Medicare’s benzodiazepine line is going the wrong way

A peer-reviewed analysis of every Medicare Part D benzodiazepine claim filed between 2017 and 2023 has just landed in Frontiers in Medicine, and the headline number is one most clinicians did not expect to see in 2026: prescriptions are up <span class="stat">82%</span>. Over six years of FDA warnings, professional society guidelines, and growing clinical recognition that long-term benzodiazepine therapy in older adults is risky, the line on the chart simply went up — from <span class="stat">1.7 million</span> claims in 2017 to <span class="stat">3.1 million</span> in 2023.

This is not a story about a new drug, a new molecule, or a new addiction crisis. It is a story about a class of medicines that has been with us for sixty years, that we have known to be habit-forming since the 1970s, and that we appear to be prescribing more aggressively, to older patients, for longer durations, in 2026 than at any point in the recent past.

The numbers, and what changed in 2020

The Frontiers paper (Silvernail and colleagues, PMID 41797773) examined the full universe of Medicare Part D benzodiazepine prescribing over seven calendar years. In <span class="stat">September 2020</span>, the FDA announced an updated boxed warning for the entire benzodiazepine class, requiring labeling to communicate risks of physiologic dependence and withdrawal — and explicitly noting that gradual tapering can mitigate withdrawal symptoms. The American Geriatrics Society’s Beers Criteria has flagged benzodiazepines as potentially inappropriate medications in adults 65+ for over a decade. The American Society of Addiction Medicine published a Joint Clinical Practice Guideline on benzodiazepine tapering in 2024.

Despite all of that, the trend went the wrong way. Mean days-supplied per beneficiary across all study years was <span class="stat">108 days</span> — more than three and a half times the 30-day ceiling that most professional guidelines recommend for short-term anxiety or insomnia treatment. Psychiatrists, who prescribe a disproportionate share of these medications, saw their per-prescriber rate climb from roughly <span class="stat">66 claims</span> in 2017 to <span class="stat">235 claims</span> in 2023 — a <span class="stat">250%</span> increase. Family medicine, internal medicine, geriatrics, and nurse practitioners each roughly doubled.

Why this matters for SUD specifically

Benzodiazepines exist in a category that the addiction-medicine field calls depressants — alongside alcohol, GHB, and (clinically) barbiturates. They produce physiologic dependence on a predictable timeline (often within four weeks of daily use), and their withdrawal syndrome is one of the few in addiction medicine that can be fatal in its own right.

Three patient populations are at elevated risk from the trend the Frontiers paper documents:

The first is older adults already on long-term benzodiazepine therapy. Falls, fractures, cognitive impairment, and motor vehicle injury risk are all dose- and duration-dependent. A 108-day average is well into the territory where deprescribing — not initiation — should be the working clinical conversation.

The second is patients with co-occurring alcohol use disorder. Concurrent use of alcohol and benzodiazepines compounds CNS depression and seizure risk during alcohol withdrawal. The benzodiazepine-AUD overlap is one of the most common dual-substance patterns in the population we serve at Rize Recovery, and it is one of the hardest to safely deprescribe outpatient.

The third is patients with co-occurring opioid use disorder. The FDA’s 2016 black-box update on benzodiazepine-opioid co-prescribing is now a decade old. Concurrent prescribing has declined among Medicare beneficiaries since then, but the absolute level of benzodiazepine exposure has risen — meaning the population at risk for an interaction is larger, not smaller.

The 13-state geography problem

One of the most useful findings in the paper is geographic. Compared to California, <span class="stat">13 states</span> had significantly higher odds of prescribing benzodiazepines for more than 30 days, and <span class="stat">5 states</span> had significantly lower odds. The paper does not name those states publicly in our reading, but the implication is that prescribing culture, not federal policy, is the primary driver of long-duration use. State medical boards, Medicaid managed-care organizations, and academic detailing programs vary enormously in how they handle benzodiazepines — and the data say that variation is showing up in patient exposure.

The paper does not name those states publicly in our reading, but the implication is that prescribing culture, not federal policy, is the primary driver of long-duration use.

For Arizona specifically, the AHCCCS preferred drug list and the state’s prescribing-pattern surveillance through the controlled substances prescription monitoring program (CSPMP) are the operative levers. We are watching for whether the state’s MCO contracts will adopt formal duration limits or step therapy on benzodiazepines as part of the 2027 contract refresh.

Where the field genuinely disagrees

It would be easy to read this paper as a simple “stop prescribing” story. The reality is harder. Many of the older adults represented in those 3.1 million claims have been on benzodiazepines for fifteen or twenty years. Forced or rapid tapers in this population can produce withdrawal seizures, protracted withdrawal syndromes, suicidality, and treatment dropout. The VA-DoD joint clinical practice guideline on benzodiazepine tapering is explicit that prescriber-initiated, patient-centered, gradual tapering — often over six to eighteen months — is the only ethical path for long-term users.

In other words: the work the field needs is not just fewer prescriptions. It is better deprescribing infrastructure — clinical pathways that combine slow taper, sleep hygiene, CBT-I for insomnia, SSRIs or buspirone for anxiety, and peer support for the patients who have been on these medications longer than some of their prescribers have been in practice.

Why this matters for people in recovery

If you are taking a benzodiazepine for anxiety, insomnia, panic, or alcohol-use-disorder management, the right next step is almost never to stop suddenly. It is to talk with your prescriber about whether the duration and dose are still appropriate for you, and — if not — to plan a gradual taper with appropriate behavioral and pharmacologic support. Most people can do this safely; some need more clinical scaffolding than others. None of it should happen in isolation.

If you or someone you love is navigating dependence on a depressant alongside another substance, treatment that addresses both at the same time is more effective than treating them sequentially. Rize’s facility navigator surfaces programs in Arizona that explicitly handle polysubstance presentations, including the benzodiazepine + AUD combination that the data above flags as the most common.

For families: the most useful thing you can know is that benzodiazepine withdrawal is genuinely medical — it is not the kind of thing you can “tough out” at home. If a loved one is trying to stop on their own, the calmest and most useful thing you can do is help them connect with a clinician who specializes in deprescribing.

→ Find a depressant-aware treatment program in Arizona → Read our deprescribing primer for families

If you or someone you know is in crisis, the 988 Suicide and Crisis Lifeline is available 24/7.