Center for Pharmacoepidemiology and Treatment Sciences, Rutgers Institute for Health, Health Care Policy and Aging Research, New Brunswick, NJ, USA.
Department of Biostatistics and Epidemiology, Rutgers University School of Public Health, Piscataway, NJ, USA.
Addiction. 2024 Feb;119(2):356-368. doi: 10.1111/add.16359. Epub 2023 Oct 10.
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%).
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.
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.
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.
苯二氮䓬类药物（BZDs）有药物过量的风险，被单独处方或与选择性 5-羟色胺再摄取抑制剂（SSRIs）同时用于治疗年轻人的焦虑和抑郁。我们旨在评估与 SSRIs 单药治疗相比，BZD 治疗开始后，同时开始 BZD 和 SSRI 治疗与 SSRIs 单药治疗相比，年轻人（18-29 岁）药物过量的风险。
设计、设置、参与者：该队列研究使用了覆盖美国私人保险（MarketScan，2009 年 1 月 1 日-12 月 31 日）和公共保险（Medicaid，2015 年 1 月 1 日-12 月 31 日）的年轻人（18-29 岁）的行政数据库。包括新开始 BZD 或 SSRI 治疗（前一年无 BZD 或 SSRI 处方）的抑郁或焦虑诊断患者。同时“BZD+SSRIs”开始被定义为在同一天开始 BZD 和 SSRI 治疗。队列包括 604664 名私人保险的年轻人（BZD=22%，BZD+SSRIs=10%，SSRIs=68%）和 110493 名公共保险的年轻人（BZD=23%，BZD+SSRIs=5%，SSRIs=72%）。
从治疗开始后 6 个月内的急诊室和住院患者（ICD 中毒代码）中确定了药物过量的医疗处理事件。估计了未经调整和倾向评分调整的累积发病率和风险比（HR）。亚分析评估了药物过量的意图。
与 SSRIs 治疗相比，BZD 治疗的药物过量调整 HR 在私人保险中为 1.36（95%置信区间[CI]：1.23-1.51），在公共保险中为 1.59（95%CI：1.37-1.83）。与 SSRIs 治疗相比，BZD+SSRIs 治疗的药物过量调整 HR 在私人保险中为 1.99（95%CI：1.77-2.25），在公共保险中为 1.98（95%CI：1.47-2.68）。
在美国的年轻人中，与 SSRIs 单药治疗相比，单独使用苯二氮䓬类药物或同时使用选择性 5-羟色胺再摄取抑制剂（SSRIs）治疗焦虑和抑郁的药物过量风险似乎更高。这些关联在私人和公共保险人群中都观察到。
