Prescription patterns of benzodiazepines and Z-drugs in Berlin prisons

Benzodiazepines and Z-drugs are commonly prescribed medications in psychiatric treatment. Prisoners are a unique patient population due to their elevated prevalence of substance abuse and psychiatric morbidity. Given the limited data about the medical treatment for prisoners, this study aims to provide an initial exploratory overview of the prescription patterns of benzodiazepines and Z-drugs in Berlin prisons.

A data set was compiled by extracting information from the documentation systems of all seven Berlin prisons. All inmates with a prescription for benzodiazepines or Z-drugs as of the cut-off date were included. Demographic characteristics, arrest circumstances, and medical histories were considered. Supplementary information on the overall prison population was obtained from officially published sources.

As of August 31, 2022, the point prevalence of benzodiazepine and Z-drug prescriptions among Berlin prisoners was 3.9% (n = 136). The duration of 46 (33.8%) prescriptions exceeded six weeks. The prescription rate in female prisoners (6.8%, n = 13/190) was significantly higher than in male prisoners (4.1%, n = 123/3299). The prescription rate in default imprisoned individuals (16.5%, n = 62/376) was significantly higher compared to in convicted and remand detainees (2.1%, n = 71/3095).

Benzodiazepines and Z-drugs were prescribed less frequently in Berlin prisons than in general outpatient care. Approximately 1/3 of all prescriptions exceeded the recommended maximum duration. Prescription rates in prison were higher among female inmates. Rates among remand detainees did not exceed those of convicted prisoners. Default imprisonment was identified as a factor influencing prescription practices, likely due to its strong association with homelessness and alcohol abuse.