Benzodiazepine Prescriptions Fell 26.7% Over a Decade, Study Finds

The share of Americans receiving prescriptions for benzodiazepines such as Xanax, Valium and Klonopin fell by 26.7 percent over the past decade, according to a Rutgers Health-led study that analyzed more than 1.1 billion prescription fills dispensed between 2013 and 2024.

The findings, published online September 30 in the American Journal of Psychiatry, show the annual prevalence of benzodiazepine dispensing declining from 7.5 percent of the population to 5.5 percent. Doses fell too: the mean total amount of medication dispensed per prescription dropped across every age group and prescriber type the researchers examined.

Benzodiazepines slow activity in the central nervous system and are prescribed for anxiety, panic attacks, insomnia and some seizure disorders. They are also among the drugs most frequently detected in overdose deaths, particularly when combined with opioids — a risk the Food and Drug Administration highlighted in prescribing warnings issued in 2016 and 2020.

What the data show

Naomi Cruz, a recent doctoral graduate at the Rutgers School of Public Health and the Rutgers Center for Pharmacoepidemiology and Treatment Science, led the analysis using the IQVIA Longitudinal Prescription dataset, a national record of dispensed prescriptions. The team counted 1,100,233,787 benzodiazepine fills over the twelve-year window and reported counts, prevalence and mean total dose per prescription annually.

"Benzodiazepines are among the most commonly prescribed medications in the United States, and they provide meaningful benefits for many patients," Cruz said. "But these medications also carry risks, particularly when used with other drugs or over long periods of time. Our findings suggest that prescribing practices may have become more cautious or selective over the past decade, but continued monitoring is important to ensure that patients receive the safest care."

Where the decline was steepest

The pullback was not evenly distributed. Prevalence fell in every age band, but the largest relative reduction appeared among young adults ages 18 to 29, where dispensing dropped 44.8 percent. That group has drawn particular attention from clinicians because benzodiazepines are frequently co-used with alcohol and illicit opioids, and because the drugs can deepen respiratory depression when they are present alongside prescription opioids.

Mean dose per prescription also declined for every age group, and the authors describe the combination of fewer prescriptions and smaller doses as consistent with more selective prescribing rather than a single policy change.

Who writes the prescriptions is shifting

The researchers split the prescriber data by specialty and found the composition of the benzodiazepine market has changed substantially. Pain medicine specialists recorded the sharpest relative decline in benzodiazepine dispensing, down 62.5 percent, followed by primary care physicians at 44.3 percent and psychiatrists and mental health specialists at 38.3 percent. Doses written by pain medicine specialists fell even further, by 65.3 percent.

At the same time, dispensing by advanced practice providers — nurse practitioners and physician assistants — rose 101.5 percent. That group has grown steadily as a share of the national prescriber workforce, and the study's authors treat the shift as a change in who manages sedative prescribing rather than as evidence about the quality of that prescribing.

Primary care physicians still dispense the largest raw number of benzodiazepine prescriptions, followed by advanced practice providers and then psychiatrists and mental health specialists.

Why the trend matters for overdose risk

Benzodiazepines rarely appear in overdose data alone. Medical examiners routinely report them alongside fentanyl, methamphetamine and alcohol, where the combination suppresses breathing more than any single substance would. Federal surveillance has repeatedly identified benzodiazepines as a common contributing factor in polysubstance deaths, which is the main reason regulators began warning prescribers about co-prescribing them with opioids.

A decade-long decline in dispensing could therefore reflect a genuine reduction in one of the risk multipliers behind the overdose crisis. The authors are careful not to claim that. Their data track what pharmacies dispensed, not how patients took it, and a person who fills fewer prescriptions for a sedative may be receiving care elsewhere — or may not be receiving care at all.

What researchers say comes next

The study was supported in part by the National Institute on Drug Abuse through grant K01DA050769. Cruz's coauthors include Hillary Samples, Greta Bushnell, Stephen Crystal and Fangzhou Xie of the Rutgers Institute for Health, Health Care Policy and Aging Research, and Mark Olfson of Columbia University.

The authors note that drug labeling changes and safety advisories issued during the study period could account for part of the trend, and they call for continued monitoring of both prescribing patterns and patient outcomes. Whether less benzodiazepine prescribing translates into better outcomes for people with anxiety disorders, or simply leaves untreated symptoms in place, is a question the dispensing data cannot answer on its own.

"While the trends we observed may indicate shifts toward safer prescribing, ongoing research can help us better understand how practices are evolving and where opportunities exist to improve care," Cruz said.