Overdoses in youth with benzodiazepine and stimulant prescriptions

1. A retrospective analysis found that 29% of youth with benzodiazepine overdose and 25% of youth with stimulant overdose had a prescription dispensed in the last 30 days.

2. There was a higher proportion of intentional overdoses with recent benzodiazepine or stimulant prescriptions, and affected youth were more likely to be female than male.

 Evidence level: 2 (good)

 Study Rundown: Between 2015-2018, more than 10% of U.S youth and young adults simultaneously used two or more psychoactive prescription medications. This retrospective study used an insurance claims database to assess the prevalence of benzodiazepine (BZD) and stimulant prescriptions in youth treated for an overdose of these substances. Nearly 3,000 youth who experienced a BZD overdose and 971 youth with a stimulant overdose were included in the study. 42% of youth with BZD overdoses and 39% of youth with stimulant overdoses had a prescription dispensed in the previous 6 months. Depression and anxiety disorders were the most common mental health diagnoses in those with BZD overdoses whereas ADHD was most common amongst those with stimulant overdoses. A strength of this study is that it stratifies results between intentional self-harm versus accidental overdoses, helping prioritize targets for intervention. However, the retrospective study design, use of private insurance-based data, and exclusion of non-hospital-based overdoses and unreported fatal overdoses are major limitations. Overall, this study highlights the significant prevalence of recent prescriptions amongst youth who experience BZD and stimulant overdoses.

Click here to read the original article in Pediatrics

Relevant reading: Medical use and misuse of psychoactive prescription medications among US youth and young adults

In-depth [retrospective cohort]: This is a retrospective study analyzing data from MarketScan commercial claims between January 1, 2016, and December 31, 2018. Individuals aged 15-24 who had >6 months of insurance enrolment with prescription coverage and who had overdoses treated in the emergency room or as an inpatient were included in the study. The primary variable of interest was the proportion of youth with BZD or stimulant (methylphenidate or amphetamine) prescription prior to a first-time overdose. Results were divided between intentional and accidental overdoses. 29% of youth with BZD overdoses and 25% youth with stimulant overdose had a prescription in the previous 30 days. Within the stimulant category, overdoses involving methylphenidate were more common (64.4%) compared to those due to amphetamine (31.8%). Amongst youth with BZD or stimulant prescriptions in the previous 6 months, 73% had an anxiety disorder diagnosis and 71% had an ADHD diagnosis. Youth with a BZD overdose had a median age at overdose of 20 years, with intentional overdoses being more prevalent in females (62.8%) than males (p<0.001). Youth with a stimulant overdose had a median age at overdose of 19 years with an intentional overdose being more common in females (54.2%) than males (p<0.001).

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