Prescription fills for benzodiazepines, the sedative class that includes Xanax, Klonopin, Ativan, and Valium, fell 26.7% across the United States from 2013 to 2024, according to a Rutgers-led study of more than 1.1 billion fills. The study, titled "National Trends in Benzodiazepine Dispensing," was published in the American Journal of Psychiatry on Sept. 30.
The average dose per prescription also dropped 18.3%. Declines appeared in every patient group, with the largest among young adults ages 18 to 29, according to the Rutgers announcement. One group moved the other way: nurse practitioners and physician assistants wrote more of these prescriptions, even as primary care doctors and psychiatrists wrote fewer.
For the millions of Americans who take these drugs for anxiety, panic attacks, insomnia, or seizures, the trend does not mean anyone should stop. Stopping suddenly can trigger dangerous withdrawal, including seizures. The findings matter most for patients and families asking whether a long-running prescription is still the right fit.
A Decade of More Selective Prescribing
The research team was led by Naomi Cruz, a recent doctoral graduate of the Rutgers School of Public Health and the Rutgers Center for Pharmacoepidemiology and Treatment Science. Co-authors included Rutgers researchers Hillary Samples, Greta Bushnell, Stephen Crystal, and Fangzhou Xie, and Columbia University psychiatric epidemiologist Mark Olfson. The work was funded by a National Institute on Drug Abuse career development grant.
"Benzodiazepines are among the most commonly prescribed medications in the United States, and they provide meaningful benefits for many patients. But these medications also carry risks, particularly when used with other drugs or over long periods of time," Cruz said.
She added that the 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."
The increase among nurse practitioners and physician assistants may reflect their growing role in primary and mental health care. The release did not explain the increase, and it remains one of the study's open questions.
"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.
FDA Warnings and Tapering Guidance
The decline came during a period of tighter federal safety warnings. In 2016, the FDA added its strongest warning to opioids and benzodiazepines about the risks of taking them together, including slowed breathing and death.
In 2020, the agency required a boxed warning for the entire benzodiazepine class. "Physical dependence can occur when benzodiazepines are taken steadily for several days to weeks, even as prescribed," the FDA said, noting that about 92 million benzodiazepine prescriptions were dispensed in 2019.
Clinical guidance has also changed. A 2025 joint guideline led by the American Society of Addiction Medicine recommends that patients who need to come off these drugs start slowly, for example with a 5% to 10% reduction in total daily dose every two to four weeks. Long-term users may need a year or more to taper safely. "A rushed or poorly managed taper can result in real harm to a patient," said Dr. Aleksandra Zgierska, an addiction and family medicine physician involved in the guideline.
Limits of Pharmacy Data
The study measured pharmacy fills, not patient outcomes. It cannot show why prescriptions fell, whether patients who stopped did better or worse, or whether some turned to other drugs. The public release did not break results down by drug, sex, or state.
Fill data also miss pills bought outside the medical system. A CDC analysis of benzodiazepine overdoses in 23 states found that deaths involving illicit benzodiazepines rose 519.6% from April to June 2019 to the same months in 2020, and 92.7% of benzodiazepine-involved deaths in the first half of 2020 also involved opioids. Counterfeit pills made to look like Xanax remain a known risk.
Misuse also persists. The federal National Survey on Drug Use and Health estimated that 4.6 million people ages 12 and older misused prescription tranquilizers or sedatives in 2024, a category that includes benzodiazepines and other drugs.
A separate study led by Olfson, published in February in the Journal of Clinical Psychiatry, found that the share of adults using benzodiazepines fell from 4.7% in 2018 to 3.4% in 2022. That survey-based study found the steepest drop among adults 56 and older, while the Rutgers fill data point to young adults, a difference likely tied to the different data sources, according to Columbia's summary of the study.
Patients taking a benzodiazepine can ask their clinician whether the drug is still needed, review all medications for risky combinations with opioids, alcohol, or sleep aids, and plan any reduction slowly. Anyone who has a seizure, severe confusion, or trouble breathing while stopping one of these drugs needs emergency care.
Key Questions Answered
How much did benzodiazepine prescriptions fall? Prescription fills dropped 26.7% from 2013 to 2024, and the average dose per prescription fell 18.3%.
Which drugs are benzodiazepines? Common examples include alprazolam (Xanax), clonazepam (Klonopin), lorazepam (Ativan), and diazepam (Valium).
Why did prescribing drop? The study did not determine why. The decline came after FDA warnings in 2016 and 2020 about overdose, dependence, and withdrawal risks.
Who prescribed more? Nurse practitioners and physician assistants increased their prescribing, while primary care doctors and psychiatrists wrote fewer.
Should I stop taking my benzodiazepine? Do not stop suddenly. Abrupt discontinuation can cause life-threatening seizures. Talk with your prescriber about a gradual plan if a change makes sense.
Does the study prove patients are safer? No. It tracked prescription fills, not health outcomes, so it cannot show whether people were better off.
Published by Medicaldaily.com
