Benzodiazepine prescribing practices for homeless veterans with mental illness

What question were you researching?

Despite the increased risk for substance use disorder and overdose death in the homeless population, benzodiazepine prescribing for this population has not been examined.

Therefore, our team decided to answer the questions:

• What is the rate of benzodiazepine prescribing in homeless versus non-homeless veterans with mental illness in the VA system?
• Are homeless veterans more likely to receive dangerous and potentially inappropriate prescriptions?

What methods did you use?

We used logistic regression to compare the likelihood of benzodiazepine prescribing and tests to compare indicators of risky and potentially inappropriate benzodiazepine prescribing patterns for homeless veterans with mental illness and their housed counterparts.

Our approach was unique in that it is the first study to attempt to investigate this question. We were able to do this in a large, national VA database, the nation’s largest provider of homeless services.

what did you find

We found that although homeless veterans were less likely than their housed peers to receive a benzodiazepine prescription, they were more likely to receive risky and possibly appropriate prescriptions, including multiple concurrent benzodiazepine prescriptions and concurrent prescriptions for benzodiazepines and opioids or sedatives.

What are the consequences;

To our knowledge, this was the first study to examine prescribing patterns for benzodiazepines as treatments for a homeless population, providing new evidence for a vulnerable and understudied population at high risk for substance use disorder, overdose, and death. These findings of high co-prescription rates with other sedative medications are of significant clinical concern, given that drug overdose death in the homeless population is the leading cause of death, at rates up to 30 times higher than the general US population. Our results highlight the need for increased attention to safe benzodiazepine prescribing practices for homeless veterans.

What are the next steps?

We hope the paper can inform clinicians about the importance of judicious prescribing of benzodiazepines in homeless patients and encourage providers to discuss with patients whether and how they are combining substances when considering whether to prescribe benzodiazepines.