Child and adolescent benzodiazepine exposure and overdose in the United States: 16 years of poison center data

Friedrich, Joseph; Sun, Christie; Geng, Xue; Calello, Diane P.; Gillam, Michael; Medeiros, Kaelen L.; Smith, Mark S.; Ruck, Bruce; Mazer‐Amirshahi, Maryann

doi:10.1080/15563650.2019.1674321

Cited by 29 publications

(27 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…15,18,21 There are also concerns about safety and the potential of diversion. 22,23 Further study is needed to understand the rationale for use of these medications by PCPs in this network. In particular, it would be important to determine if subspecialist involvement was associated with prescription of benzodiazepines in these pediatric patients.…”

Section: Discussionmentioning

confidence: 99%

Medication Management of Anxiety and Depression by Primary Care Pediatrics Providers: A Retrospective Electronic Health Record Study

Bannett

Rm³

et al. 2021

Preprint

View full text Add to dashboard Cite

Objectives: To describe medication management of children diagnosed with anxiety and depression by primary care providers. Study Design/Methods: We performed a retrospective cross-sectional analysis of electronic health record (EHR) structured data. All visits for pediatric patients seen at least twice during a four-year period within a network of primary care clinics in Northern California were included. Descriptive statistics summarized patient variables and most commonly prescribed medications. For each subcohort (anxiety, depression, and both (anxiety+depression)), logistic regression models examined the variables associated with medication prescription. Results: Of all patients (N=93,025), 2.8% (n=2635) had a diagnosis of anxiety only, 1.5% (n=1433) depression only, and 0.79% (n=737) both anxiety and depression (anxiety+depression); 18% of children with anxiety and/or depression had comorbid ADHD. A total of 14.0% with anxiety (n=370), 20.3% with depression (n=291), and 47.5% with anxiety+depression (n=350) received a psychoactive non-stimulant medication. For anxiety only and depression only, sertraline, citalopram, and fluoxetine were most commonly prescribed. For anxiety+depression, citalopram, sertraline, and escitalopram were most commonly prescribed. The top prescribed medications also included benzodiazepines. Logistic regression models showed that older age and having developmental or mental health comorbidities were independently associated with increased likelihood of medication prescription for children with anxiety, depression, and anxiety+depression. Insurance type and sex were not associated with medication prescription. Conclusions: PCPs prescribe medications more frequently for patients with anxiety+depression than for patients with either diagnosis alone. Medication choices generally align with current recommendations. Future research should focus on the use of benzodiazepines due to safety concerns in children.

show abstract

Section: Discussionmentioning

confidence: 99%

Medication Management of Anxiety and Depression by Primary Care Pediatrics Providers: A Retrospective Electronic Health Record Study

Bannett

Rm³

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…This increasing rate of pharmaceutical exposures among children 13–19 is consistent with international studies in Australia [ 23 ], East Asia [ 24 ], and Eastern Europe [ 25 ]. Growing numbers of adult prescriptions of analgesic drugs [ 26 ], psychoactive drugs [ 27 ], and the rising use of non-prescription medications [ 12 ] are identified as potential driving factors for this trend. The current study further identified a noteworthy proportion of pharmaceutical exposure-related deaths due to suicidal attempts in age groups of 6–12 and 13–19 years.…”

Section: Discussionmentioning

confidence: 99%

Trends in Childhood Poison Exposures and Fatalities: A Retrospective Secondary Data Analysis of the 2009–2019 U.S. National Poison Data System Annual Reports

Dodd-Butera

Beaman

et al. 2021

Pediatric Reports

View full text Add to dashboard Cite

Despite significant prevention efforts, childhood poison exposures remain a serious public health challenge in the United States. This study aimed to assess annual trends of pharmaceutical vs. non-pharmaceutical poison exposures in the US among children 0–19 years and compare the odds of death by children’s age group. Poison exposure and fatality data were retrospectively extracted from 2009 to 2019 National Poison Data System (NPDS) annual reports for children in all reported age groups. Overall, there was a significant reduction in the annual population-adjusted poison exposures in children (annual percentage change = −2.54%, 95% CI = −3.94% to −1.15%, p < 0.01), but not in poisoning-related fatalities. Children 0–5 had similar odds of dying from exposure to non-pharmaceuticals vs. pharmaceuticals. The odds of children 6–12 dying from non-pharmaceuticals vs. pharmaceuticals was 2.38 (95% CI = 1.58, 3.58), χ2 = 18.53, p < 0.001. In contrast, the odds of children 13–19 dying from pharmaceuticals vs. non-pharmaceuticals was 3.04 (95% CI = 2.51, 3.69), χ2 = 141.16, p < 0.001. Suicidal intent accounted for 40.63% of pharmaceutical deaths in children 6–12, as well as 48.66% of pharmaceutical and 31.15% of non-pharmaceutical deaths in children 13–19. While a significant decline in overall childhood poison exposures was reported, a decrease in poisoning-related fatalities was not observed. Children in different age groups had contrasting relative odds of death from pharmaceutical and non-pharmaceutical exposures. Among older children, a greater proportion of poisoning-related deaths was due to intentional suicide. These findings provide evidence of age-specific trends in childhood poison exposure risk and directions for future poison prevention efforts and behavioral health partnerships.

show abstract

“…Data from the US National Poison Data System suggest that the proportion of intentional (ie, overdose, abuse, or suicide) exposures, among all benzodiazepine exposures, increased from 37% to 47.7% between 2000 and 2015 among youth aged ,18 years. 2 The severity of medical outcomes after benzodiazepine exposure also increased significantly during this period. 2 In 2018, 1.6% of American adolescents aged 12 to 17 years old reported benzodiazepine misuse in the past year, a figure that has remained stable since 2015.…”

Section: Benzodiazepine Misusementioning

confidence: 93%

Severe Benzodiazepine Use Disorder in a 16-Year-Old Adolescent: A Rapid and Safe Inpatient Taper

et al. 2021

View full text Add to dashboard Cite

We describe the case of a 16-year-old boy with a 1-year history of severe benzodiazepine misuse. After being denied access to several treatment programs and hospital centers that felt unprepared to manage benzodiazepine use disorder and withdrawal in an adolescent, the patient was admitted to a tertiary pediatric unit for rapid inpatient tapering and detoxification. The patient was hospitalized for 13 days and received decreasing doses of diazepam under close monitoring of withdrawal symptoms. The taper was well tolerated, and the patient was transferred to a youth residential substance use treatment center, where he completed a successful 2-month placement. This case highlights the lack of adolescent-friendly facilities allowing safe tapering of rapid-acting benzodiazepines in North America. Given high rates of benzodiazepine misuse among youth and the risks associated with benzodiazepine misuse and withdrawal, there is a critical need for more research, provider training, and dedicated resources in this area.

show abstract

Child and adolescent benzodiazepine exposure and overdose in the United States: 16 years of poison center data

Cited by 29 publications

References 16 publications

Medication Management of Anxiety and Depression by Primary Care Pediatrics Providers: A Retrospective Electronic Health Record Study

Medication Management of Anxiety and Depression by Primary Care Pediatrics Providers: A Retrospective Electronic Health Record Study

Trends in Childhood Poison Exposures and Fatalities: A Retrospective Secondary Data Analysis of the 2009–2019 U.S. National Poison Data System Annual Reports

Severe Benzodiazepine Use Disorder in a 16-Year-Old Adolescent: A Rapid and Safe Inpatient Taper

Contact Info

Product

Resources

About