Time Trends in Prescribing of Anxiolytic, Sedative, and Hypnotic Drugs in the United States

Sedative, anxiolytic, and hypnotic (sleep-promoting) medications are extensively prescribed in clinical practice. Most are benzodiazepine (BZ) receptor agonists, but other drug classes are prescribed as well. Reliable quantitative data on the extent of prescribing, and changes in prescribing patterns over time, are needed to support risk-benefit decisions for individual patients and physicians, as well as public policy and regulatory decisions on product labeling, dosing recommendations, and use restrictions as applicable.

Retail and mail-order pharmacy dispensing data from 2006 to 2023 was evaluated using the Medical Expenditure Panel Survey component of the Agency for Healthcare Research and Quality, as appearing in the public domain (ClinCalc.com). Also evaluated was 2019 and 2023 data from the Centers for Medicare & Medicaid Services (CMS), providing federal health care coverage under Medicare Part D and Medicaid programs. Specific medications targeted were: BZ derivatives, zolpidem, and non-BZs taken for anxiety disorders and insomnia (buspirone, trazodone, and dual orexin receptor antagonists).

ClinCalc data indicated that prescribing of BZ-agonist agents (inclusive of zolpidem) was maximal in year 2014, then declined annually to about 50% of that maximum by year 2023. CMS Medicare Part D and Medicaid data reported a similar trend. The non-BZ sedating antidepressant trazodone was the most commonly prescribed hypnotic medication, with trazodone numbers more than double those for zolpidem by 2023. CMS Medicare Part D and Medicaid data reported similar trends. The dual orexin receptor antagonist hypnotics, available only as brand names at high cost, were not listed by ClinCalc, but CMS data indicated only modest use compared with trazodone.

The overall shift away from BZ agonist prescribing in the last decade has potential public health drawbacks as well as benefits, the balance of which is not established. The net clinical implications need close analysis using validated and objective biomedical and epidemiologic methodologies.