Association of prescription drug monitoring programs with benzodiazepine prescription dispensation and overdose in adolescents and young adults

Abstract

Introduction

Prescription drug monitoring programs are state-run databases designed to support safe prescribing of controlled substances and reduce prescription drug misuse. We analyzed healthcare claims data to determine the association between prescription drug monitoring programs with mandated provider review and adolescent and young adult benzodiazepine prescription dispensing and overdose.

Methods

We performed a state-level retrospective cohort study to evaluate the association between implementation of prescription drug monitoring programs with mandated provider review and benzodiazepine prescription dispensing and benzodiazepine-related overdoses among adolescents (13–18 years) and young adults (19–25 years) between 1 January 2008 and 31 December 2019. Data were obtained from a United States commercial health insurance company.

Results

There were 74,539 (1.8%) adolescents and 246,760 (4.0%) young adults with at least one benzodiazepine prescription dispensed. Benzodiazepine overdoses occurred among 1,569 (0.04%) and 3,202 (0.05%) adolescents and young adults, respectively. Implementation of a prescription drug monitoring program with mandated provider review was associated with a 6.8% (95% CI, 1.6–11.8) yearly reduction in benzodiazepine prescription dispensing among adolescents and a 12.5% (95% CI, 9.3–15.5) yearly reduction among young adults. There was no decrease in benzodiazepine overdoses in either age group (-15.4% [95% CI, −21.5 to 3.0] and −8.0% [95% CI, −18.0 to 3.2] yearly change in adolescents and young adults, respectively).

Discussion

Consistent with prior work, our study did not find an association between prescription drug monitoring program implementation and reduction in benzodiazepine-related overdoses among adolescents and young adults. However, the substantial reduction in benzodiazepine prescription dispensing is encouraging.

Conclusion

Prescription drug monitoring programs were associated with decreases in benzodiazepine prescription dispensing, but not benzodiazepine-related overdoses in this cohort of adolescents and young adults. These findings serve to inform development of further policies to address rising rates of benzodiazepine misuse and overdose in this patient population.

Keyword:

• Benzodiazepine
• overdose
• prescription drug misuse
• adolescents
• prescription drug monitoring program

Author contributions

MT, MM, and FB conceived the study. MT obtained funding and drafted the initial manuscript. JH provided substantial expert knowledge. KO, KM, and MM performed data analysis. FB provided expert supervision. All authors contributed substantially to revisions. MT takes responsibility for the study as a whole.

Disclosure statement

No potential conflict of interest was reported by the authors.

Table 1. Benzodiazepine prescription dispensing and benzodiazepine-related overdoses, 2008–2019.*

Additional information

Funding

Dr. Michael S. Toce received a research award from the American Academy of Clinical Toxicology (https://www.clintox.org/grants/aact-research-award) in support of this study. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.