title: Trends in prescribing of sedative-hypnotic medications in the USA: 1993-2010.
abstract: Non-benzodiazepine receptor agonists (nBZRAs) were developed as an alternative to benzodiazepines (BZDs) to treat insomnia. Little is known about how the introduction of nBZRAs influenced trends in BZD prescribing. We examined BZD and nBZRA prescribing trends from 1993 to 2010.
  
  
  
  We used the National Ambulatory Medical Care Survey to examine 516,118 patient visits between 1993 and 2010. We categorized visits as BZD, nBZRA, or BZD + nBZRA visits based on medications prescribed in each visit and applied linear probability regression models to assess trends in visits.
  
  
  
  Increases were observed in proportions of visits that were BZD (2.6% in 1993 to 4.4% in 2010, p < 0.001) and nBZRA (0% to 1.4%, p < 0.001). Increases in BZD visits were primarily after 2002, with prescribing in the preceding years remaining relatively stable. We also found increases in BZD + nBZRA visits (0% to 0.4%, p < 0.001). Among patients with sleep disorders, there was an increase in nBZRA visits (2.3% to 13.7%, p < 0.001), and decline in BZD visits (23.5% to 10.8%, p = 0.015). Just under a third (30.8%) of any sedative-hypnotic visits were for adults aged 65+ years, among whom increases in BZD, nBZRA, and BZD + nBZRA visits were observed across the study period.
  
  
  
  There were increases in prescribing of nBZRAs between 1993 and 2010. Increases in prescribing of BZDs were also observed, especially after 2002. The introduction of nBZRAs likely resulted in declines in BZD prescribing among those with a sleep disorder, but not other groups. Delivery of behavioral treatments should be encouraged to avert adverse outcomes associated with sedative-hypnotic use. Copyright © 2015 John Wiley & Sons, Ltd.
authors.affiliation: Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.|Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.|Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA.
authors.forename: Christopher N
authors.initials: CN
authors.lastname: Kaufmann
authors.affiliation: Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Adam P
authors.initials: AP
authors.lastname: Spira
authors.affiliation: Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.|Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: G Caleb
authors.initials: GC
authors.lastname: Alexander
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Lainie
authors.initials: L
authors.lastname: Rutkow
authors.affiliation: Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.|Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
authors.forename: Ramin
authors.initials: R
authors.lastname: Mojtabai
mesh_terms: D000328:Adult; D000368:Aged; D001569:Benzodiazepines / Q000008:administration & dosage*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012893:Sleep Wake Disorders / Q000188:drug therapy*; D014481:United States; D055815:Young Adult
chemical_list: D006993:Hypnotics and Sedatives; D001569:Benzodiazepines
keywords: anxiety; pharmacoepidemiology; prescribing trends; sedative-hypnotics; sleep