Advertisement

European Journal of Clinical Pharmacology

, Volume 68, Issue 3, pp 311–319 | Cite as

Use of addictive anxiolytics and hypnotics in a national cohort of incident users in Norway

  • Svein R. KjosavikEmail author
  • Sabine Ruths
  • Steinar Hunskaar
Pharmacoepidemiology and Prescription

Abstract

Purpose

To examine (1) incidence rates for treatment with addictive anxiolytics and hypnotics in Norway, (2) the proportions initiated by general practitioners (GPs), psychiatrists, and other physicians, and (3) the course of the treatment among incident users during a 3.5 year follow-up period.

Method

Data on all prescriptions of anxiolytics (ATC code N05B) and hypnotics (N05C) dispensed to the general population from 1 January 2004 to 31 August 2009 were extracted from the Norwegian Prescription Database and merged with data about GPs from the Norwegian Regular General Practitioner Scheme.

Results

One-year incidence rates per 1,000 inhabitants were 18.2 for anxiolytics, 24.5 for hypnotics, and 35.4 for anxiolytics and hypnotics combined. GPs and psychiatrists initiated the treatment to 75.4 and 2.4%, respectively. Only 30.8% received short-term treatment as recommended. Long-term use (11.8%) and heavy use (1.4%) were most common for treatments initiated by a GP, but the risk both of long-term and of heavy use was highest for patients initially treated by a psychiatrist. The amount redeemed during the first quarter was the strongest predictor of long-term use and of heavy use. However, even during the quarter with highest drug consumption, 81.5% of the patients received <1 DDD/day.

Conclusions

This study indicates that physicians’ prescribing strategy towards initial users is crucial in order to prevent inappropriate drug use. There is a need to implement relevant guidelines and systems for structured clinical audits in general practice.

Keywords

Anxiolytics Hypnotics Incidence Long-term use General practitioners Psychiatrists 

Notes

Acknowledgments

We thank the Fund for Research in General Practice, the Norwegian Medical Association, and the Norwegian Directorate of Health for grants supporting this study. The authors thank professor Stein Atle Lie at Uni Research, Bergen, for his statistical advice.

Declaration of interest

None declared.

References

  1. 1.
    The Norwegian Institute of Public Health (2010) Addictive drugs. http://www.fhi.no/dokumenter/9f4576d31a.PDF
  2. 2.
    Hajak G, Muller WE, Wittchen HU, Pittrow D, Kirch W (2003) Abuse and dependence potential for the non-benzodiazepine hypnotics zolpidem and zopiclone: a review of case reports and epidemiological data. Addiction 98:1371–1378PubMedCrossRefGoogle Scholar
  3. 3.
    Orriols L, Salmi LR, Philip P, Moore N, Delorme B, Castot A, Lagarde E (2009) The impact of medicinal drugs on traffic safety: a systematic review of epidemiological studies. Pharmacoepidemiol Drug Saf 18:647–658PubMedCrossRefGoogle Scholar
  4. 4.
    Paterniti S, Dufouil C, Alperovitch A (2002) Long-term benzodiazepine use and cognitive decline in the elderly: the epidemiology of vascular aging study. J Clin Psychopharmacol 22:285–293PubMedCrossRefGoogle Scholar
  5. 5.
    Zint K, Haefeli WE, Glynn RJ, Mogun H, Avorn J, Sturmer T (2010) Impact of drug interactions, dosage, and duration of therapy on the risk of hip fracture associated with benzodiazepine use in older adults. Pharmacoepidemiol Drug Saf 19:1248–1255PubMedCrossRefGoogle Scholar
  6. 6.
    Bandelow B, Zohar J, Hollander E, Kasper S, Moller HJ, Allgulander C, Ayuso-Gutierrez J, Baldwin DS, Buenvicius R, Cassano G, Fineberg N, Gabriels L, Hindmarch I, Kaiya H, Klein DF, Lader M, Lecrubier Y, Lepine JP, Liebowitz MR, Lopez-Ibor JJ, Marazziti D, Miguel EC, Oh KS, Preter M, Rupprecht R, Sato M, Starcevic V, Stein DJ, van Ameringen M, Vega J (2008) World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the pharmacological treatment of anxiety, obsessive-compulsive and post-traumatic stress disorders—first revision. World J Biol Psychiatry 9:248–312PubMedCrossRefGoogle Scholar
  7. 7.
    Taylor DJ, Roane BM (2010) Treatment of insomnia in adults and children: a practice-friendly review of research. J Clin Psychol 66:1137–1147PubMedCrossRefGoogle Scholar
  8. 8.
    World Health Organization (2009) Pharmacological treatment of mental disorders in primary health care. http://whqlibdoc.who.int/publications/2009/9789241547697_eng.pdf
  9. 9.
    Norwegian Board of Health Supervision (2001) Vanedannende legemidler, forskrivning og forsvarlighet. http://www.helsetilsynet.no/upload/Publikasjoner/andrepublikasjoner/vanedannende_legemidler_forskrivning_forsvarlighet_ik-2755.pdf
  10. 10.
    Norwegian Medicines Agency (2000) Behandling av søvnvansker. http://www.legemiddelverket.no/upload/76527/publikasjon8-2000.pdf
  11. 11.
    Isacson D (1997) Long-term benzodiazepine use: factors of importance and the development of individual use patterns over time—a 13-year follow-up in a Swedish community. Soc Sci Med 44:1871–1880PubMedCrossRefGoogle Scholar
  12. 12.
    van Hulten R, Isacson D, Bakker A, Leufkens HG (2003) Comparing patterns of long-term benzodiazepine use between a Dutch and a Swedish community. Pharmacoepidemiol Drug Saf 12:49–53PubMedCrossRefGoogle Scholar
  13. 13.
    Neutel CI (2005) The epidemiology of long-term benzodiazepine use. Int Rev Psychiatry 17:189–197PubMedCrossRefGoogle Scholar
  14. 14.
    Norwegian Medicines Agency (2002) Flunitrazepam: legemidler som inneholder flunitrazepam omklassifiseres til reseptgruppe A fra 2003-01-01. http://www.slv.no/templates/InterPage_16527.aspx
  15. 15.
    NOMESCO (2009) Medicines consumption in the Nordic countries 2004–2008. Nordic Medico Statistical Committee. http://nomesco-eng.nom-nos.dk/filer/publikationer/Medicines%20consumption%202004-2008%20web.pdf
  16. 16.
    Kjosavik SR, Ruths S, Hunskaar S (2009) Psychotropic drug use in the Norwegian general population in 2005: data from the Norwegian prescription database. Pharmacoepidemiol Drug Saf 18:572–578PubMedCrossRefGoogle Scholar
  17. 17.
    The Norwegian Institute of Public Health (2009) The Norwegian prescription database. http://www.norpd.no/
  18. 18.
    WHO Collaborating Center for Drug Statistics Methodology (2010) ATC / DDD index 2010. http://www.whocc.no/atc_ddd_index/
  19. 19.
    The Ministry of Health and Care Services (2000) Regulation relating to a Municipal Regular GP Scheme. http://www.regjeringen.no/en/dep/hod/dok/lover_regler/reglement/2000/regulation-relating-to-a-municipal-regul.html?id=420530
  20. 20.
    Grytten J, Skau I, Carlsen F (2004) Patient satisfaction with general practice services before and after the list patient reform. Tidsskr Nor Laegeforen 124:652–654PubMedGoogle Scholar
  21. 21.
    Grytten J, Skau I, Sorensen R, Aasland OG (2004) Physicians' work situation a year after the list patient system reform. Tidsskr Nor Laegeforen 124:358–361PubMedGoogle Scholar
  22. 22.
    Norwegian Social Science Data Services (2010) Data from the regular GP scheme, individual level data. http://www.nsd.uib.no/nsd/english/individualdata.html
  23. 23.
  24. 24.
    Kjosavik SR, Hunskaar S, Aarsland D, Ruths S (2011) Initial prescription of antipsychotics and antidepressants in general practice and specialist care in Norway. Acta Psychiatr Scand 123:459–465PubMedCrossRefGoogle Scholar
  25. 25.
    van Hulten R, Teeuw KB, Bakker A, Leufkens HG (2003) Initial 3-month usage characteristics predict long-term use of benzodiazepines: an 8-year follow-up. Eur J Clin Pharmacol 58:689–694PubMedGoogle Scholar
  26. 26.
  27. 27.
    Hausken AM, Furu K, Skurtveit S, Engeland A, Bramness JG (2009) Starting insomnia treatment: the use of benzodiazepines versus z-hypnotics. A prescription database study of predictors. Eur J Clin Pharmacol 65:295–301PubMedCrossRefGoogle Scholar
  28. 28.
    Ohayon MM, Lader MH (2002) Use of psychotropic medication in the general population of France, Germany, Italy, and the United Kingdom. J Clin Psychiatry 63:817–825PubMedCrossRefGoogle Scholar
  29. 29.
    Veronese A, Garatti M, Cipriani A, Barbui C (2007) Benzodiazepine use in the real world of psychiatric practice: low-dose, long-term drug taking and low rates of treatment discontinuation. Eur J Clin Pharmacol 63:867–873PubMedCrossRefGoogle Scholar
  30. 30.
    Isacson D, Bingefors K, Wennberg M, Dahlstrom M (1993) Factors associated with high-quantity prescriptions of benzodiazepines in Sweden. Soc Sci Med 36:343–351PubMedCrossRefGoogle Scholar
  31. 31.
    Olfson M, Klerman GL (1993) Trends in the prescription of psychotropic medications. The role of physician specialty. Med Care 31:559–564PubMedCrossRefGoogle Scholar
  32. 32.
    Pincus HA, Tanielian TL, Marcus SC, Olfson M, Zarin DA, Thompson J, Magno Zito J (1998) Prescribing trends in psychotropic medications: primary care, psychiatry, and other medical specialties. JAMA 279:526–531PubMedCrossRefGoogle Scholar
  33. 33.
    Dybwad TB, Kjolsrod L, Eskerud J, Laerum E (1997) Why are some doctors high-prescribers of benzodiazepines and minor opiates? A qualitative study of GPs in Norway. Fam Pract 14:361–368PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Svein R. Kjosavik
    • 1
    • 2
    Email author
  • Sabine Ruths
    • 1
    • 2
  • Steinar Hunskaar
    • 1
  1. 1.Research Group for General Practice, Department of Public Health and Primary Health CareUniversity of BergenBergenNorway
  2. 2.Research Unit for General Practice in Bergen, Uni HealthBergenNorway

Personalised recommendations