High prescribing and state-level variation in z-drug use among Medicare patients

BackgroundZ-drugs are nonbenzodiazepine hypnotics used for sleep initiation and maintenance that have been shown to increase the risk of fall-related injuries in patients aged 65 and older. The American Geriatrics Society Beers criteria classifies them as a high-risk medication and strongly recommends avoiding prescribing z-drugs to the elderly due to adverse effects. The objective of this study was to determine the prevalence of Z-drug prescribing among Medicare patients. MethodsZ-drug prescription data was extracted from the Centers for Medicare and Medicaid Services State Drug Utilization Data (CMS SDUD) 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 prescribed by providers within each specialty was also determined. ResultsZolpidem was the most prescribed z-drug, making up 95.0% of all z-drug prescriptions. Prescriptions per 100 enrollees were significantly elevated in Utah (28.2) and Arkansas (26.7) and significantly lower in Hawaii (9.3) relative to the national average (17.5). The specialties 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 elevated for psychiatry relative to other specialties. ConclusionsContrary to the Beers criteria, z-drugs are being prescribed to Medicare enrollees over age 65 at high rates. While sleep disturbances in the elderly should not be ignored, alternative therapies must be considered to avoid the serious adverse effects of z-drugs. Key PointsMore than one-half million Medicare patients received z-drug prescriptions in 2018 that were inconsistent with the Beers criteria. Z-drug prescriptions per 100,000 Medicare patients were significantly elevated in Utah and Arkansas. Family Medicine had the highest number of prescriptions out of all medical specialties. Psychiatry had a significantly higher number of prescriptions per provider compared to all other specialties.