More U.S. Teens Are Overdosing on Valium, Xanax
The number of kids overdosing on commonly prescribed anxiety medications such as Xanax, Valium or Ativan has risen dramatically during the past decade, a new study shows.
Child and teenage ODs caused by these benzodiazepine drugs increased by 54% between 2000 and 2015, according to data logged by U.S. poison control centers.
The increase in benzodiazepine overdoses among kids appears to reflect an increase in the number of prescriptions handed out for the drugs, said study co-author Dr. Diane Calello, executive and medical director of the New Jersey Poison Control Center at Rutgers New Jersey Medical School's Department of Emergency Medicine.
Benzodiazepines like Valium, Xanax, Ativan and Klonopin have been traditionally prescribed to treat anxiety and insomnia, but doctors have started handing them out as substitute for opioids, Calello said.
"As a nation, we're trying to cut down more and more on opioid prescribing," Calello said. "Medications like this may be a substitute and may be more available."
She and her colleagues found nearly 297,000 benzodiazepine cases reported to U.S. poison control centers between 2000 and 2015.
The proportion of cases rose from 17.7 per 100,000 children in 2000 to a high of 29.3 per 100,000 in 2009. In 2015, it stood at 27.3 per 100,000.
Nearly half of these overdoses occur in kids who have intentionally taken the drugs, either to get high or to attempt suicide, the data showed.
The proportion of intentional exposure cases increased to about 48% in 2015, compared with 36% in 2010, researchers found.
Meanwhile, cases of accidental ingestion decreased from 61% in 2010 to 50% in 2015.
The health outcomes of benzodiazepine overdose also have become more severe over the years.
Only a handful of kids die from benzodiazepine overdose. For example, 23 died in 2015.
But the percentage that suffer severe illness from their overdose increased to 24% in 2015, up from 14% in 2000.
One reason for this is 4 of 5 teenagers take benzodiazepines with other substances, such as alcohol or opioids, according to the data.
"Taking too much lorazepam [Ativan] will make you sleepy," Calello said. "If you take a lot of it, you'll have trouble breathing. If you combine it with alcohol, that is going to happen a lot faster."
The researchers found that throughout the study period, 251 kids died from taking a benzodiazepine with other substances, compared to only two who suffered a fatal overdose from the drug alone.
Further, 26% suffered a potentially life-threatening effect from combined use, compared with only 6% who took benzodiazepines alone.
This tracks with data from the U.S. National Institute on Drug Abuse, which shows that more than 30% of overdoses involving opioids also involve benzodiazepines.
Benzodiazepines really shouldn't be used to treat anxiety in kids these days, said Dr. Victor Fornari, vice chair and director of child and adolescent psychiatry at Zucker Hillside Hospital in Glen Oaks, N.Y. Cognitive behavioral therapy and selective serotonin reuptake inhibitors (SSRIs) have been shown to be more effective, he explained.
"While there may be some clinical benefit to the judicious prescribing of a benzodiazepine for the acute treatment of panic in youth, there is no evidence that the ongoing use is clinically warranted, and may actually be placing the youth at increased risk for self-harm," Fornari said. "Clinicians are cautioned to reconsider the ongoing treatment of adolescents with benzodiazepines."
To prevent these overdoses, parents need to be more careful about how they store medications, said Dr. Teresa Murray Amato, chair of emergency medicine at Long Island Jewish Forest Hills Hospital in New York City. She and Fornari were not involved with the study.
"Like many other toxicological exposures, adolescents often will take what is available in either their own family's medicine cabinets or those of their friends," Amato said.
Before filling a prescription for a benzodiazepine, parents should talk with their doctor about whether the medication is necessary. If it is, they should ask for smallest prescribed amount so they can decrease the amount of leftover unused pills, Amato said.
Any prescriptions not being actively taken should be discarded, either by handing them over at a pharmacy's drug take-back day or by flushing them, Calello said.
"If you have meds in your house that you're not taking, you should ditch them," Calello said. "Get rid of them."
The U.S. Poison Control Center phone number is (800) 222-1222.
The new study was published recently in the journal Clinical Toxicology.
The U.S. National Institute on Drug Abuse has more about benzodiazepines and opioids.
SOURCES: Diane Calello, M.D., executive and medical director, New Jersey Poison Control Center, Rutgers New Jersey Medical School's Department of Emergency Medicine, Newark, N.J.; Victor Fornari, M.D., vice chair and director, child and adolescent psychiatry, Zucker Hillside Hospital, Glen Oaks, N.Y.; Teresa Murray Amato, M.D., chair, emergency medicine, Long Island Jewish Forest Hills Hospital, Forest Hills, N.Y.; Oct. 15, 2019, Clinical Toxicology, online