Abstract
Background Z-drugs are nonbenzodiazepine hypnotics used for sleep
initiation and maintenance; these drugs increase the risk of fall-related
injuries in older adults. The American Geriatrics Society’s Beers
criteria classifies Z-drugs as high-risk and strongly recommends avoiding
prescribing Z-drugs to older adults due to adverse effects. The study objectives
were to determine the prevalence of Z-drug prescribing among Medicare Part D
patients and identify state or specialty-dependent prescribing differences. This
study also aimed to determine prescribing patterns of Z-drugs to Medicare
patients.
Methods Z-drug prescription data was extracted from the Centers for
Medicare and Medicaid Services State Drug Utilization Data for 2018. For all 50
states, the number of prescriptions per 100 Medicare enrollees and days-supply
per prescription was determined. The percentage of total prescriptions
prescribed by each specialty and the average number of prescriptions per
provider within each specialty was also determined.
Results Zolpidem was the most prescribed Z-drug (95.0%).
Prescriptions per 100 enrollees were significantly high in Utah (28.2) and
Arkansas (26.7) and significantly low in Hawaii (9.3) relative to the national
average (17.5). Family medicine (32.1%), internal medicine
(31.4%), and psychiatry (11.7%) made up the largest percentages
of total prescriptions. The number of prescriptions per provider was
significantly high among psychiatrists.
Discussion Contrary to the Beers criteria, Z-drugs are prescribed to older
adults at high rates.
Key Words
elderly - older adult - zolpidem - zopiclone - zaleplon
