title: A controlled study of the effects of state surveillance on indicators of problematic and non-problematic benzodiazepine use in a Medicaid population.
abstract: OBJECTIVE
  Benzodiazepines (BZs) are safe, effective drugs for treating anxiety, sleep, bipolar, and convulsive disorders, but concern is often expressed about their overuse and potential for abuse. We evaluated the effects of physician surveillance through a Triplicate Prescription Program (TPP) on problematic and non-problematic BZ use.
  
  
  METHODS
  This study uses interrupted time series analyses of BZ use in the New York (intervention) and New Jersey (control) Medicaid programs for 12 months before and 24 months after the New York BZ TPP. The regulation required NY physicians to order BZs on triplicate prescription forms with one copy forwarded by pharmacies to a state surveillance unit. Study participants were community-dwelling persons over age 18 continuously enrolled between January 1988 and December 1990 in New York (n = 125,837) or New Jersey Medicaid (n = 139,405).
  
  
  RESULTS
  During the baseline year, 20.2% of New York and 19.3% of New Jersey cohort members received at least one BZ prescription. After the TPP, there was a sudden, sustained reduction in BZ use of 54.8% (95% CI = [51.4%, 58.3%]) in New York with no changes in New Jersey. Significantly greater reductions were experienced by young women, and persons living in zip codes that were urban, predominantly Black, or with a high density of poor households. Increases in potential substitute medications were modest. At baseline, nearly 60% of BZ recipients had no evidence of potentially problematic use. Despite a somewhat greater likelihood of discontinuation of BZ therapy among those with potentially problematic use, the largest impact of the TPP was a substantially greater relative reduction in access to BZs among non-problematic users.
  
  
  CONCLUSIONS
  State-mandated physician surveillance dramatically reduces BZ use with limited substitution of alternative drugs, lowers rates of possible abuse, but may severely limit non-problematic BZ use.
authors.affiliation: Harvard Medical School and Harvard Pilgrim Health Care, Boston, MA 02215, USA.
authors.forename: Dennis
authors.initials: D
authors.lastname: Ross-Degnan
authors.forename: Linda
authors.initials: L
authors.lastname: Simoni-Wastila
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Brown
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Gao
authors.forename: Connie
authors.initials: C
authors.lastname: Mah
authors.forename: Leon E
authors.initials: LE
authors.lastname: Cosler
authors.forename: Thomas
authors.initials: T
authors.lastname: Fanning
authors.forename: Peter
authors.initials: P
authors.lastname: Gallagher
authors.forename: Carl
authors.initials: C
authors.lastname: Salzman
authors.forename: Richard I
authors.initials: RI
authors.lastname: Shader
authors.forename: Thomas S
authors.initials: TS
authors.lastname: Inui
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Soumerai
mesh_terms: D000328:Adult; D000368:Aged; D014151:Anti-Anxiety Agents / Q000009:adverse effects / Q000627:therapeutic use; D001569:Benzodiazepines / Q000009:adverse effects / Q000627:therapeutic use; D015331:Cohort Studies; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D004363:Drug Utilization / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008484:Medicaid / Q000331:legislation & jurisprudence*; D008875:Middle Aged; D009515:New Jersey; D009518:New York; D010818:Practice Patterns, Physicians' / Q000331:legislation & jurisprudence*; D015397:Program Evaluation; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000517:prevention & control
chemical_list: D014151:Anti-Anxiety Agents; D001569:Benzodiazepines