Impact of policy measures targeting benzodiazepines and Benzodiazepine-related drugs in Lithuania: interrupted time series analysis

Abstract

Purpose Prescribing recommendations, communication programmes, and mandatory electronic prescribing were implemented in Lithuania to promote responsible use of benzodiazepines and benzodiazepine-related drugs (BZRDs). We assessed the impact of policy measures on benzodiazepine/BZRD prescribing patterns in Lithuania. Methods We analysed utilisation of oral benzodiazepines/BZRDs in Lithuania from 2018 to 2024, using national prescription data and wholesale medicines data. Benzodiazepines/BZRDs included (1) anxiolytic benzodiazepines; (2) hypnotic benzodiazepines; and (3) BZRDs. The policy intervention period spanned from November 1, 2020, to July 1, 2021. We used ARIMA models to assess monthly incidence, prevalence, and long-term use prevalence (≥ 180 days) per 1,000 inhabitants. Besides, the numbers of defined daily doses (DDDs) prescribed and sold to pharmacies per 1,000 inhabitants were studied. We estimated baseline slopes, step changes after implementation, and changes in slopes after implementation. Results In total, 717,590 patients received 6,974,059 prescriptions for benzodiazepines or BZRDs. Prior to implementing the policy measures, there were upward trends in incidence, prevalence, and long-term use prevalence across all classes. Following the implementation, monthly incidence stabilised and prevalence decelerated for anxiolytic benzodiazepines and BZRDs. The prevalence of hypnotic benzodiazepines showed a significant immediate reduction after implementation. Long-term use prevalence continued to increase for all benzodiazepine/BZRD classes after implementation of the policy. Before the policy measures were implemented, monthly DDDs sold to pharmacies were gradually declining for anxiolytic benzodiazepines, but were stable for other classes. In contrast, monthly DDDs prescribed were increasing across all classes. Following the policy measures, immediate reductions in DDDs sold to pharmacies were observed, without changes in slopes. The prescribed and sold DDDs converged after implementing the policy measures. Conclusion From a public health perspective, the policy measures implemented in 2020 and 2021 had only a limited impact on the prescribing patterns of benzodiazepines and BZRDs in Lithuania. They continued to be used long-term, highlighting the persistence of potentially irrational prescribing.