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Comment & Response |

The Popularity of Benzodiazepines, Their Advantages, and Inadequate Pharmacological Alternatives—Reply

Mark Olfson, MD, MPH1; Marissa King, PhD2; Michael Schoenbaum, PhD3
[+] Author Affiliations
1Department of Psychiatry, College of Physicians and Surgeons, Columbia University and New York State Psychiatric Institute, New York
2School of Management, Yale University, New Haven, Connecticut
3Office of the Director, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
JAMA Psychiatry. 2015;72(6):624. doi:10.1001/jamapsychiatry.2015.24.
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In Reply Dr Starcevic questions whether long-term benzodiazepine use poses health risks to older adults. He suggests that for older adults, long-term use of benzodiazepines does not increase the risk for fractures, is much safer than antidepressants, and generally maintains its clinical effectiveness over time.

The totality of empirical evidence strongly supports an association in older adults between benzodiazepine use and an increased risk for falls.1 To cast doubt, Dr Starcevic cites a report that did not find a significant decrease in hip fractures following a drop in benzodiazepine use after implementation of a statewide triplicate prescription policy. However, a key flaw of this analysis was its neglect of the large concomitant increase in the use of other sedative hypnotics (eg, meprobamate, chloral hydrate, and ethchlorvynol) that likely counteracted the expected safety benefits of reduced benzodiazepine use.2

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June 1, 2015
Vladan Starcevic, MD, PhD, FRANZCP
1University of Sydney, Sydney Medical School–Nepean, Discipline of Psychiatry, Sydney, Australia
JAMA Psychiatry. 2015;72(6):623-624. doi:10.1001/jamapsychiatry.2014.3248.
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