What is the prevalence of long‑term benzodiazepine use among adults in the United States?

Prevalence of Long-Term Benzodiazepine Use in the United States

Approximately 3% of the adult U.S. population uses benzodiazepines long-term (≥120 days), with rates increasing dramatically with age—from 2.6% in young adults (18-35 years) to 8.7% in older adults (65-80 years). 1

Overall Benzodiazepine Use Patterns

• In 2008, approximately 5.2% of U.S. adults aged 18-80 years filled at least one benzodiazepine prescription during the year 1
• Women use benzodiazepines nearly twice as frequently as men across all age groups 1
• Between April 2017 and March 2018 in England (comparable Western healthcare system), 3.1% of adults received benzodiazepine prescriptions, with 50.4% of those users receiving continuous prescriptions for at least 12 months 2

Age-Specific Prevalence Data

Young Adults (18-35 years)

• 2.6% receive benzodiazepine prescriptions annually 1
• Of those who receive benzodiazepines, only 14.7% progress to long-term use (≥120 days) 1
• 15.0% receive prescriptions from psychiatrists 1

Middle-Aged Adults (36-50 years)

• 5.4% receive benzodiazepine prescriptions annually 1
• Long-term use accounts for a higher proportion compared to younger adults 1

Older Middle-Aged Adults (51-64 years)

• 7.4% receive benzodiazepine prescriptions annually 1
• The proportion using benzodiazepines long-term continues to increase 1

Older Adults (65-80 years)

• 8.7% receive benzodiazepine prescriptions annually, representing the highest prevalence of any age group 1
• 31.4% of older adult benzodiazepine users progress to long-term use (≥120 days), more than double the rate in young adults 1
• Only 5.7% receive prescriptions from psychiatrists, indicating most prescribing occurs in primary care 1
• The population-based visit rate reaches 463.7 per 1,000 persons aged 80 and older 3

Long-Term Use Characteristics

Definition Variability

• The most common research definition for "long-term" benzodiazepine use is ≥6 months of use during a year 4
• Definitions in published studies range from one month to several years, creating challenges in comparing prevalence estimates 4
• The proportion of all benzodiazepine users who are long-term users ranges from 6% to 76% across studies (mean 24%), with higher estimates (47%) in studies focusing exclusively on elderly populations 4

Clinical Context of Long-Term Use

• Only 16.0% of older adults on continuation benzodiazepine therapy have any documented mental health diagnosis 3
• Fewer than 1% of benzodiazepine users are provided or referred to psychotherapy 3
• 10.0% of benzodiazepine users are also prescribed opioids concurrently, creating dangerous polypharmacy 3
• Long-term use typically involves steady treatment with low doses, though elderly patients more commonly exceed recommended doses 4

Continuation Patterns

• Among older adults aged 80 and older, 90.2% of benzodiazepine visits represent continuation prescriptions rather than new starts 3
• The proportion of continuation visits (versus new prescriptions) increases steadily with age 3
• From 2015-16 to 2017-18 in England, benzodiazepine prescriptions decreased by 5.1%, suggesting some reduction efforts, but long-term use remained stable at approximately 50% of all users 2

Geographic and Socioeconomic Patterns

• In England, benzodiazepine prescribing showed slightly decreased rates in areas of higher deprivation, contrasting with antidepressants and opioids which increased with deprivation 2
• The highest prescribing rates for benzodiazepines were concentrated in southwest, southeast, and east England, with markedly lower rates in northern regions 2

Critical Context

Despite decades of evidence documenting safety concerns—including falls, fractures, cognitive impairment, and dependence—and clinical guidelines recommending against long-term use, approximately 1 in 3 older adults who start benzodiazepines continue them long-term. 1, 3 This represents a significant gap between evidence-based recommendations and real-world prescribing practices, particularly concerning given that most long-term users lack documented mental health diagnoses and receive virtually no psychotherapy 3.