(P-350) Overdose Risk Following Prescription Benzodiazepine Treatment in Young People

Background: Benzodiazepines (BZDs) are central nervous system depressants and rank second among prescription drugs involved in overdoses. Adolescents and young adults have higher rates of hospitalizations and emergency department (ED) visits due to BZD misuse compared to other ages. However, the risk of drug overdose following prescription BZD treatment in young people and whether it is elevated compared to alternative treatments are not known.

Objectives: To estimate the risk of medically treated drug overdose in young people prescribed BZD treatment compared to alternative treatments.

Methods: In a US claims database, we identified privately insured adolescents and young adults (10-29 years) newly initiating BZD or SSRI treatment with a recent anxiety or depression diagnosis. We examined two treatment decisions: a) initiating BZD treatment vs. SSRI treatment and b) simultaneously initiating BZD+SSRI treatment vs. SSRI treatment alone. The outcomes, any drug overdose and BZD overdose, were defined based on ICD diagnostic codes in an ED or inpatient setting within 6 months of treatment initiation. We estimated crude and propensity score adjusted (IPTW with trimming applied) rates and rate ratios (RR) with 95% confidence intervals (CIs). Primary analyses were intention-to-treat, with youth followed until event, end of enrollment, or 6 months.

Results: The cohort included 840,825 youth with a recent anxiety or depression diagnosis initiating treatment with BZD alone (18%), BZD+SSRI (8%), or SSRI alone (75%). The mean age was 21 years, 65% were female, 63% had a recent anxiety diagnosis, and 50% a recent depression diagnosis. Overall, 0.99% had an ED visit or hospitalization for a drug overdose within 6 months and 0.15% had a BZD-related overdose. The crude rates of drug overdose were 1.6 per 100 person-years in BZD alone initiators, 2.3 in BZD+SSRI initiators, and 2.4 in SSRI alone initiators.

After weighting, rates of drug overdose were higher in youth initiating BZD treatment: BZD alone vs. SSRI alone (RR=1.18, 95%CI 1.07-1.30); BZD+SSRI vs. SSRI alone (RR=1.74, 95%CI 1.55-1.95). Rates of BZD-related overdoses were also higher in youth initiating BZD treatment: BZD alone vs. SSRI alone (RR=4.49, 95%CI 3.77-5.35); BZD+SSRI vs. SSRI alone (RR=8.06, 95%CI 6.64-9.78).

Conclusions: In youth with anxiety and depression, BZD treatment was associated with an elevated rate of medically treated drug overdose and BZD overdose compared to an alternative medication treatment. Cautious prescribing of BZDs may be warranted, particularly in young people with elevated risk of overdose or substance misuse.