INNOVATIONS in pharmacy

Prevalence and Predictors of Non-Benzodiazepine Use in Patients with Alcohol Withdrawal Syndrome in United States Emergency Departments – a cross-sectional study

Kirolos Zakhary

Northeast Ohio Medical University

Sophia Bruno

Northeast Ohio Medical University

Caleb Myatt

Northeast Ohio Medical University

Vindya Perera

Ohio State University Wexner Medical Center

Kerolese Saleh

Northeast Ohio Medical University

Jacob Smearman

Cleveland Clinic Akron General Medical Center

Madeline Yuzwa

Northeast Ohio Medical University

Mate Soric

Northeast Ohio Medical University

Stephanie Zampino

Summa Health Akron Campus

DOI: https://doi.org/10.24926/iip.v15i3.6270

Keywords: alcohol, withdrawal, non-benzodiazepine, emergency

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Abstract

Purpose:

Benzodiazepines are the mainstay treatment in Alcohol Withdrawal Syndrome (AWS), though they have the potential for abuse and cognitive side effects. Non-benzodiazepines are of growing interest for treatment of AWS; however, the prevalence of non-benzodiazepine use remains unknown. The purpose of this study is to evaluate the prevalence and predictors of non-benzodiazepine use for AWS in the Emergency Department (ED).

Methods:

A cross-sectional, retrospective study utilizing data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) spanning the years 2014-2020 investigated patients presenting to the ED with AWS. The primary outcome of this study is the prevalence of patients with AWS who received non-benzodiazepine treatment during their ED visit. The secondary outcome was the identification of predictor variables for non-benzodiazepine use. A multivariate logistic regression with a backward elimination approach was employed to identify predictor variables.

Results:

A total of 2,300 unweighted ED visits included over the study years. When weighted, this represented over 15.2 million ED visits. Across the study period, 3.1% (95% CI, 1.6-6.1%) of patients received non-benzodiazepines. Positive predictors of non-benzodiazepine use included the year 2020 compared to 2014 (OR 6.32, 95% CI, 1.39-28.73) and comorbid depression (OR 4.13, 95% CI, 1.38-12.36). Negative predictors of non-benzodiazepine use included ages 18-40 compared to ages 41-64 (OR 0.34, 95% CI, 0.13-0.91), nursing home residence compared to private residence (OR 0.02, 95% CI, 0.001-0.80), and the South compared to the Midwest region of the United States (OR 0.19, 95% CI, 0.07- 0.51).

Conclusion:

This study found that non-benzodiazepine use, despite being less common, is becoming more prevalent. Further research is needed to determine the optimal dosing and duration of non-benzodiazepines for AWS. Understanding the factors influencing the prescription patterns of non-benzodiazepines can contribute to informed decision-making and improve the management of AWS.