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A study of more than 1.1 billion U.S. benzodiazepine prescription fills found that the number dispensed fell 26.7% between 2013 and 2024, while the average dose per prescription dropped 18.3%. The Rutgers-led researchers say the patterns may reflect more selective prescribing, but the data do not establish why use declined or whether patients’ access and outcomes changed.
U.S. benzodiazepine prescription fills fell 26.7% between 2013 and 2024, according to a Rutgers Health study analyzing more than 1.1 billion fills. The researchers also found that the average dose per prescription declined by 18.3%, trends they said may indicate that clinicians have become more cautious or selective in prescribing the sedatives.
The study, published in the American Journal of Psychiatry, examined dispensing of medicines including Xanax, Valium, Ativan and Klonopin. Benzodiazepines slow activity in the central nervous system and are prescribed for conditions including anxiety, panic attacks, insomnia and some seizure disorders. The researchers reported that fills declined across all patient populations, with the largest drop among adults ages 18 to 29.
The study also identified changes in the mix of prescribers. Primary care physicians and psychiatrists wrote fewer prescriptions, while prescriptions from advanced practice providers, including nurse practitioners and physician assistants, increased. The analysis further found an 18.3% reduction in average dose per prescription. The study reports these patterns; it does not, by itself, establish what caused them or how they affected individual patients.
Lead author Naomi Cruz, a recent doctoral graduate affiliated with the Rutgers School of Public Health and Rutgers Center for Pharmacoepidemiology and Treatment Science, said the results suggest prescribing may have become more cautious over the decade. The research was supported in part by the National Institute on Drug Abuse. The authors said the findings are their responsibility and do not necessarily represent the official views of the National Institutes of Health.
Prescribing Trends and Patient Safety
Benzodiazepines can provide meaningful benefits for patients, but their use also carries risks, particularly over extended periods or when combined with other medicines. The Rutgers researchers point to the drugs’ involvement in overdose deaths, often alongside other substances such as opioids, as a reason prescribing patterns matter for public health.
A sustained decline in fills and in average dose could be consistent with clinicians limiting exposure to these risks. But the study does not show that every decline represents safer care: prescription counts alone cannot establish whether patients received suitable treatment, whether prescriptions were stopped or changed for clinical reasons, or whether people could still access needed medication. The results describe a broad national trend, not an assessment of any one patient’s care.
The shift in prescriber types is also relevant to how care is delivered. As the health care workforce changes, monitoring prescribing across professions may help researchers and health systems understand where medication decisions are taking place. The study documents that distributional change but does not explain its causes or determine whether it altered patient outcomes.
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Warnings and a Decade of Change
The study covers 2013 through 2024, a period that included federal warnings about benzodiazepines and opioids. The U.S. Food and Drug Administration issued warnings in 2016 and 2020 about prescribing the medicines together and about risks related to medication misuse. Those warnings provide relevant context for the researchers’ interpretation, but the study does not establish that they caused the observed decline.
Benzodiazepines remain widely prescribed and are used for several different conditions. A fall in national dispensing does not mean the medicines are no longer used, nor does it show that treatment needs have changed in the same way for every age group or diagnosis. The authors describe the trend as potentially consistent with more selective practice, rather than proof of a specific policy effect or a measured improvement in safety.
The paper, “National Trends in Benzodiazepine Dispensing,” was published in the American Journal of Psychiatry in 2026. Its coauthors include researchers from Rutgers and Columbia University. The reported analysis is based on prescription-fill data, so its conclusions concern dispensing trends rather than a complete account of clinical decisions, medication use, or health outcomes.
Causes and Patient Effects Remain Unclear
The analysis shows that dispensing declined, but it does not establish why the decline occurred. The reported figures do not isolate the effects of FDA warnings, changes in clinical guidance, shifts in patient demand, insurance or health care access, or other factors. The study’s findings about prescriber categories likewise describe who wrote prescriptions, not what drove those changes.
It is also unclear from the supplied study summary how the trends affected treatment quality, symptom control, adverse events or access for people who benefit from benzodiazepines. The lower average dose may be consistent with more selective prescribing, as the researchers suggest, but it is not a direct measure of patient safety. No patient-level outcome results are included in the report summary, and the study does not support conclusions about what an individual should do with a prescription.
Further Monitoring of Prescribing Patterns
The researchers call for continued monitoring and further research to clarify how prescribing practices are changing and where care could improve. Follow-up work would need to examine the reasons behind the trends and assess outcomes alongside fill counts and dose levels, including whether patients receive appropriate treatment and whether risks change.
No specific next study, publication date or policy action is identified in the report. For now, the findings provide a national snapshot through 2024; later data would be needed to show whether the decline continued after that period. The study is not medical advice. People with questions about benzodiazepine treatment should discuss them with a qualified health professional rather than changing medication on their own.
Key Questions
How much did benzodiazepine dispensing decline?
The study found that U.S. prescription fills fell 26.7% from 2013 to 2024. It also reported an 18.3% decline in average dose per prescription over the period.
Which patients had the largest reported decline?
The largest decline in prescription prevalence was observed among adults ages 18 to 29. The study summary says declines occurred across all patient populations.
Does the study prove doctors are prescribing more safely?
No. The researchers said the trends may indicate more cautious or selective prescribing, but the reported analysis does not prove what caused the changes or measure whether patient safety improved.
Which types of clinicians wrote fewer prescriptions?
The study reported fewer prescriptions from primary care physicians and psychiatrists, while prescribing by advanced practice providers, including nurse practitioners and physician assistants, increased.
Should patients change their medication because of these findings?
No individual treatment decision follows from this national trend analysis. Patients should speak with a qualified health professional about their own medication and should not change a prescription based solely on the study.
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