Dispensing of benzodiazepines and benzodiazepine-related drugs in Estonia, Latvia and Lithuania: a cross-national drug utilisation study

PURPOSE OF ARTICLE: Although isolated reports indicate widespread use of benzodiazepines and benzodiazepine-related drugs (BZRDs) in the Baltic States, utilisation patterns remain poorly described. We examined utilisation patterns of benzodiazepines and BZRDs in Estonia, Latvia, and Lithuania. MATERIALS AND METHODS: A drug utilisation study was conducted using nationwide prescription databases from the Baltic states between 2019 and 2023. Dispensed benzodiazepine and BZRD prescriptions were identified using Anatomical Therapeutic Chemical codes: anxiolytic benzodiazepines (N05BA); hypnotic benzodiazepines (N05CD); antiepileptic benzodiazepines (N03AE); and BZRDs (N05CF). Annual incidence and prevalence per 1,000 inhabitants were calculated. Therapeutic intensity was assessed as defined daily doses (DDDs) per user per year. RESULTS: Between 2019 and 2023, incidence of benzodiazepine and BZRD use declined in Estonia (from 40.8 to 32.8 users/1,000 inhabitants), remained stable in Latvia (46.5-48.9 users/1,000 inhabitants), and fluctuated in Lithuania (44.4-56.8 users/1,000 inhabitants). Prevalence decreased in Estonia from 103.0 to 94.0 users/1,000 inhabitants, but increased in Latvia and Lithuania until 2022, followed by a decline in 2023 to 102.0 and 117.6 users/1,000 inhabitants. Incidence and prevalence of all benzodiazepine and BZRD classes declined in Estonia. Although antiepileptic benzodiazepine use declined in Latvia and Lithuania, BZRD use increased. In Lithuania, prevalence of hypnotic and anxiolytic benzodiazepines increased. In 2023, therapeutic intensity reached 121 DDDs/user in Estonia, 92 DDDs/user in Latvia, and 97 DDDs/user in Lithuania. CONCLUSIONS: Benzodiazepine and BZRD use remained high in the Baltic states. Estonia showed the lowest prevalence but highest therapeutic intensity. In Latvia and Lithuania, overall use changed little. Continuous monitoring of prescribing practices is warranted.