Benzodiazepines are frequently prescribed to patients suffering from anxiety, nervousness or sleep problems. In 2007, over 10 million prescriptions of benzodiazepines for 1.8 million individuals were issued in the Netherlands. The general practitioner (GP) is responsible for most of these prescriptions
Although it is generally recommended to use benzodiazepines for only a brief period, a substantial proportion of patients become long-term chronic users of this medication
. Long-term use carries the risk of dependence, cognitive impairment, accidents and falls, especially in the elderly
. In the Dutch population, this long-term use of benzodiazepines has remained persistent over the years (1992–2002) despite efforts to reduce its use and renewal of the guidelines
. Even attempts by community pharmacies in collaboration with GPs to substantially reduce the long-term use of benzodiazepines failed to succeed
In the Netherlands, in an attempt to impose a reduction in benzodiazepine use, health care insurance reimbursement of this medication was stopped on January 1st 2009. Although this regulation was primarily implemented to reduce or prevent the long-term use and addictive effects of this medication, it also served to diminish the costs involved in supplying this medication. However, apart from long-term users, also first and short-term users were affected by this regulation.
Not all patients were deprived of reimbursement for this medication. The administration of benzodiazepines remained funded for individuals who are dependent on this medication in the absence of an adequate alternative. This applies to patients that use benzodiazepines to curtail epileptic seizures, to individuals with anxiety disorders in which at least two anti-depressants fail to ameliorate symptoms, and to patients with multiple psychiatric conditions that necessitate the administration of high doses of benzodiazepines. Finally, palliative sedation used in terminal care is also exempted from this regulation, as are patients that require diazepam medication for muscular spasms resulting from neurological disorders.
In preparing for implementation of this regulation, physicians and pharmacists were asked to inform their patients that reimbursement of this medication would be terminated in 2009 and that those who continue to use benzodiazepines would bear the costs of purchasing the medication. Physicians were encouraged to discuss discontinuation with their patients as a viable option and offer suitable alternatives. Discontinuation of this medication would then best be carried out gradually in close collaboration with the physician and pharmacist.
This reimbursement restriction has led to a moderate decrease in the number of incident diagnoses and initiation of benzodiazepine use in patients with newly diagnosed anxiety or sleeping disorders in 2009
. However, whether the overall use (prevalence) has changed over a longer period remains unknown.
In the present study, we investigated whether benzodiazepine use changed after termination of the reimbursement of the medication. The number of quarterly accumulated prescription days for each benzodiazepine user was compared between the 2007/2008 and 2009/2010 periods. Prescription days were defined as the number of days that benzodiazepines were prescribed during each trimester.
We anticipated a reduction in prescription days during 2009 and 2010. In order to explore which type of user experienced the most change, the users were categorized into initial, short-term and long-term users. We hypothesized that long-term users would show the most change.