Benzodiazepines closely associated with drug overdose in patients with sleep disorders

A new article published in the Journal of American Medical Association shows that in comparison to other pharmacologic treatments for common sleep disorders, benzodiazepines were linked to a higher risk of drug overdose in young people over the course of the subsequent six months, particularly in those who had recently received an opioid prescription.

Adolescent sleep disturbances are treated with benzodiazepines; nonetheless, benzodiazepine overdoses can happen, frequently in conjunction with opioids. Greta A. Bushnell and colleagues conducted this investigation to determine if benzodiazepine medication for sleep disorders is linked to a higher risk of drug overdose in young individuals when compared to other pharmacologic therapies (hydroxyzine, trazodone, zaleplon, zolpidem, and eszopiclone).

From January 1, 2009, to December 31, 2018, a US commercial claims database (MarketScan) was used to identify privately insured individuals aged 10 to 29. The trial comprised young adults with a diagnosis of a sleep problem starting benzodiazepine (n = 23 084) or comparator pharmacologic therapy (n = 66 706). The period covered by the statistical study was from November 1, 2021, to May 16, 2022. new application of benzodiazepine therapy or pharmacological controls. Within six months following the start of therapy, incident diagnosed drug overdoses were found in inpatient and emergency department records. With intention-to-treat and as-treated analysis, the propensity score-adjusted cumulative incidence of overdose and hazard ratios (HRs) were calculated. Results were divided according to previous opioid prescription fills.

The key findings of this study were:

1. The group comprised 66 706 young persons starting a control therapy and 23 084 young people starting benzodiazepine medication. 

2. 9.7% of benzodiazepine users and 12.3% of the comparison group were still getting therapy six months after treatment began.

3. At six months, the crude incidence of drug overdose was 0.9% for benzodiazepine initiators and 0.8% for initiators of comparator treatments.

4. In adjusted analyses, benzodiazepines were linked to a higher risk of drug overdose than the comparator therapy.

5. When compared to young people who had not recently filled a prescription for an opioid, this association was stronger in the former group.

In conclusion, the risk of drug overdose must be taken into account when administering benzodiazepines to children.

Reference:

Bushnell, G. A., Gerhard, T., Keyes, K., Hasin, D., Cerdá, M., & Olfson, M. (2022). Association of Benzodiazepine Treatment for Sleep Disorders With Drug Overdose Risk Among Young People. In JAMA Network Open (Vol. 5, Issue 11, p. e2243215). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2022.43215