#VisualAbstract: Only one quarter of benzodiazepine prescriptions in youth are for approved indication

1. This cohort study analyzed health care claims from 2008-2019 and found that benzodiazepine prescribing in adolescents and young adults peaked in 2015 and 2013 respectively, and has been declining since.

2. Only approximately one quarter of cases involved an approved indication for benzodiazepine use, raising alarms that these medications are frequently being prescribed for indications that are not evidence-based.

Evidence Rating Level: 2 (Good)

Study Rundown (retrospective cohort): In addition to being dangerous and addictive substances themselves, benzodiazepines are also associated with an increased risk of opioid-related mortality in children and adolescents. This study sought to analyze and describe trends in youth benzodiazepine prescribing between 2008 and 2019. Researchers collected health care claim data from a commercial insurance plan that covered over four million adolescents (aged 13-18), and six million young adults (aged 19-25). Overall, benzodiazepines were prescribed at least once to 1.8% of adolescents and 4.0% of young adults, with diazepam being most the most common choice in adolescents and alprazolam in young adults. A simultaneous opioid prescription was provided to 26.1% of the adolescents receiving benzodiazepines, and 24.0% of young adults. Prevalence of benzodiazepine dispensing peaked in 2015 for adolescents and in 2013 for young adults, and subsequently decreased steadily until the end of the study period. Alarmingly, only one quarter of cases involved an approved indication for benzodiazepine use.

This study highlights the frequency of use of these dangerous medications despite a lack of evidence-based indications. Clinicians should remain judicious in their use of these medications, only prescribing when necessary for approved indications and limiting co-prescription with opioids when possible. This study is strengthened by its very large cohort, though limited in that data was gathered from a single private insurance provider and may not be generalizable to those who use Medicaid or are uninsured. It also relies on diagnostic coding to assess indications for prescription, which can be unreliable.

Click to read the study in JAMA Pediatrics

Relevant Reading: Child and adolescent benzodiazepine exposure and overdose in the United States: 16 years of poison center data

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