Which Americans Take the Most Sedatives?

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Benzodiazepines (Ativan, Valium, Xanax) are more often prescribed in the South and less often in the West, the Centers for Disease Control and Prevention reports.

Benzodiazepines are a class of prescription drugs prone to abuse, and in 2012 doctors wrote 37.6 benzodiazepine prescriptions per 100 persons in the United States. Remember benzodiazepines come in short-acting forms like Ativan (lorazepam) and Xanax (alprazolam) and longer-acting forms like Klonopin (clonazepam). This issue is important because people in the United States consume opioid pain relievers at a greater rate than any other nation and in one third of deaths from opioids, benzodiazepines are also found in the bloodstream.

Turns out most of these prescriptions are written in the South. The overall prescribing rate for benzodiazepines in the South for 2012 was 43.1 per 100 persons a startling 54% higher than the West’s 27.9 per 100 persons. Like the South, prescribing rates in the Midwest (38.2 per 100) and the Northeast (38.1 per 100) were both above the national rate of 37.6 prescriptions per 100 persons, according to the CDC.

Which states have the highest number of folks getting benzos? West Virginia is the highest in the U.S. at 71.9 prescriptions per 100 persons—almost 4 times more than Hawaii. After West Virginia it was Alabama, Tennessee, and Rhode Island.

Why is this? Factors accounting for the regional variation are unknown. Such wide variations are not due to underlying differences in the health status of the population.

The rates of use of benzodiazepine sedatives showed about three- to five-fold variation from the highest to lowest states. Interestingly, benzodiazepine prescribing rates in the South are similar to the findings of higher prescribing rates for other drugs in the South, including antibiotics and stimulants in children. Regional variation cannot be explained by variation in the prevalence of the conditions treated by these drugs. So there aren’t more patients with generalized anxiety disorder in the South than other areas of the U.S.

High rates of sedative prescriptions might produce worse outcomes for patients. In the case of benzodiazepines this might expose populations to greater risks for overdose and falls and certainly greater potential for abuse and addiction.

What’s up south?

Dr O.

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