Sedative, Hypnotic, Anxiolytic Use Disorders Rose from 2001 to 2019 in Young Adults

Greta Bushnell, PhD, MSPH

Credit: Rutgers, School of Public Health

A recent study reported that sedative, hypnotic, and anxiolytic use disorders diagnoses increased 3- to 5-fold between 2001 and 2019 for adolescents and young adults.¹ The prevalence of these diagnoses was low in adolescents.

“The increase in diagnoses of these disorders may be due to changes in the availability, use and misuse of sedatives, hypnotics and anxiolytics, as well as an increase in detection, awareness and diagnosing of these disorders,” said lead investigator Greta Bushnell, PhD, MSPH, an assistant professor at the Rutgers Center for Pharmacoepidemiology and Treatment Science, in a statement.²

Many sedative, hypnotic, or anxiolytic substances, such as benzodiazepines or z-hypnotics, are FDA approved to treat sleep and anxiety disorders.¹ However, the Drug Enforcement Administration has identified these substances as having a risk of misuse and dependency. Due to these risks, investigators sought to measure trends in the prevalence of sedative, hypnotic, or anxiolytic disorder diagnoses in adolescents and young adults from 2001 to 2019.

The cross-sectional study included adolescents aged 13 – 17 years and young adults aged 18 – 29 years with ≥ 10 months Medicaid enrollment in the calendar year and had ≥ 1 International Classification of Diseases (ICD) diagnostic code from an inpatient or outpatient file for sedative, hypnotic, and anxiolytic use disorders. Data from Analytic eXtracts and Transformed Medicaid Analytic Files was collected on 5.7 million people in 2001 (3,011,620 adolescents, 2,692, 307 young adults) to 13.2 million (6,279,083 adolescents, 6,886,192 young adults) in 2019. In 2019, 48.6% adolescents and 58.9% young adults were female, and the race break down for adolescents and young adults was 35.9% and 30.2% Hispanic, 32.2% and 35.6% White, and 19.6% and 18.4% Black, respectively.

The prevalence of sedative, hypnotic, and anxiolytic use disorder diagnoses increased 3- to -5-fold from 2001 to 2019 for adolescents (0.01% to 0.04%) and young adults (0.05% to 0.24%). Among young adults, diagnoses were twice as prevalent in those 25 to 29 years compared with 18 – 24 years.

The increased diagnoses trend from 2001 to 2019 was observed across all race and ethnicities (P < .001). Young adults who were non-Hispanic Black (624%) and Hispanic (529%) had the greatest relative increases in diagnoses compared with young adults in other race/ethnicity subgroups. However, the largest absolute change from 2001 to 2019 was in White young adults (0.30 percentage points) and Hispanic adolescents (0.05 percentage points).

During the study, 1.09% to 1.75% of adolescents and 4.26% to 9.01% of young adults had a prescription in benzodiazepine, z-hypnotic or barbiturate each calendar year. Adolescents and young adults with a prescription in 2019 had a 5- and 9-times greater prevalence of sedative, hypnotic, and anxiolytic use disorder diagnoses, respectively, compared with those without a prescription.

Sedative, hypnotic, and anxiolytic use disorder diagnoses increased from 2001 to 2019 in young adults with and without prescriptions of benzodiazepine, z-hypnotic or barbiturate. With a prescription, diagnoses increased from 0.39% to 1.77%, and without one diagnoses increased 0.03% to 0.18%. For a benzodiazepine prescription specifically among young adults, the prevalence of diagnoses increased from 0.52% in 2001 to 2.00% in 2019, compared with 0.03% in 2001 to 0.18% in 2019 in those without a benzodiazepine prescription

Most adolescents (76%) and young adults (91%) with a diagnosis of sedative, hypnotic, and anxiolytic use disorders in 2019 had a comorbid substance use disorder. Cannabis use disorder was the most common in adolescents and opioid use disorder in young adults.

“Efforts to target nonmedical use of these drugs is important as a means to reduce this disorder,” Bushnell said.²

She said that clinicians should be cautious to prescribe benzodiazepine, z-hypnotic or barbiturate to this young population due to the rise of these disorders.

“While sedative, hypnotic and anxiolytic use disorders are less common than other substance use disorders, it warrants attention from clinicians and researchers given treatment difficulties and the association with other substance use issues,” Bushnell continued.

References

1. ^{Bushnell G, Lloyd K, Olfson M, Gerhard T, Keyes K, Cerdá M, Hasin D. Nationwide trends in diagnosed sedative, hypnotic or anxiolytic use disorders in adolescents and young adults enrolled in Medicaid: 2001-2019. Addiction. 2025 Jan 22. doi: 10.1111/add.16749. Epub ahead of print. PMID: 39844019.}
2. ^{Researchers track sharp increase in diagnoses for sedative, hypnotic and anxiety use disorder in young adults. EurekAlert! January 23, 2025. https://www.eurekalert.org/news-releases/1070679?. Accessed January 23, 2025.}