Benzodiazepine Prescribing Patterns Following Mass Traumatic Events.

Importance: While clinical guidelines generally advise caution with benzodiazepine use following trauma, prescribing patterns during mass traumatic events reveal tensions between formal recommendations and frontline care delivery. Objective: To assess changes in benzodiazepine prescribing patterns following the October 7, 2023, terrorist attacks in Israel and examine factors associated with prescribing decisions. Design, Setting, and Participants: This population-based retrospective cohort study was conducted using the electronic database of Clalit Health Services in Israel, the country's largest health care service, covering approximately 54% of the population. The number of individuals receiving benzodiazepine prescriptions in the 7- and 30-day periods following the October 7 attacks, in all Clalit Health Services' members aged 18 years or older who were actively insured as of October 7, 2023, were compared with the same population in 2022. Main Outcomes and Measures: The primary outcome was changes in overall and first-time benzodiazepine prescriptions during the 7-day and 30-day periods following October 7, 2023, compared with the same periods in 2022. Secondary outcomes included prescriber characteristics and factors associated with receiving new prescriptions. Results: In a population of nearly 4 million individuals, total benzodiazepine prescriptions increased by 219% in the first week (from 8600 to 27 408) and 57% over 30 days (from 54 969 to 86 568) compared with 2022. First-time prescriptions showed a 10-fold increase in the first week (from 329 to 3690) and a 268% increase over 30 days (from 2751 to 10 135). Primary care physicians issued 92.5% of new prescriptions. Geographic proximity to conflict zones (adjusted odds ratio, 2.34; 95% CI, 1.89-2.90) and preexisting anxiety diagnoses (adjusted odds ratio, 1.79; 95% CI, 1.63-1.96) were significantly associated with receiving new prescriptions. Conclusions and Relevance: In this study, the October 7 attacks were associated with substantial increases in benzodiazepine prescribing, particularly among primary care physicians, revealing the tension between clinical guidelines and pragmatic crisis management. These findings suggest a need to better understand and support frontline prescribing decisions during mass trauma events through enhanced clinician training and support systems.