title: Long-term use of benzodiazepines: Definitions, prevalence and usage patterns - a systematic review of register-based studies.
abstract: BACKGROUND
  Numerous treatment guidelines recommend that long-term use of benzodiazepines (BZD) should be avoided primarily due to development of tolerance and a risk for BZD dependence. Despite this, long-term BZD use remains a controversial subject in clinical patient care with "for and against" debates. However, there is no explicit understanding of what is meant by long-term BZD use in real world. The aim of this study was to assess different definitions, usage patterns, prevalence and other characteristics of long-term BZD use based on published register-based studies. Synthesis of these characteristics is essential to derive a meaningful definition of long-term BZD.
  
  
  METHODS
  Systematic review of register-based studies on long-term BZD use published in 1994-2014.
  
  
  RESULTS
  Fourty-one studies met our predetermined inclusion criteria. The length of BZD use defined as "long-term" varied in these studies ranging from one month to several years. The most common definition was six months or longer during a year. The prevalence of long-term BZD use in the general population was estimated to be about 3%. The relative proportion of long-term BZD users (all definitions) in adult BZD users ranged from 6% to 76% (mean 24%; 95% CL 13-36%). The estimates were higher in studies only on the elderly (47%; 95% CL 31-64%). Long-term use involved typically steady treatment with low BZD doses. However, in elderly patients long-term BZD use and exceeding recommended doses was relatively common. Several characteristics associated with long-term use were found.
  
  
  CONCLUSIONS
  Long-term BZD use is common and a clinical reality. Uniform definitions for "long-term", which is in line with population-based evidence, is needed to have more comparable results between studies. Our systematic review suggests that duration of BZD treatment over six months, the most common definition for long-term BZD use in the included studies. As also recommended previously, it is a useful starting point for further analyses on disadvantages but also potential advantages associated with long-term BZD use.
authors.affiliation: Department of Psychiatry, University of Turku, Turku University Central Hospital and Turku Psychiatry, Kiinamyllynkatu 4-8 (Building 11B), 20521 Turku, Finland; Clinical Pharmacy Group, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5, 00014 Helsinki, Finland. Electronic address: terhi.a.kurko@helsinki.fi.
authors.forename: T A T
authors.initials: TA
authors.lastname: Kurko
authors.affiliation: Research Department, Social Insurance Institution, Nordenskiöldinkatu 12, Helsinki, Finland.
authors.forename: L K
authors.initials: LK
authors.lastname: Saastamoinen
authors.affiliation: Clinical Pharmacy Group, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5, 00014 Helsinki, Finland.
authors.forename: S
authors.initials: S
authors.lastname: Tähkäpää
authors.affiliation: Research Department, Social Insurance Institution, Nordenskiöldinkatu 12, Helsinki, Finland.
authors.forename: A
authors.initials: A
authors.lastname: Tuulio-Henriksson
authors.affiliation: Department of Psychiatry, University of Turku, Turku University Central Hospital and Turku Psychiatry, Kiinamyllynkatu 4-8 (Building 11B), 20521 Turku, Finland.
authors.forename: T
authors.initials: T
authors.lastname: Taiminen
authors.affiliation: Department of Clinical Neuroscience, Karolinska Institutet, Karolinska Universitetssjukhuset Solna, 17176 Stockholm, Sweden; Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland.
authors.forename: J
authors.initials: J
authors.lastname: Tiihonen
authors.affiliation: Clinical Pharmacy Group, Faculty of Pharmacy, University of Helsinki, Viikinkaari 5, 00014 Helsinki, Finland.
authors.forename: M S
authors.initials: MS
authors.lastname: Airaksinen
authors.affiliation: Department of Psychiatry, University of Turku, Turku University Central Hospital and Turku Psychiatry, Kiinamyllynkatu 4-8 (Building 11B), 20521 Turku, Finland.
authors.forename: J
authors.initials: J
authors.lastname: Hietala
mesh_terms: D000367:Age Factors; D014151:Anti-Anxiety Agents / Q000009:adverse effects / Q000627:therapeutic use; D001569:Benzodiazepines / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D000069451:Long Term Adverse Effects / Q000209:etiology / Q000517:prevention & control; D054539:Medication Therapy Management; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015995:Prevalence; D019966:Substance-Related Disorders / Q000209:etiology / Q000517:prevention & control*
chemical_list: D014151:Anti-Anxiety Agents; D001569:Benzodiazepines
keywords: Anxiolytics; Benzodiazepines; Hypnotics; Long-term; Systematic review; Use