Teens and young adults who are treated for sleep issues with benzodiazepines, a class of medication sometimes prescribed to treat anxiety and insomnia, may be at a higher risk of overdose, according to a new study, published November 22 in JAMA Network Open.
Benzodiazepines, or “benzos,” are a class of medication commonly prescribed to treat conditions such as anxiety and insomnia, and includes drugs such as Xanax, Ativan, Valium and Klonopin.
“The risk of drug overdose with benzodiazepine treatment is an important safety consideration when treating adolescents and young adults,” said a coauthor of the study, Greta Bushnell, PhD, a researcher and faculty member at Rutgers School of Public Health in New Brunswick, New Jersey, in a press release. “We hope these results can inform prescribing decisions and encourage close monitoring in this young patient population.”
The Number of Overdose Deaths Involving Benzodiazepine Continues to Climb
According to the National Institute on Drug Abuse, benzodiazepines were involved in 12,290 overdose deaths in 2020, up from 6,872 in 2011 and 1,135 in 1999.
These medications can calm or sedate a person by raising the level of the neurotransmitter GABA in the brain. If a person takes both opioids and benzodiazepines, it can increase the risk of overdose significantly, because they both cause sedation and suppress breathing. The combination is so dangerous that the FDA began issuing black box warnings (the highest level warning) against mixing the two drugs.
Teens and Young Adults Who Took Benzodiazepines for Sleep Issues Were at Higher Risk of Overdose Than Those Who Took Other Treatments
To further understand the risks of drug overdose in young people who were prescribed a benzodiazepine treatment for insomnia, researchers used a U.S. database of privately insured people ages 10 to 29.
Researchers identified about 90,000 young people who took some type of sleeping aid. A total of 23,084 individuals were prescribed benzodiazepine treatment and 66,706 started non-benzodiazepine treatments for sleep disorders, such as trazodone, hydroxyzine, zolpidem (Ambien), zaleplon (Sonata), and eszopiclone (Lunesta).
Investigators compared the risk of drug overdose in the six months after treatment began for both groups, and found that in an age-adjusted analysis, young people starting benzodiazepine treatment had a 44 percent higher risk of drug overdose at six months than the group who used other treatments. This risk was even higher for young people with a recent opioid prescription, according to the findings.
Young People Should Be Informed of the Potential Associated Risks of Benzodiazepines
Given that there aren’t many large, head-to-head trials of benzodiazepine versus alternative sleep medications in a younger population, continued observational research on the comparative safety of pharmacologic treatments for sleep disorders is necessary to guide treatment decisions, the researchers wrote.
“For young people with insomnia who have not responded to nonpharmacologic interventions, nonbenzodiazepine sleep medication should be strongly considered for those with recent opioid prescriptions,” the researchers wrote.
Given that benzodiazepines are frequently used along with other substances, it is important to discuss with young people the potential associated harms, said Bushnell. “Because other substance use may be unknown to the prescriber, adolescents and young adults should be screened for substance use and a history of overdoses before treatment,” she said.
Bushnell said continued research is needed to determine how specific benzodiazepine treatment details, such as dosage, alter the risks of overdose.
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