-term use was defined as >90 days’ supply, in a year. Gender-specific logistic regressions were fit to estimate any and long-term benzodiazepine use, test for linear trends over 8-years and explore factors associated with trends. Results: The trend of age-adjusted benzodiazepine use over 8-years rose significantly from 25.0 to 26.8% among men and 31.2 to 38.8% among women. Long-term use in men and women increased from 15.4 to 16.4% and 18.0 to 22.7%, respectively. Comorbid psychiatric and alcohol use disorders (AUD) were associated with a greater increase in long-term use of benzodiazepines. In 2010, 61% of benzodiazepine users received >90 days’ supply. Among those prescribed benzodiazepines long-term, 11% had AUD and 47% were also prescribed opioids long-term. Conclusion: Despite VA/DoD clinical guidelines recommending against routine use of benzodiazepines for PTSD, the adjusted prevalence of long-term use increased among men and women with PTSD in VISN 20. Widespread concomitant use of benzodiazepines and opioids suggests risk management systems and research on the efficacy and safety of these medications are needed. Published by Elsevier Ireland Ltd. 1. Introduction Posttraumatic stress disorder (PTSD) is one of the most common mental health conditions among patients in the Veterans Affairs (VA) health care system and is associated with significant morbid- ity (Jacobsen et al., 2001; Keane and Kaloupek, 1997) and mortality (Boscarino, 2006). Approximately 41% of all VA patients and 52% of those from Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) with a mental health disorder have a documented PTSD diagnosis (Petrakis et al., 2011). Several clinical guidelines (American Psychiatric Association, 2004; Baldwin et al., 2005), including the current VA/Department of * Corresponding author at: VA Puget Sound Health Care System – Seattle Division (S116ATC), 1660 S. Columbian Way, Seattle, WA 98108, United States. Tel.: +1 206 764 2743; fax: +1 206 764 2293. E-mail addresses: Eric.Hawkins@va.gov, emhawkins 9@msn.com (E.J. Hawkins). Defense (DoD) clinical guideline, recommend behavioral therapies and selective serotonin reuptake inhibitors (SSRIs) for treatment of PTSD and caution against routine use of benzodiazepines to manage PTSD symptoms, citing risks associated with their use and lack of evidence supporting improvements in PTSD symptoms (The Management of Post-Traumatic Stress Working Group, 2010; Stein et al., 2006). Despite these recommendations benzodiazepines are commonly prescribed (31% in fiscal year 2009; Lund et al., 2011) among VA patients diagnosed with PTSD (Mohamed and Rosenheck, 2008). Specific clinical indications for benzodiazepine use among patients with PTSD are unknown, but benzodiazepines have a quick onset and provide rapid relief of anxiety (Hoffman and Mathew, 2008) and insomnia (Riemann and Perlis, 2009), symp- toms common in patients with PTSD. There are several contraindications and potential risks asso- ciated with routine benzodiazepine use in patients with PTSD. Administration of benzodiazepines in patients with early posttrau- matic stress symptoms may be associated with the development of 0376-8716/$ – see front matter. Published by Elsevier Ireland Ltd. doi:10.1016/j.drugalcdep.2012.01.003