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Comment & Response
June 2015

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

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

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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