Associate Professor Universite Laval Quebec City, Canada
Background: Benzodiazepines and Z-drugs (i.e., zopiclone and zolpidem) are the most widely prescribed sedatives. Due to a wide range of side effects (e.g., fall-related injuries, neurological issues), they are listed as potentially inappropriate medications and their use should be restricted to specific purposes and circumstances.
Objectives: We examined the use and costs of benzodiazepines and Z-drugs across Canada over 6 years.
Methods: We conducted a retrospective, repeated cross-sectional study examining dispensations of benzodiazepines and Z-drugs across Canada from July 2016 to June 2022. All data was obtained using IQVIA’s Canadian Compuscript data audit. Drug dispensing and costs of were available monthly with all dosages, forms and formulations over the study period being categorized by drug class. We report both total and yearly averages and examined overall trends in volume over the study period using the Mann-Kendall test. All analyses were performed using SAS version 9.3 and a p-value < 0.05 was considered statistically significant.
Results: Over 8.91B units of benzodiazepines and Z-drugs (7.53B units [84.4%] and 1.38B units [14.6%], respectively) were dispensed in Canada over the 6-year study; total cost of dispensations amounted to $CAN 4.40B. In terms of volume, yearly dispensations of benzodiazepines dropped from 1.43B units in 2016-2017 to 1.11B units in 2021-2022 (p-value < 0.001 for trend). Alternatively, yearly volumes of Z-drugs dispensations remained relatively constant over the 6-year period with a mean of 230.8M units dispensed each year. Despite these differences in volume over time, dispensing for these two drug classes dropped from a high of $CAN 676.7M in 2016-2017 to a low of $CAN 638.3M in 2021-2022.
Conclusions: Our results indicate that the overall volume and cost of benzodiazepines dispensed in Canada have dropped over this 6-year period without corresponding compensation with Z-drugs. The use of other drug classes (e.g., quetiapine, trazodone), however, may have increased and should be monitored in future studies.
