A large proportion of teens who overdosed on medications used to treat anxiety and attention-deficit hyperactivity disorder (ADHD) were prescribed those agents for mental health issues, according to findings published in Pediatrics. Overdoses in adolescents commonly involve prescription benzodiazepines or psychostimulants, suggesting that clinicians must weigh the risks and benefits of these medications more closely, the study authors suggested.
In 2019, 4777 youth died from a drug overdose in the United States; 727 of these fatal overdoses involved benzodiazepines and 902 involved psychostimulants, according to data from the Centers for Disease Control and Prevention. In 2020, 2928 nonfatal benzodiazepine overdoses were reported among youth aged 15 to 24 years. Rates of emergency department (ED) visits for fatal and nonfatal benzodiazepine overdoses increased by 24% in people of all ages between 2019 and 2020 during the COVID-19 pandemic.
Researchers of the current study used the MarketScan commercial claims database to identify youth aged 15 to 24 years who had a hospital or ED encounter for an overdose involving stimulants (n=971) or benzodiazepines (n=2987) from January 01, 2016, to December 31, 2018. Researchers then compared the data with prescription records to determine whether these youth had been prescribed those medications.
Among youth with benzodiazepine overdoses, 29% had a prescription dispensed in the month prior to overdose and 42% in the 6 months prior to overdose. For stimulant overdoses, 25% of youth had a stimulant prescription dispensed in the previous month and 39% in the previous 6 months. Those with intentional overdoses were more likely to have recent prescriptions for these drugs than youth with unintentional overdoses. More than half of benzodiazepine overdoses (56%) were intentional compared with 40% of stimulant overdoses.
“These findings highlight the need for physicians to assess youth for self-injury risk who are prescribed benzodiazepines and stimulants, as well as the need for varying efforts to prevent intentional and unintentional overdoses,” said lead author Greta Bushnell, PhD, MSPH, of the Center for Pharmacoepidemiology and Treatment Sciences at Rutgers Institute for Health, Health Care Policy and Aging Research (IFH). “Further, since the potential for harm with benzodiazepines and stimulants increases with other substances such as alcohol, illicit drugs, and opioids, discussions around limiting concurrent substance use is warranted.”
Clinician encounters when these medications are prescribed may provide an ideal opportunity for assessing overdose risk, Dr Bushnell noted.
The findings are limited by the inability to distinguish between amphetamine overdoses that were related to prescribed agents vs illicit substances. Also, the study does not account for youth with overdoses who did not present to the hospital or ED setting or events in which medication involvement was not recorded, the study authors noted.
Bushnell G, Samples H, Gerhard T, Calello DP, Olfson M. Benzodiazepine and stimulant prescriptions before overdose in youth. Pediatrics. 2022 Mar 2:e2021055226. doi: 10.1542/peds.2021-055226.
Teens and young adults overdosing on drugs for common mental health issues. News release. Rutgers University. March 10, 2022. Accessed March 10, 2022. https://www.rutgers.edu/news/teens-and-young-adults-overdosing-drugs-common-mental-health-issues