A recent comprehensive study conducted by researchers at Columbia University Mailman School of Public Health and Columbia University Irving Medical Center reveals a significant decline in benzodiazepine prescriptions among U.S. adults over a five-year period from 2018 to 2022. This reduction is particularly notable among adults aged 56 and older, signaling possible shifts in clinical practices and growing awareness regarding the risks associated with these medications. Despite this encouraging trend, the study raises concerns about the prevalent co-prescribing of benzodiazepines with other central nervous system (CNS) depressants, including opioids, which could amplify adverse effects and complicate patient outcomes.
Benzodiazepines, a class of psychoactive drugs commonly prescribed for conditions such as anxiety, insomnia, and seizures, have been under scrutiny due to their potential for dependence, withdrawal syndromes, and a range of safety risks including falls, cognitive impairments, and overdose. Dr. Mark Olfson, a professor of Epidemiology and Psychiatry at Columbia University, emphasized the complexity physicians face in balancing therapeutic benefits against these considerable hazards, especially as patients advance in age. The heightened sensitivity of older adults to sedative effects underscores the critical need for cautious prescribing.
In clinical practice, the American Geriatrics Society explicitly advises minimizing benzodiazepine use in older adults, particularly when combined with opioids or other CNS depressants. This caution stems from historical data indicating a tripling of office-based visits involving co-prescriptions of these medications between 1990 and 2016. Such combinations significantly escalate the risk for dangerous drug–drug interactions, leading to adverse events that compromise patient safety. Olfson and colleagues underscore that the persistence of such prescribing patterns today highlights ongoing challenges in clinical risk management.
To acquire these insights, the research team analyzed data from the Medical Expenditure Panel Survey (MEPS), encompassing responses from over 104,000 adults representing the civilian, noninstitutionalized U.S. population. This dataset enabled the examination of age-specific trends in benzodiazepine usage alongside concurrent administration of other CNS depressants. The robustness of this nationally representative survey adds weight to the findings and reflects real-world prescribing trends across diverse demographics.
The analysis revealed a decline in annual benzodiazepine use from 4.7% among adults in 2018 to just 3.4% in 2022. The largest decline occurred in adults aged 56 and above, who saw usage rates drop from 7.0% to 4.7%. Comparatively, adults between 36 and 55 years experienced a smaller decrease from 4.4% to 3.4%, while the youngest adult cohort (18–35 years) showed minimal change, with rates moving from 2.1% to 1.8%. These patterns suggest an age-related responsiveness to changing prescribing guidelines and heightened provider vigilance targeting older populations.
Despite the overall reduction in benzodiazepine treatment, the study found that co-prescription with other CNS depressants remains alarmingly common. Approximately 41.6% of benzodiazepine users concurrently received another CNS depressant within the same year, intensifying the risk profile. Adults aged 36 to 55 exhibited the highest rates of co-prescribing at 44.6%, closely followed by the group aged 56 and older at 43%. Younger adults were less likely to be co-prescribed additional CNS sedatives, with only 30% in this category. These figures highlight significant overlap and possible polypharmacy concerns within mid-to-late adult populations.
The research further delved into clinical subpopulations to identify which patients are most frequently exposed to these drug combinations. Notably, among adults in fair or poor general health, 72% of benzodiazepine users also received another CNS depressant, markedly elevating their risk for negative health outcomes. Similarly, patients experiencing serious psychological distress had a 63% co-prescription rate. These findings underscore the challenges clinicians face in treating complex, comorbid conditions while avoiding harmful medication interactions.
Given these patterns, Dr. Olfson stresses the urgent need for clinicians to conduct thorough medication reconciliations before initiating benzodiazepine therapy. This comprehensive review should include all prescribed and over-the-counter medications to detect possible CNS depressant overlaps that could exacerbate sedation, respiratory depression, and cognitive decline. Careful patient monitoring and consideration of non-pharmacologic alternatives where appropriate are critical steps in mitigating risk.
The study’s collaboration extended beyond Columbia University, involving experts from the Agency for Healthcare Research and Quality and the National Institute on Drug Abuse, including Chandler McClellan, Samuel Zuvekas, and Carlos Blanco. Their collective expertise bolsters the methodological rigor and multidisciplinary approach to understanding national-scale prescribing trends and implications for public health.
While the downward trend in benzodiazepine prescribing is a promising development, the persistent high rates of co-prescription with other CNS depressants signal an ongoing public health concern. This complex prescribing environment demands enhanced provider education, patient engagement, and implementation of clinical guidelines that prioritize safety without compromising access to necessary psychiatric and neurological care.
In conclusion, this landmark study offers valuable insights into evolving patterns of benzodiazepine use across adult age groups in the United States. It highlights the dual narrative of progress and persistent challenge: reductions in use signify improved risk awareness, while prevalent co-prescribing underscores the intricacies of managing polypharmacy in vulnerable populations. Moving forward, intensified efforts are essential to optimize pharmacotherapy, balancing efficacy with safety to protect the well-being of adults confronting mental health and chronic medical conditions.
Subject of Research: Trends and patterns in benzodiazepine prescribing and co-prescription with central nervous system depressants among U.S. adults
Article Title: Trends in Benzodiazepine Prescribing to Adults in the United States: Results From the Medical Expenditure Panel Survey
News Publication Date: February 25, 2026
Web References:
Journal of Clinical Psychiatry DOI 10.4088/JCP.25m16125
Columbia University Mailman School of Public Health
Keywords: benzodiazepines, CNS depressants, opioids, polypharmacy, aging, drug interactions, mental health, epidemiology, public health, prescription trends, patient safety, comorbidities
