Benzodiazepines consumption in Albania during 2015-2020
Joana Mihani-Faculty of Medicine, Tirana, Albania
Introduction Benzodiazepines (BZD) are a class of psychoactive drugs. Some of the most used drugs within
this group are: Diazepam, Chlordiazepoxide, Lorazepam, Bromazepam, Alprazolam, Clonazepam etc. BZD
are prescribed for several clinical indications: insomnia, anxiolytics, panic attack, muscle relaxant,
adjuvant in bipolar therapy, alcohol withdrawal syndrome, epilepsy (1). The wide use and popularity of
BZD have increased concerns for abuse and dependence potential with the use of these drugs (2). There
are very few studies focused on BDZ use in Albania. So far, health authorities have evidenced the
phenomenon of drugs getting dispensed without medical prescription in Albania (3).
Study aims: The most important aim of this study is to evidence in qualitative terms BZD use from
reimbursed scheme and compare it with overall pharmaceutical market consumption using the World
Health Organization (WHO) ATC/DDD methodology, which is a golden standard recommended for drug
utilization studies (4).
Material and methods: The ATC/DDD methodology of WHO was applied and defined daily doses/1000
inhabitants/day (DID) for every BDZ part of drug reimbursed list (RDL) from 2015-2020 were calculated,
using official data published in the website of Drug Reimbursed Found of Albania (www.fsdksh.com.al). In
the website data for reimbursed scheme consumption, and the total consumption are found. A
Reimbursed DID and Dispensed DID were calculated (5,6,7,8). Population data were found in the Albanian
National Institute of Statistics (9).
Results:
• Five BDZ were part of RDL during 2015-2020: Clonazepam, Diazepam, Chlordiazepoksid,
Clorazepat dipotassium and Lorazepam. Most used drug is Lorazepam
• In the reimbursed scheme the year with the higher consumption level is 2015 with 1.39 DID.
• Mean consumption in the study period is 0.99 DID, so almost 1 in 1000 (0.1% of Albanian
population) has used one of the BDZ part of RDL using the reimbursed scheme every day of the
year.
1.60
1.40
1.20
1.00
0.80
0.60
0.40
0.20
-
2015 2016 2017 2018 2019 2020
Lorazepam 0.77 0.68 0.61 0.15 0.35 0.42
Chlorazepate
Dipotassium
0.02 0.02 0.01 0.00 0.00 -
Chlordiazepoxide 0.14 0.12 0.12 0.12 0.13 0.13
Diazepam 0.33 0.27 0.25 0.23 0.21 0.18
Clonazepam 0.13 0.13 0.11 0.11 0.11 0.10
Chart 1: Reimbursed DID during 2015-2020
Dispensed DDD calculated for the same period are like shown in chart 2.
15.00
10.00
5.00
-
2015 2016 2017 2018 2019 2020
Lorazepam 6.18 7.65 6.32 2.65 1.59 4.62
Chlorazepate Dipotassium 0.09 0.14 0.00
Chlordiazepoxide 0.98 0.96 1.41 0.94 0.44 0.33
Diazepam 4.60 4.11 3.95 3.08 2.03 1.62
Clonazepam 0.44 0.55 0.44 0.39 0.34 0.46
Chart 2: Dispensed DDD/1000 inhabitants/day during 2015-2020
• The year with higher overall consumption is 2016 and lower was 2019, but in 2020 the rising trend
is clear.
• Mean Dispensed DID was 9.38.
• BDZ consumption has varied during the period a lot, especially the most used drug Lorazepam has
been subject to these changes.
• Overall consumption decries drastically in 2019, and this may be due to Ministry of Health controls
to pharmacies in the end of 2018, to prevent BDZ dispensed without medical prescriptions (3).
• Reimbursed DDD is only 10% of total Dispensed DDD, and this means that Albanian pay a lot out
of pocket for BDZ, and part of this could be the drug to be taken without medical prescription.
• The situation is worst if we consider that not all BDZ that are part of Albanian pharmaceutical
market are part of RDL
• In 2020 we see a rising trend of consumption, this maybe due to lock down and Covid-2019
promoted stress.
Recommandations
• RDL should be expanded will more BDZ drugs available in the Albanian Pharmaceutical market.
• Lowing the burden of out of pocked BDZ use for Albanian patients because reimbursed scheme
covers only 10% of overall consumption.
• Continuous control and monitoring of pharmaceutical market is highly recommended to prevent
relapse of this drugs used without medical prescription.
• Especially, Lorazepam should be monitored with special attentions because is the drug with the
higher variation of consumption.
• The 2020 rising usage trend should be addressed in what proportion is due to Covid-2019 effect.
• Implementing a strategy for continuous usage of drug utilization studies as an effective tool for
monitoring the quality of health system.
• Information of population of mental health issues and special need for consulting a specialist
when using drugs related to these health problems.
References
1. Griffin CE 3rd, Kaye AM, Bueno FR, Kaye AD. Benzodiazepine pharmacology and central nervous system-mediated effects. Ochsner J. 2013;13(2):214-223. PMCID: PMC3684331 PMID: 23789008.
2. Wick JY. The history of benzodiazepines. The Consultant Pharmacist : the Journal of the American Society of Consultant Pharmacists. 2013 Sep;28(9):538-548. DOI: 10.4140/tcp.n.2013.538.
PMID: 24007886.
3. Drugs without prescription. Controls in pharmacies are intensified. https://www.shendetesia.gov.al/barnat-pa-recete-intensifikohen-kontrollet-ne- farmaci/ Published: 11 October 2018.
Accessed: 20 July 2021
4. The ATC/DDD Methodology. https://www.who.int/tools/atc-ddd-toolkit/methodology. Last Accessed: 331 May 2021
5. Reports and statistics FSDKSH. https://fsdksh.gov.al/statistika/. Last Accessed: 31 May 2021
6. ATC/DDD Index N05CD Benzodiazepine derivatives. https://www.whocc.no/atc_ddd_index/?code=N05CD&showdescription=no. Last Accessed: 20 March 2021
7. ATC/DDD Index N05BA Benzodiazepine derivatives. https://www.whocc.no/atc_ddd_index/?code=N05BA&showdescription=no. Last Accessed: 20 March 2021
8. ATC/DDD Index N03AE Benzodiazepine derivatives. https://www.whocc.no/atc_ddd_index/?code=N03AE&showdescription=no. Last Accessed: 20 March 2021
9. INSTAT population. http://www.instat.gov.al/al/temat/treguesit-demografik%C3%AB-dhe-social%C3%AB/popullsia/#tab3. Last Accessed: 20 March 2021
