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A study of more than 1.1 billion U.S. benzodiazepine prescription fills found that fills fell 26.7% from 2013 through 2024, while the average dose per prescription declined 18.3%. The researchers said these trends may reflect more selective prescribing, but the study does not establish why use fell or whether patient outcomes changed.
A study of more than 1.1 billion U.S. benzodiazepine prescription fills found that the number dispensed fell 26.7% from 2013 through 2024, while average dose per prescription decreased 18.3%. Rutgers Health researchers said the patterns may indicate more cautious or selective prescribing, a relevant shift because the sedatives can carry added risks when used with opioids or over long periods.
Published in the American Journal of Psychiatry, the study examined dispensing trends for benzodiazepines, a class that includes Xanax, Valium, Ativan and Klonopin. These medications slow activity in the central nervous system and are used for conditions including anxiety, panic attacks, insomnia and some seizure disorders. The researchers reported declines in prescription prevalence across all patient populations included in their analysis, with the largest decline among adults ages 18 to 29.
The researchers also found changes in who wrote prescriptions. Primary care physicians and psychiatrists wrote fewer, while prescriptions from advanced practice providers, including nurse practitioners and physician assistants, increased. The average dose per prescription fell 18.3% over the study period. The report does not give a separate cause for these prescriber shifts or dose changes.
The study’s lead author, Naomi Cruz, a recent doctoral graduate of Rutgers School of Public Health and the Rutgers Center for Pharmacoepidemiology and Treatment Science, said the findings suggest prescribing may have become more cautious or selective. She also said continued monitoring is needed. The research was supported in part by the National Institute on Drug Abuse; the authors said its findings do not necessarily represent the official views of the National Institutes of Health.
Falling Fills Amid Safety Concerns
The decline matters because benzodiazepines can provide meaningful benefits to patients, but risks can rise when they are combined with certain other drugs or used over long periods. The study authors noted that benzodiazepines are increasingly involved in overdose deaths, many involving combinations with other drugs, including opioids. The dispensing data document a change in prescribing patterns; they do not show whether that change reduced overdoses or improved safety.
Lower average doses and fewer fills could be consistent with more selective prescribing, as the researchers suggest. But the trend alone cannot establish that clinicians changed their practices because of safety concerns, nor whether patients’ medical needs or access to care changed. The distinction matters for evaluating the balance between reducing medication risks and maintaining treatment for people who benefit from these medicines.
Warnings Preceded the Study Period’s End
The researchers place their findings against a backdrop of federal safety warnings. The U.S. Food and Drug Administration issued warnings in 2016 and 2020 about prescribing benzodiazepines with opioids and about medication misuse. Those warnings occurred during the period covered by the study, which began in 2013 and ended in 2024.
The study, titled “National Trends in Benzodiazepine Dispensing,” was published in 2026. Its authors include researchers affiliated with Rutgers and Columbia University. The analysis counts prescription fills and examines dispensing patterns; it is not, by itself, an assessment of individual treatment decisions or patient outcomes.
What the Dispensing Data Cannot Show
The reported declines do not establish why fewer prescriptions were filled. The study summary does not identify how much of the change reflects clinician decisions, patient choices, shifts in health care access or other factors. It also does not report whether patients who received fewer or lower-dose prescriptions had different health outcomes.
The researchers describe the trends as potentially consistent with more cautious prescribing, rather than proof of a single cause. The summary also does not provide enough detail to assess how patterns varied by specific medication, diagnosis or region. Further research would be needed to connect dispensing changes with prescribing decisions and patient safety.
Researchers Call for Continued Monitoring
Cruz said continued monitoring and further research can help clarify how prescribing practices are changing and where care could improve. That work could examine whether the observed trends persist beyond 2024 and how changes in fills and dose relate to treatment needs and patient outcomes.
For now, the study establishes a national dispensing trend over its 2013–2024 observation period. It does not set out a specific next study or milestone, and the available report does not say when additional findings may be released.
Key Questions
How much did benzodiazepine fills decline?
The study found a 26.7% decline in U.S. benzodiazepine prescription fills from 2013 through 2024.
Did the average prescription dose also change?
Yes. Researchers reported that the average dose per prescription decreased 18.3% over the study period.
Does the study prove that prescribing became safer?
No. The researchers said the trends may indicate more cautious or selective prescribing. The reported dispensing data do not establish the cause of the declines or show whether patient outcomes improved.
Which age group had the largest decline?
The largest decline in prescription prevalence was reported among adults ages 18 to 29. The study summary does not give the size of that age-specific decline.
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