Anxiolytic-hypnotic drugs: relationships between prescribing, abuse and suicide. 1991

A Melander, and K Henricson, and P Stenberg, and P Löwenhielm, and J Malmvik, and B Sternebring, and L Kaij, and U Bergdahl
Department of Clinical Pharmacology, University of Lund, Sweden.

In 1978 the third largest Swedish city, Malmö, known to have the highest suicide frequency in the country, was found to have a higher prescription rate (defined daily doses (DDD) per 1,000 inhabitants per day) of anxiolytic-hypnotic drugs (AHD) than the country, the corresponding county, other counties, and other cities, including the largest (Stockholm) and second largest (Göteborg = Gothenburg) cities. Barbiturate prescribing in Malmö was 40% higher than in Stockholm and 90% higher than in Göteborg, and the frequency of suicide due to barbiturates was three-times higher than in Göteborg. A small proportion (2.4% of all AHD-prescribing doctors) of private practitioners wrote a large percentage (24%) of all AHD prescriptions. Prescription surveillance and an information campaign in Malmö were accompanied by a 4-year decrease in AHD prescribing (12%), in AHD abuse (40%), in barbiturate prescribing (45%), and in barbiturate suicides (70%). The total suicide rate was reduced by 25%. There was no corresponding 4-year increase in suicide due to other drugs, or by other means, but after 5 to 7 years there was an increase in suicide by non-pharmacological means. The contribution of benzodiazepines to the frequency of suicide was very small, whereas their contribution to AHD abuse was considerable. In Göteborg, where no corresponding intervention was carried out, there was also a reduction in barbiturate prescribing (34%) and in barbiturate suicides (45%), but in contrast there was a continuous increase both in overall AHD and benzodiazepine prescribing, surpassing Malmö after 5 years. Far from a reduction there was a 7-year increase in the overall frequency of suicide. Apparently, AHD abuse and suicide can be greatly reduced by restricted prescribing of AHD, and this may but need not be accompanied by an increase in suicide by other means. Targeted drug information campaigns may assist in changing prescription patterns and their medical and social impact.

UI MeSH Term Description Entries
D006993 Hypnotics and Sedatives Drugs used to induce drowsiness or sleep or to reduce psychological excitement or anxiety. Hypnotic,Sedative,Sedative and Hypnotic,Sedatives,Hypnotic Effect,Hypnotic Effects,Hypnotics,Sedative Effect,Sedative Effects,Sedatives and Hypnotics,Effect, Hypnotic,Effect, Sedative,Effects, Hypnotic,Effects, Sedative,Hypnotic and Sedative
D010818 Practice Patterns, Physicians' Patterns of practice related to diagnosis and treatment as especially influenced by cost of the service requested and provided. Clinical Practice Patterns,Physician's Practice Patterns,Clinical Practice Pattern,Pattern, Clinical Practice,Patterns, Clinical Practice,Practice Pattern, Clinical,Practice Patterns, Clinical,Practice Patterns, Physician's,Prescribing Patterns, Physician,Physician Practice Patterns,Physician Prescribing Pattern,Physician Prescribing Patterns,Physician's Practice Pattern,Physicians' Practice Pattern,Physicians' Practice Patterns,Practice Pattern, Physician's,Practice Pattern, Physicians',Practice Patterns, Physician,Prescribing Pattern, Physician
D011307 Drug Prescriptions Directions written for the obtaining and use of DRUGS. Drug Prescribing,Drug Prescription,Drug Prescribings,Prescribing, Drug,Prescribings, Drug
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D013405 Suicide The act of killing oneself. Suicides
D013548 Sweden Country in northern Europe, bordering the Baltic Sea, between Finland and Norway. The capital is Stockholm.
D014151 Anti-Anxiety Agents Agents that alleviate ANXIETY, tension, and ANXIETY DISORDERS, promote sedation, and have a calming effect without affecting clarity of consciousness or neurologic conditions. ADRENERGIC BETA-ANTAGONISTS are commonly used in the symptomatic treatment of anxiety but are not included here. Anti-Anxiety Agent,Anti-Anxiety Drug,Anxiolytic,Anxiolytic Agent,Anxiolytic Agents,Tranquilizing Agents, Minor,Anti-Anxiety Drugs,Anti-Anxiety Effect,Anti-Anxiety Effects,Antianxiety Effect,Antianxiety Effects,Anxiolytic Effect,Anxiolytic Effects,Anxiolytics,Tranquillizing Agents, Minor,Agent, Anti-Anxiety,Agent, Anxiolytic,Agents, Anti-Anxiety,Agents, Anxiolytic,Agents, Minor Tranquilizing,Agents, Minor Tranquillizing,Anti Anxiety Agent,Anti Anxiety Agents,Anti Anxiety Drug,Anti Anxiety Drugs,Anti Anxiety Effect,Anti Anxiety Effects,Drug, Anti-Anxiety,Drugs, Anti-Anxiety,Effect, Anti-Anxiety,Effect, Antianxiety,Effect, Anxiolytic,Effects, Anti-Anxiety,Effects, Antianxiety,Effects, Anxiolytic,Minor Tranquilizing Agents,Minor Tranquillizing Agents
D019966 Substance-Related Disorders Disorders related to substance use or abuse. Chemical Dependence,Drug Abuse,Drug Addiction,Drug Dependence,Drug Habituation,Drug Use Disorder,Drug Use Disorders,Organic Mental Disorders, Substance-Induced,Substance Abuse,Substance Dependence,Substance Related Disorder,Substance Use,Substance Use Disorder,Substance Use Disorders,Prescription Drug Abuse,Substance Addiction,Abuse, Drug,Abuse, Prescription Drug,Abuse, Substance,Addiction, Drug,Addiction, Substance,Chemical Dependences,Dependence, Chemical,Dependence, Drug,Dependence, Substance,Dependences, Chemical,Disorder, Drug Use,Disorder, Substance Related,Disorder, Substance Use,Disorders, Substance Related,Drug Abuse, Prescription,Habituation, Drug,Organic Mental Disorders, Substance Induced,Related Disorder, Substance,Related Disorders, Substance,Substance Abuses,Substance Uses,Use, Substance

Related Publications

A Melander, and K Henricson, and P Stenberg, and P Löwenhielm, and J Malmvik, and B Sternebring, and L Kaij, and U Bergdahl
June 2015, Nihon rinsho. Japanese journal of clinical medicine,
A Melander, and K Henricson, and P Stenberg, and P Löwenhielm, and J Malmvik, and B Sternebring, and L Kaij, and U Bergdahl
June 1991, Drug and alcohol dependence,
A Melander, and K Henricson, and P Stenberg, and P Löwenhielm, and J Malmvik, and B Sternebring, and L Kaij, and U Bergdahl
January 2008, The European journal of general practice,
A Melander, and K Henricson, and P Stenberg, and P Löwenhielm, and J Malmvik, and B Sternebring, and L Kaij, and U Bergdahl
October 1984, Lakartidningen,
A Melander, and K Henricson, and P Stenberg, and P Löwenhielm, and J Malmvik, and B Sternebring, and L Kaij, and U Bergdahl
December 2007, Pharmacy world & science : PWS,
A Melander, and K Henricson, and P Stenberg, and P Löwenhielm, and J Malmvik, and B Sternebring, and L Kaij, and U Bergdahl
January 1991, Farmaco (Societa chimica italiana : 1989),
A Melander, and K Henricson, and P Stenberg, and P Löwenhielm, and J Malmvik, and B Sternebring, and L Kaij, and U Bergdahl
January 1964, Laeknabladid,
A Melander, and K Henricson, and P Stenberg, and P Löwenhielm, and J Malmvik, and B Sternebring, and L Kaij, and U Bergdahl
June 1994, European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology,
A Melander, and K Henricson, and P Stenberg, and P Löwenhielm, and J Malmvik, and B Sternebring, and L Kaij, and U Bergdahl
September 1973, Annals of internal medicine,
A Melander, and K Henricson, and P Stenberg, and P Löwenhielm, and J Malmvik, and B Sternebring, and L Kaij, and U Bergdahl
January 2016, Journal of family medicine and primary care,
Copied contents to your clipboard!