Prolonged use of benzodiazepine in primary health care: evaluation of effectiveness, dependence and cognitive function

BACKGROUND: Anxiety and insomnia are global health challenges often managed in Primary Health Care (PHC). Benzodiazepines (BZD) are commonly prescribed, but prolonged use increases risks such as cognitive impairment, dependence, and tolerance. This study assessed PHC users with prolonged BZD use for anxiety or insomnia, focusing on dependence, effectiveness, and cognitive function. RESEARCH DESIGN AND METHODS: A cross-sectional study was conducted with 144 prolonged BZD users in PHC. Data collection included sociodemographic and clinical questionnaires, alongside instruments assessing dependence, cognition, insomnia, and anxiety. Logistic regression analyses were performed. RESULTS: Participants had a mean age of 64.3 years (SD=10.97) and average BZD use duration of 10 years. Prevalence of polypharmacy (54.9%), high anticholinergic load (41%), falls (29.2%), and alcohol use (33.4%) was observed. Falls were linked to severe problematic BZD use, while aging, cognitive impairment, mild insomnia, and lower anxiety were linked to less severe use. Severe insomnia correlated with extreme concerns about medication availability. Older age, white race, and better insomnia or anxiety profiles reduced non-adherence risks, whereas illiteracy increased them. Severe withdrawal symptoms elevated fall risk. CONCLUSIONS: Findings stress the need for BZD deprescription.