Physician benzodiazepine self-use prior to and during the COVID-19 pandemic in Ontario, Canada: a population-level cohort study

Daniel Myran; Christina Milani; Michael Pugliese; Jennifer M Hensel; Manish Sood; Claire E Kendall; Tetyana Kendzerska; Peter Tanuseputro

doi:10.1136/bmjopen-2022-062742

Physician benzodiazepine self-use prior to and during the COVID-19 pandemic in Ontario, Canada: a population-level cohort study

BMJ Open. 2023 Apr 21;13(4):e062742. doi: 10.1136/bmjopen-2022-062742.

Authors

Daniel Myran^{1

2

3

4}, Christina Milani^{2

5}, Michael Pugliese^{2

4}, Jennifer M Hensel⁶, Manish Sood^{2

4

7}, Claire E Kendall^{8

2}, Tetyana Kendzerska^{2

4

9}, Peter Tanuseputro^{8

2

4

5}

Affiliations

¹ Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada dmyran@ohri.ca.
² Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
³ Bruyere Research Institute, Ottawa, Ontario, Canada.
⁴ ICES, Ottawa, Ontario, Canada.
⁵ Division of Palliative Care, Bruyere Research Institute, Ottawa, Ontario, Canada.
⁶ University of Manitoba, Winnipeg, Manitoba, Canada.
⁷ Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
⁸ Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada.
⁹ Respirology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.

Abstract

Objectives: The aim of this study was to investigate physician benzodiazepine (BZD) self-use pre-COVID-19 pandemic and to examine changes in BZD self-use during the first year of the pandemic.

Design: Population-based retrospective cohort study using linked routinely collected administrative health data comparing the first year of the pandemic to the period before the pandemic.

Setting: Province of Ontario, Canada between March 2016 and March 2021.

Participants: INTERVENTION: Onset of the COVID-19 pandemic in March 2020.

Outcomes measures: The primary outcome measure was the receipt of one or more prescriptions for BZD, which was captured via the Narcotics Monitoring System.

Results: In a cohort of 30 798 physicians (mean age 42, 47.8% women), we found that during the year before the pandemic, 4.4% of physicians had 1 or more BZD prescriptions. Older physicians (6.8% aged 50+ years), female physicians (5.1%) and physicians with a prior mental health (MH) diagnosis (12.4%) were more likely than younger (3.7% aged <50 years), male physicians (3.8%) and physicians without a prior MH diagnosis (2.9%) to have received 1 or more BZD prescriptions. The first year of the COVID-19 pandemic was associated with a 10.5% decrease (adjusted OR (aOR) 0.85, 95% CI: 0.80 to 0.91) in the number of physicians with 1 or more BZD prescriptions compared with the year before the pandemic. Female physicians were less likely to reduce BZD self-use (aOR_female=0.90, 95% CI: 0.83 to 0.98) compared with male physicians (aOR_male=0.79, 95% CI: 0.72 to 0.87, p_interaction=0.046 during the pandemic. Physicians presenting with an incident MH visit had higher odds of filling a BZD prescription during COVID-19 compared with the prior year.

Conclusions: Physicians' BZD prescriptions decreased during the first year of the COVID-19 pandemic in Ontario, Canada. These findings suggest that previously reported increases in mental distress and MH visits among physicians during the pandemic did not lead to greater self-use of BZDs.

Keywords: EPIDEMIOLOGY; Health policy; MEDICAL EDUCATION & TRAINING; PUBLIC HEALTH.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Benzodiazepines / therapeutic use
COVID-19* / epidemiology
Cohort Studies
Female
Humans
Male
Ontario / epidemiology
Pandemics
Physicians*
Retrospective Studies

Substances

Benzodiazepines