title: Declining benzodiazepine use in veterans with posttraumatic stress disorder.
abstract: OBJECTIVE
  Clinical practice guidelines issued by the US Department of Veterans Affairs (VA) and the Department of Defense caution against benzodiazepine use among veterans with posttraumatic stress disorder (PTSD) because of insufficient evidence for efficacy and emerging safety concerns. We examined recent trends in benzodiazepine prescribing among veterans with PTSD in terms of frequency of use, duration of use, and dose.
  
  
  METHODS
  Administrative VA data from fiscal years 1999 through 2009 were used to identify veterans with PTSD according to ICD-9 codes extracted from inpatient discharges and outpatient encounters. Benzodiazepine use among these individuals was determined for each fiscal year by using prescription drug files. Modal daily doses were examined by using standard daily dosage units.
  
  
  RESULTS
  The number of veterans receiving care for PTSD in the VA increased from 170,685 in 1999 to 498,081 in 2009. The proportion of individuals receiving a benzodiazepine decreased during this time period from 36.7% to 30.6%. In addition, the proportion of long-term users (> 90 days) decreased from 69.2% to 64.1%, and daily dose decreased from 2.1 to 1.8 standard daily dosage units.
  
  
  CONCLUSIONS
  Decreasing benzodiazepine use among veterans with PTSD is encouraging. However, the frequency of use remains above 30%, and focused interventions may be required to achieve further reductions. Given the growing number of veterans being diagnosed and treated for PTSD, minimizing benzodiazepine exposure will remain a vital policy issue for the VA.
authors.affiliation: Center for Comprehensive Access and Delivery Research and Evaluation, Veterans Affairs Medical Center, Iowa City, IA 52246, USA. Brian.Lund@va.gov
authors.forename: Brian C
authors.initials: BC
authors.lastname: Lund
authors.forename: Nancy C
authors.initials: NC
authors.lastname: Bernardy
authors.forename: Bruce
authors.initials: B
authors.lastname: Alexander
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Friedman
mesh_terms: D001569:Benzodiazepines / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D016208:Databases, Factual / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data / Q000639:trends*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013313:Stress Disorders, Post-Traumatic / Q000188:drug therapy* / Q000523:psychology; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data; D014728:Veterans / Q000523:psychology*
chemical_list: D001569:Benzodiazepines