Benzodiazepine-related harms in young people: Informing policy, interventions, and prescribing

PROJECT SUMMARY/ABSTRACT.
This Mentored Research Scientist Development Award (K01) proposal will develop Dr. Greta Bushnell’s career
as an independent investigator, and enable her to advance into a new line of research focused on evaluating
misuse and abuse related morbidity of medicines prescribed to young people and the policies and practices that
can mitigate these harmful outcomes. This new direction of research requires distinct training in substance abuse
policy, misuse and abuse liability of prescription drugs, adolescent development of substance use, analysis of
state-level policies, and advanced methods to address confounding control. With a training program supported
by an experienced team of investigators, Dr. Bushnell will complete the proposed research, filling key gaps
surrounding benzodiazepine (BZD) misuse and abuse related harms in young people and modifiable factors to
reduce these harms. This research focus comes at a pertinent time of rising BZD-related morbidity, continued
prescribing, lack of safety data in youth at developmental risk for substance use problems, and current
opportunities to leverage opioid-related policies to reduce BZD-related harms. Overdose deaths involving BZDs
significantly increased in recent years with »11,500 deaths in 2017, partially attributed to the opioid crisis, and in
adolescents and young adults there were »39,000 emergency department visits for BZD-related poisonings in
2016. Despite BZDs being frequently prescribed to adolescents (3%) and young adults (6%), there are no
estimates on overdose risk following BZD treatment and it is unknown whether and to what extent BZD
prescribing to youth inadvertently increases risk of BZD or other substance misuse later in life. Prescription drug
monitoring programs (PDMPs) represent a potentially important, but understudied, means to mitigate BZD-
related morbidity. PDMPs are state-run surveillance systems collecting patient details on prescriptions for
controlled substances with capabilities to detect risky prescribing. Dr. Bushnell will use large, national
administrative claims data (2000-2018) covering privately and publicly insured young people (10-29 years) to
evaluate whether selected state PDMP features decrease BZD-related harms and risky BZD prescribing in young
people (Aim 1). To evaluate individual-level risks, she will quantify overdose risk following BZD treatment in
young people compared to alternative treatments and by prescription details (Aim 2) using the national claims
datasets with measures from Area Health Resources Files. She will then evaluate whether adolescent BZD
treatment increases downstream risks of BZD misuse or harmful substance use in early adulthood (Aim 3) using
the nationwide Monitoring the Future sample of high school seniors with panel surveys into early adulthood
(»2,450/year, 1976-2016). The proposal will inform an R01 submission on identifying youth-specific risk factors
in the progression from treatment with BZDs, or other controlled substances, to abuse and leveraging this
knowledge to inform interventions. Addressing these questions and developing this new line of research are only
feasible with intensive training, support, and protected time, which the K01 can provide.

Grant Number: 5K01DA050769-05
NIH Institute/Center: NIH
Principal Investigator: Greta Bushnell