OBJECTIVES: There have been rising concerns about the long-term use of benzodiazepines (BZDs) and Z-drugs regarding possible adverse effects, such as drug tolerance and risk of falls. Hence, strict monitoring of their prescribing is recommended. In this study, we aim to investigate the real-world prescribing patterns and long-term use of BZDs and Z-drugs in Hong Kong from 2014 to 2023.

METHODS: We used the health record data from the Clinical Data Analysis and Reporting System (CDARS). CDARS contains demographics and clinical data of all patients served in the public healthcare system in Hong Kong. We included all adult patients aged 18+ having a prescription at least once during the study period. Joinpoint regression was used to identify any trend change over time and to estimate the average annual percent change (AAPC) of drug prevalence and incident rate.

RESULTS: 753,412 patients had been prescribed BDZs or Z-drugs from 2014-2023. The overall annual prevalence increased by 3.44%, with a significant change in 2021. In 2014-2021, the increasing rate was 4.32% annually but dropped to 0.4% after 2021. The increasing trend was evident across age groups: 18-24, 25-49, 50-64, and over 65, albeit AAPC was highest among the youngest age group (AAPC: 9.22 [95% C.I. 8.04-10.39]). The overall incident rate increased by 1.52% annually. The incident rate among 65+ decreased after 2019, while that of the youngest age group increased continuously over time (AAPC: 7.42 [6.15, 8.62]). Patients with BZDs or Z-drugs prescriptions for over 6 months were most prevalent and have been increasing (AAPC for BZDs: 4.53 [4.15, 4.91], for Z-drugs: 6.15 [5.81, 6.44]).

CONCLUSIONS: Overall, we found the increasing trend in BZDs and Z-drugs prescribing with some differences among age groups. There is a decreasing trend among 65+ after 2021, while more young adults were prescribed BZDs as prevalent and new patients.