Identification of Study Participants and Drug Classification

All enrolled persons ≥18 years, which were prescribed at least one benzodiazepine or Z-drug in 2018, were included. Benzodiazepines and Z-drugs are available only by prescription in Switzerland. Prescribers do not have any information about prescription from other physicians. Every prescribed drug purchased in a pharmacy is charged to the health insurance company. Benzodiazepines and Z-drugs were classified based on their therapeutic and chemical properties according to the Anatomical Therapeutic Chemical (ATC) classification system of the World Health Organization.29 Anxiolytic benzodiazepines were classified under N05BAxx, sedative benzodiazepines were classified under N05CDxx and Z-drugs under N05CFxx. Benzodiazepines, which were used for the treatment of epilepsy (clonazepam (N03AE01), midazolam (N03AE02)), were excluded.

Additionally, benzodiazepines were categorized as short-acting for a half-life (t1/2) <24 h and long-acting for a half-life (t1/2) >24 h.1 According to the Ashton Manual classification of long-acting and short-acting benzodiazepines and similar drugs were defined as follows: Oxazepam (N05BA04), Lorazepam (N05BA06), Bromazepam (N05BA08), Alprazolam (N05BA12), Triazolam (N05CD05), Lormetazepam (N05CD06), Temazepam (N05CD07), Midazolam (N05CD08), Zopiclone (N05CF01) and Zolpidem (N05CF02) were classified as short-acting agents. Diazepam (N05BA01), Chlordiazepoxid (N05BA02), Clorazepate (N05BA05), Clobazam (N05BA09), Ketazolam (N05BA10), Prazepam (N05BA11), Flurazepam (N05CD01), Nitrazepam (N05CD02) and Flunitrapezam (N05CD03) were classified as long-acting agents.30

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