Sedative, Hypnotic Drug Misuse 5x in Young Adults Since 2001

More teens and young adults appear to be developing addiction or dependence on drugs that help them sleep, calm down, and manage anxiety.

The prevalence of sedative, hypnotic, or anxiolytic use disorders [SHA-UD] increased by three- to fivefold in adolescents and young adults between 2001 and 2019, respectively, according to a research report published in Addiction. The highest prevalence was among White men between 18 and 29 years of age.

“Teens and young adults come in with stories that are eerily similar: They were prescribed a benzodiazepine or a sleep aid during a tough time — maybe it was finals week, a bad breakup, or the early signs of an anxiety disorder,” said Jasmine Sawhne, MD, MBA, a psychiatrist in private practice in both New York and California, who was not involved in the research. “What starts as a short-term solution too often becomes a crutch, and eventually, it spirals into dependency or misuse.”

The substance use disorder is characterized by significant impairment or distress caused by taking substances like benzodiazepines, carbamates, and barbiturates. Extended use can lead to dependency and increased tolerance. A patient might continue taking the drug despite experiencing negative consequences in school or their personal lives.

Bushnell and her colleagues analyzed data from Medicaid enrollees between ages 13 and 29 years across 42 states from 2001 to 2019. Diagnoses of the disorder increased in adolescents from 0.01% in 2001 to 0.04% in 2019, with more pronounced prevalence in young adults from 0.54% in 2001 to 0.24% in 2019. The largest increases were observed among Black and Hispanic enrollees.

Within the young adult group, SHA-UD diagnoses were twice as prevalent among 25-29-year-olds than those between 18 and 24 years of age.

Greta Bushnell, PhD, MSPH, an assistant professor at the Rutgers Center for Pharmacoepidemiology and Treatment Science in New Brunswick, New Jersey, and lead author of the study, said that although SHA-UD is less common than other substance use disorders, clinicians should pay special attention to patients who are currently prescribed benzodiazepine, z-hypnotics, or barbiturates.

“I was surprised by the magnitude of the increase we observed in SHA-UD diagnoses, particularly in young adults,” she said. Although “some of the increase we observed is likely related to more recognition and awareness of SHA-UD disorders.”

The majority of adolescents (95%) and young adults (69%) diagnosed with a SHA-UD in 2019 did not have an SHA prescription dispensed in that same calendar year. However, among teens and young adults with an SHA prescription dispensed, diagnoses of the use disorder were substantially more prevalent.

SHA-UD diagnoses were also more prevalent among adolescents and young adults with an anxiety disorder, ADHD, or sleep disorder diagnosis, conditions that are associated with the prescription drugs. 

Diagnosis and Treatment

When making a diagnosis, clinicians should ask patients how many times they have attempted to decrease use, how often they experience cravings, and if they have experienced withdrawal when attempting to stop, said Zishan Khan, MD, a child, adolescent, and adult psychiatrist with Mindpath Health in Fresco, Texas. Some of his patients will report difficulties with memory or problems with coordination while intoxicated with the drugs.

Clinicians should also ask patients about other substance use, such as alcohol, cocaine, or marijuana, he said.

The report showed a majority of both the adolescent (76.0%) and young adult (91.0%) cases in 2019 had a comorbid substance use disorder. Cannabis use disorder was the most commonly co-occurring disorder in adolescents (61.9%), and opioid use disorder the most common in young adults (66.6%).

“Many diagnoses occur alongside other substance use disorders, reinforcing the need for thorough evaluation,” Khan said.

Treatment for the disorder starts with managing withdrawal. Depending on the severity of addiction and dependence, a primary care clinician can help the patient on their own, but in other cases should refer to a psychiatrist or addiction treatment facility. Khan said that benzodiazepine withdrawal can lead to seizures and death. 

“This sort of withdrawal is best treated in the hospital or treatment facility, whether by a psychiatrist or an internist, since it may require IV medication or potential lifesaving interventions,” he said. “However, withdrawal can be avoided altogether when it comes to sedative hypnotics if the patient is weaned off the medication slowly and carefully, which can be done by a primary care provider or a psychiatrist.”

Sawhne also said clinicians should work toward building a relationship of trust. 

“Young adults can be defensive or even ashamed about their medication use,” Sawhne said. “Judgment shuts them down. I try to create a space where they feel safe talking about their struggles and choices without fear of being shamed.”

She said she explains to patients how sedative, hypnotic, or anxiolytic drugs work and suggests alternative prescription drugs that do not carry a risk for dependency or addiction, such as buspirone.

Khan said clinicians should be conservative in prescribing sedatives and anti-anxiety medications that are known to be addictive, includingalprazolam or lorazepam. Clinicians who are switching a patient to a nonaddictive drug for anxiety should discuss the potential delay in effectiveness.

Nonaddictive drugs “can take time to properly work and may not be as impactful right away for the patient, especially if they have already been primed to taking stronger anxiolytics like benzodiazepines,” he said. “Therefore, careful monitoring of the patient may be needed to ensure anxiety is being effectively addressed since simply prescribing the medication may not be enough to manage their symptoms.”

The study was funded by the National Institute on Drug Abuse. One study author reported receiving grants from Sanofi outside the submitted work.

Lisa Marie Basile is an author and medical writer based in New York City.