A new study published in JAMA Open Network looked at the association of benzodiazepine treatment for sleep disorders with a drug overdose risk among young people.

“Benzodiazepines are a treatment option for sleep disorders,” study author Greta A. Bushnell told us. “However, overdose is a potential concern with benzodiazepines, particularly when used with other central nervous system depressants such as opioids. Given the lack of safety data in young populations, we wanted to determine whether youth initiating benzodiazepines had an increased risk of drug overdose compared with alternative prescription treatments for sleep disorders.”

The research team’s hypothesis was that there would be an elevated risk of drug overdose within the first six months for young people starting benzodiazepine treatment compared to young people starting alternative prescription treatments.

“Most of the available safety data on benzodiazepine treatment is from adult populations,” Bushnell told us. “Through this study, we sought to add to information on the safety of benzodiazepine treatment in adolescents and young adults.”

While benzodiazepines are commonly involved in overdoses in adolescents and young adults, the risk of an overdose following prescribed benzodiazepine treatment and whether the risk was elevated compared to alternative prescription medications were unknown.

“To answer this research question, we utilized a large national commercial claims database,” Bushnell told us. “We identified young people aged 10-29 years with a sleep disorder diagnosis who initiated benzodiazepine treatment or an alternative prescription medication, specifically trazodone, hydroxyzine, or Z-hypnotics.”

Researchers then identified drug overdose events from an emergency department or inpatient setting within the six months following treatment initiation.

The research team found that young people prescribed benzodiazepine treatment for common sleep disorders had an increased risk of drug overdose compared to young people prescribed alternative treatments. The risk of drug overdose was highest in adolescents and young adults with a recent opioid prescription.

“We were not surprised by the findings,” Bushnell told us. “To note, the majority of adolescents and young adults with sleep disorders had short-term benzodiazepine treatment, which is consistent with treatment guidelines.”

Going forward, Bushnell explained that it will remain important to screen adolescents and young adults for substance use and prior overdose when benzodiazepine treatment is being considered.

“Additionally, in youth prescribed benzodiazepines, clear communication between patients and providers on the potential harms of benzodiazepines when taken with other substances is needed,” Bushnell told us. “There are many factors that go into treatment selection. The risk of drug overdose with benzodiazepine treatment is one factor to be considered when weighing the risks and benefits of treatment options.”

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