Benzodiazepines linked to increased risk for drug overdose among young people

Benzodiazepines, compared with alternative pharmacologic treatments for common sleep disorders, were linked to an increased risk for drug overdoses among young people, researchers reported in JAMA Network Open.

Benzodiazepines are prescribed for the treatment of adolescent sleep disorders. However, overdoses occur, often in combination with opioids, Greta A. Bushnell, PhD, of the center for pharmacoepidemiology and treatment sciences at Rutgers Institute for Health in New Brunswick, New Jersey, and colleagues wrote.

Bushnell and colleagues sought to evaluate whether benzodiazepine treatment for sleep disorders, compared with alternative pharmacologic treatments — trazodone, hydroxyzine, zolpidem, zaleplon, or eszopiclone — were associated with increased risk for drug overdoses.

The researchers conducted a cohort study that included privately insured people aged 10 to 29 years identified from a United States commercial claims database. Young people with a sleep disorder diagnosis initiating benzodiazepine (n = 23,084) or comparator pharmacologic treatments (n = 66,706) were included in the study.

The study included 23,084 young people initiating benzodiazepine treatment (62.6% female; mean age, 23 years) and 66,706 initiating a comparator treatment (57.6% female; mean age, 22 years).

Six months after treatment initiation, 9.7% (95% CI, 9.3%-10.1%) of benzodiazepine users and 12.3% (95% CI, 12.1%-12.6%) of the comparator group were still receiving treatment. The crude incidence of drug overdose at 6 months was 0.9% for benzodiazepine users and 0.8% for those taking comparator treatments, the authors wrote.

In adjusted analyses, an increased risk of drug overdose was associated with benzodiazepine compared with other treatments (intention-to-treat analysis: HR, 1.25; 95% CI, 1.03-1.51; as-treated analysis: HR, 1.44; 95% CI, 1.14-1.8). The association was stronger among young people with a recent prescription opioid fill compared with those without a prescription fill (as-treated analysis: aHR, 2.01; 95% CI, 1.24-3.25 vs. aHR, 1.31; 95% CI, 1-1.7).

“When treating young people for sleep disorders, it is important to consider the elevated risk of drug overdose with benzodiazepine treatment compared with alternative pharmacologic treatments,” Bushnell and colleagues wrote. “Adolescence and young adulthood are critical periods for which rigorous information is needed on the risks of benzodiazepine and other treatments for sleep disorders, given the consequences of sleep disorders and the potential for treating insomnia to reduce adverse outcomes.”