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A study of more than 1.1 billion U.S. benzodiazepine prescription fills found that the number dispensed fell 26.7% between 2013 and 2024. The average dose per prescription also declined, but the researchers say the trends may reflect more selective prescribing and do not, by themselves, establish why prescribing changed or how patient outcomes were affected.
A Rutgers-led study found that U.S. benzodiazepine prescription fills fell 26.7% from 2013 to 2024, with the average dose per prescription also decreasing. The analysis covered more than 1.1 billion fills; its authors say the pattern may reflect more cautious prescribing, though the data do not establish what caused the decline or whether it improved patient outcomes.
Published in the American Journal of Psychiatry, the study examined national trends in dispensing for benzodiazepines, a group of medicines that includes Xanax, Valium, Ativan and Klonopin. These drugs slow activity in the central nervous system and are used for conditions including anxiety, panic attacks, insomnia and some seizure disorders. The researchers reported a 26.7% decrease in prescription fills over the 2013–2024 period.
The study also found that the average dose per prescription declined 18.3%. Prescribing prevalence fell across the patient populations examined, with the largest decline among adults ages 18 to 29. The report did not identify a single cause for these changes; the authors described more selective prescribing as a possible explanation rather than a proven one.
The analysis found shifts in the types of clinicians writing prescriptions. Prescriptions from primary care physicians and psychiatrists decreased, while those from advanced practice providers, including nurse practitioners and physician assistants, increased. These are trends in dispensing and prescriber mix; they do not show, on their own, whether individual patients stopped treatment, switched clinicians or received alternative care.
What the Decline May Signal
Benzodiazepines can provide meaningful benefits, but their risks are a continuing concern, particularly with long-term use or combination with other drugs. The study’s authors note that these medicines are increasingly involved in overdose deaths, many involving other substances such as opioids. The decrease in fills and average dose may indicate changes in how clinicians weigh those benefits and risks, but the study does not demonstrate that prescribing changes caused a reduction in harm.
The findings matter because a national change in medication dispensing can inform discussion of prescribing practices and patient safety. A lower fill count is not automatically evidence of better care: patients’ needs differ, and the reported figures do not reveal whether reduced prescribing was appropriate in each case or whether people had access to effective alternatives. The authors’ emphasis is on continued monitoring, rather than treating the decline alone as proof of a safer system.
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Warnings and Prescribing Trends
Benzodiazepines are widely prescribed in the United States, and federal safety warnings have addressed risks when they are combined with opioids and concerns about medication misuse. The Food and Drug Administration issued warnings related to these issues in 2016 and 2020, according to the report. The study documents dispensing trends across the decade in which those warnings were issued; it does not isolate their effect from other possible influences on prescribing.
The research was led by Naomi Cruz, a recent doctoral graduate of the Rutgers School of Public Health and the Rutgers Center for Pharmacoepidemiology and Treatment Science. Coauthors included researchers from Rutgers and Columbia University. The study, “National Trends in Benzodiazepine Dispensing,” was published in 2026 and received partial support from the National Institute on Drug Abuse. The authors state that the study’s contents do not necessarily represent the official views of the National Institutes of Health.
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What the Dispensing Data Cannot Show
The findings establish changes in prescription fills and average dose, but they do not explain why those measures fell. The study report does not show how much of the decline reflects updated clinical judgment, changes in patient demand, shifts in health care delivery or other factors. It also does not establish whether the FDA warnings directly changed prescribing behavior.
The reported trends do not, by themselves, reveal how many patients experienced withdrawal, changed to other treatments, or lost access to medication they needed. Nor do they show whether overdose deaths or other health outcomes changed as a result of the dispensing patterns. The authors call for continued monitoring, and the available findings should not be taken as individual medical guidance. Patients should discuss medication changes with a qualified health professional.
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Further Study of Prescribing and Outcomes
The researchers say ongoing work is needed to track how prescribing practices evolve and identify where care can improve. A next step for research would be to examine the reasons behind changes in fills and dose, alongside patient access, treatment choices and health outcomes. The study report does not announce a specific follow-up date or a planned next analysis.
For now, the 2013–2024 figures provide a national account of declining benzodiazepine dispensing and changing prescriber patterns. Whether those trends amount to safer care will depend on evidence beyond prescription counts, including whether patients receive appropriate treatment and avoid preventable harms.
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Key Questions
How much did benzodiazepine dispensing decline?
The study found that U.S. benzodiazepine prescription fills decreased 26.7% from 2013 to 2024. It analyzed more than 1.1 billion fills.
Did the average dose also change?
Yes. The researchers reported an 18.3% decline in the average dose per prescription over the period studied.
Does the study prove doctors became more cautious?
No. The authors said the trends may suggest more cautious or selective prescribing, but the analysis does not establish the cause of the decline.
Which patients saw the largest decrease?
The largest decline in prevalence was reported among adults ages 18 to 29. The report also found declines across the patient populations examined.
Should patients change their medication because of these findings?
No. The study reports national trends, not instructions for individual treatment. Anyone considering a medication change should consult a qualified health professional.
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