Drug overdose risk with benzodiazepine treatment in young adults: Comparative analysis in privately and publicly insured individuals

IF 5.2 1区医学 Q1 PSYCHIATRY

Addiction Pub Date : 2023-10-10 DOI:10.1111/add.16359

Greta A. Bushnell, Moira A. Rynn, Tobias Gerhard, Katherine M. Keyes, Deborah S. Hasin, Magdalena Cerdá, Abner Nyandege, Mark Olfson

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Abstract

Background and Aims

Benzodiazepines (BZDs) carry a risk for drug overdose and are prescribed alone or simultaneously with selective-serotonin reuptake inhibitors (SSRIs) for the treatment of anxiety and depression in young adults. We aimed to measure risks of drug overdose following BZD treatment initiation, and simultaneous BZD and SSRI initiation, compared with SSRI treatment alone in young adults with depression or anxiety.

Design, Setting, Participants

The cohort study used administrative databases covering privately (MarketScan, 1/1/2009–12/31/2018) and publicly (Medicaid, 1/1/2015–12/31/2016) insured young adults (18–29 years) in the United States. Those with depression or anxiety diagnoses newly initiating BZD or SSRI treatment (without BZD or SSRI prescriptions in prior year) were included. Simultaneous “BZD + SSRI” initiation was defined as starting BZD and SSRI treatment on the same day. The cohorts included 604 664 privately insured young adults (BZD = 22%, BZD + SSRI = 10%, SSRI = 68%) and 110 493 publicly insured young adults (BZD = 23%, BZD + SSRI = 5%, SSRI = 72%).

Measurements

Incident medically treated drug overdose events were identified from emergency department and inpatient encounters (ICD poisoning codes) within 6 months of treatment initiation. Crude and propensity-score adjusted cumulative incidence and hazard ratios (HR) were estimated. Sub-analyses evaluated drug overdose intent.

Findings

Adjusted HRs of drug overdose for BZD vs. SSRI treatment was 1.36 (95% confidence interval [CI]:1.23–1.51) in privately and 1.59 (95%CI:1.37–1.83) in publicly insured young adults. The adjusted HRs of drug overdose for BZD + SSRI treatment vs. SSRI treatment were 1.99 (95%CI:1.77–2.25) in privately and 1.98 (95%CI:1.47–2.68) in publicly insured young adults.

Conclusions

Among young adults in the United States, initiating benzodiazepine treatment for anxiety and depression, alone or simultaneously with selective-serotonin reuptake inhibitors (SSRI), appears to have an increased risk of medically treated drug overdose compared with SSRI treatment alone. These associations were observed in publicly and privately insured individuals.

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年轻人苯二氮卓类药物治疗的药物过量风险：私人和公共保险个人的比较分析。

背景和目的：苯二氮卓类药物（BZDs）有药物过量的风险，单独或与选择性血清素再摄取抑制剂（SSRIs）同时服用，用于治疗年轻人的焦虑和抑郁。我们的目的是测量在患有抑郁症或焦虑症的年轻人中，BZD治疗开始后，以及同时开始BZD和SSRI治疗后，与单独进行SSRI治疗相比，药物过量的风险。设计、设置、参与者：队列研究使用了涵盖私人（MarketScan，2009年1月1日至2018年12月31日）和公共（Medicaid，2015年1月15日至2016年12月30日）投保年轻人（18-29岁）的管理数据库年）。新开始BZD或SSRI治疗（前一年未开具BZD或SSLI处方）的抑郁症或焦虑症患者也包括在内。同时“BZD + SSRI的起始定义为在同一天开始BZD和SSRI治疗。队列包括604 664名私人投保的年轻人（BZD = 22%，BZD + SSRI = 10%，SSRI = 68%）和110 493名公开投保的年轻人（BZD = 23%，BZD + SSRI = 5%，SSRI = 72%）。测量：在开始治疗的6个月内，从急诊科和住院患者的遭遇（ICD中毒代码）中确定了药物过量事件。估计粗略和倾向评分调整后的累计发病率和危险比（HR）。亚分析评估了药物过量的意图。研究结果：BZD与SSRI治疗药物过量的校正HR在私人中为1.36（95%置信区间[CI]1.23-1.51），在公共保险的年轻人中为1.59（95%可信区间:1.37-1.83）。BZD药物过量的校正HR + SSRI治疗与SSRI治疗相比，私人保险的年轻人为1.99（95%CI:1.77-2.25），公共保险的年轻人为1.98（95%CI:1.47-2.68）。结论：在美国的年轻人中，与单独使用选择性血清素再摄取抑制剂（SSRI）相比，单独或同时使用苯二氮卓类药物治疗焦虑和抑郁，似乎会增加药物过量的风险。在公共和私人投保的个人身上观察到了这些关联。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Addiction 医学-精神病学

CiteScore

10.80

自引率

6.70%

发文量

319

审稿时长

3 months

期刊介绍： Addiction publishes peer-reviewed research reports on pharmacological and behavioural addictions, bringing together research conducted within many different disciplines. Its goal is to serve international and interdisciplinary scientific and clinical communication, to strengthen links between science and policy, and to stimulate and enhance the quality of debate. We seek submissions that are not only technically competent but are also original and contain information or ideas of fresh interest to our international readership. We seek to serve low- and middle-income (LAMI) countries as well as more economically developed countries. Addiction’s scope spans human experimental, epidemiological, social science, historical, clinical and policy research relating to addiction, primarily but not exclusively in the areas of psychoactive substance use and/or gambling. In addition to original research, the journal features editorials, commentaries, reviews, letters, and book reviews.