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Key Points Question What are the characteristics of US counties with high rates of opioid overdose mortality and low capacity to deliver medications for opioid use disorder? Findings In this cross-sectional study of data from 3142 US counties, counties in the South Atlantic, Mountain, and East North Central divisions had more than twice the odds of being at high risk for opioid overdose mortality and lacking in capacity to deliver medications for opioid use disorder. Higher density of primary care clinicians, a younger population, micropolitan status, and lower rates of unemployment were associated with lower risk of opioid overdose and lower risk of lacking in capacity to deliver medications for opioid use disorder. Meaning Strategies to address mortality from opioid overdose by increasing treatment for addiction should target urban counties in Appalachia, the Midwest, and the Mountain division and include efforts to increase primary care clinicians and employment opportunities.

Objective: Determine the prevalence of benzodiazepine use, including both use as-prescribed and misuse; characterize misuse; determine whether and how misuse varies by age. Methods: Cross-sectional analysis of the 2015 and 2016 National Survey on Drug Use and Health (NSDUH), a nationally-representative sample of U.S. adults (n=86,186). Measurements included past-year prescription benzodiazepine use and misuse (i.e., use "any way a doctor did not direct"), along with substance use and use disorders, mental illness, and demographic characteristics. Misuse was compared between younger (18-49) and older (≥50) adults. Results: 30.6 million adults (12.6%) reported past-year benzodiazepine use annually: 25.3 million (10.4%) as-prescribed and 5.3 million (2.2%) with misuse. Misuse accounted for 17.2% of benzodiazepine use overall. Adults 50-64 had the highest prescribed use (12.9%). Those 18-25 had the highest misuse (5.2%), while adults ≥65 had the lowest (0.6%). Misuse and abuse or dependence of prescription stimulants or opioids were strongly associated with benzodiazepine misuse. Misuse without a prescription was the most common type of misuse, while a friend or relative was the most common source. Adults ≥50 were more likely to use a benzodiazepine more often than prescribed and to help with sleep. Conclusions: Benzodiazepine use in the U.S. is higher than previously reported and misuse accounted for nearly 20% of use overall. Use among adults 50-64 has now exceeded use by those ≥65. Clinicians should monitor patients also prescribed stimulants or opioids for benzodiazepine misuse. Improved access to behavioral interventions for sleep or anxiety may reduce some misuse.