Paracelsus
Addictionist
- Joined
- Nov 23, 2021
- Messages
- 269
- Reaction score
- 284
- Points
- 63
A new study published in Addiction reveals a sharp increase in sedative, hypnotic, and anxiolytic use disorders (SHA-UD) among adolescents and young adults enrolled in Medicaid across the United States. Conducted by researchers from Rutgers University, Columbia University, and New York University, the study provides the first national estimates of diagnosed SHA-UD among youth over nearly two decades, from 2001 to 2019.
SHA-UD is a substance use disorder characterized by problematic and recurrent use of sedative, hypnotic, or anxiolytic medications, leading to significant impairment or distress. These medications include benzodiazepines (such as Xanax and Valium), z-hypnotics (such as Ambien), and barbiturates, all of which are commonly prescribed for anxiety and sleep disorders but have a high potential for misuse and dependency. Previous research has suggested that nearly half of adolescents who are prescribed these medications also report non-medical use by age 18, making SHA-UD a growing public health concern.
The study analyzed Medicaid data from 42 U.S. states, capturing trends among individuals aged 13 to 29 who were enrolled in Medicaid for at least ten months each year. Over the study period, the prevalence of SHA-UD diagnoses rose from 0.01% to 0.04% among adolescents (ages 13–17) and from 0.05% to 0.24% among young adults (ages 18–29). These increases translate to a threefold rise among adolescents and a nearly fivefold increase among young adults, suggesting a growing burden of sedative-related substance use disorders in this population.
One of the most striking aspects of the study is the racial and ethnic disparities in SHA-UD trends. The largest relative increases in diagnoses were observed among non-Hispanic Black (624% increase) and Hispanic (529% increase) young adults. Despite these sharp increases, non-Hispanic White young adults continued to have the highest overall prevalence of SHA-UD in 2019 (0.38%), compared to 0.11% for Black young adults and 0.09% for Hispanic young adults. These findings challenge the conventional perception that sedative and anxiolytic misuse is predominantly an issue among White populations and underscore the need for more inclusive prevention and treatment strategies.
The study also examined SHA-UD diagnoses in relation to prescription patterns. While only a small percentage of adolescents and young adults diagnosed with SHA-UD had a sedative or anxiolytic prescription filled in the same year, those who did were significantly more likely to have a diagnosed use disorder. Among young adults with a prescription for benzodiazepines, z-hypnotics, or barbiturates, the prevalence of SHA-UD was nearly ten times higher than in those without a prescription. This suggests that, while most SHA-UD cases occur without a current prescription, those who are prescribed these medications may be at particularly high risk of developing a disorder.
The study also found a strong link between SHA-UD and other mental health and substance use disorders. Among young adults diagnosed with SHA-UD in 2019, a staggering 91% had at least one co-occurring substance use disorder, with opioid and cannabis use disorders being the most common. Additionally, 79% had a diagnosed mental health condition, including anxiety disorders (57%), depression (49%), and attention deficit hyperactivity disorder (13%). These findings highlight the complexity of SHA-UD and the importance of integrated treatment approaches that address co-occurring psychiatric and substance use disorders.
The researchers suggest that multiple factors may have contributed to the rising rates of SHA-UD diagnoses. Increased awareness, improved screening practices, and changes in diagnostic criteria over time may have led to higher detection rates. However, shifts in prescribing patterns and the availability of sedative medications—whether through medical channels or other sources—are also likely to have played a role. While some studies have reported a decline in prescription sedative misuse among high school students in recent years, other data suggest an increase in emergency room visits and overdose deaths involving benzodiazepines, raising concerns about ongoing public health risks.
For more details, you can access the full study here: https://doi.org/10.1111/add.16749
If you're interested in such publications, please react and leave comments