Intentional benzodiazepine poisoning in older adults reported to United States Poison Centers

Abstract

Introduction

Despite known contraindications, benzodiazepines are frequently prescribed for older adults. This study utilizes poison control center data on benzodiazepine-involved cases aged 50 and above to compare the characteristics of suspected suicide attempt with other intentional misuse cases. We also examined associations of major medical outcomes (major effect/death) with demographic characteristics and other co-used substances in each group.

Methods

The study employed data from the America’s Poison Center National Poison Data System from 2015–2022. Descriptive statistics and binary logistic regression models were used.

Results

Of the benzodiazepine-poisoning cases of intentional misuse (n = 93,245), 85 percent were suicide attempts and 15 percent were other intentional misuses. Reports to poisons centers showed a decline from 2019–2022 when compared to 2015–2016. However, the likelihood of a reported suicide attempt, compared to other intentional misuse, was greater in 2019–2022 compared to 2015–2016 and among those who co-used antidepressants, anxiolytics, atypical antipsychotics, other benzodiazepines, other analgesics, anticonvulsants, and alcohol. The odds of major effect/death in both groups were also greater in 2019–2022, with suicide attempt cases in advanced ages showing higher odds. The co-use of antidepressants, prescription opioids, atypical antipsychotics, anticonvulsants, and other analgesics were associated with a higher likelihood of major effect/death in both exposure groups. For instance, adjusted odds ratios for co-used prescription opioids were 2.20 (95 percent confidence intervals: 2.09–2.31) among suicide attempt cases and 3.51 (95 percent confidence intervals: 3.10–3.97) among other intentional misuse cases.

Discussion

Healthcare providers need to screen for suicidal ideation among benzodiazepine users, with special attention to an increased risk of suicide attempt among those who co-use antidepressants and opioids and to decreasing adverse outcomes in all misuse cases. Assessments of underlying mental health and substance use problems and medication regimens to minimize polypharmacy and drug interactions are needed to reduce adverse outcomes.

Conclusions

Though the numbers of benzodiazepine-involved suicide attempt and other intentional misuse cases reported to United States poison centers decreased in recent years, the likelihood of major medical effect/death among these cases have increased.

Keywords:

• Older adults
• benzodiazepines
• suicide attempt
• antidepressants
• opioids
• alcohol

Acknowledgements

The America’s Poison Centers made the National Poison Data System (NPDS) available to the authors for this study. This study’s findings and conclusions are those of the authors alone and do not necessarily represent the official position of the America’s Poison Centers or participating poison control centers.

Authors’ contributions

All authors contributed to conceptualization. SDB applied for and obtained the de-identified NPDS data and provided overall guidance on the data system and analysis. NGC conducted data analysis and drafted the paper. BYC provided consultation on pharmaceutical and medical contents. CNM provided statistical consultation. All authors contributed to final editing and agree to publication of the paper. Each author certifies that their contribution to this work meets the standards of the International Committee of Medical Journal Editors.

Disclosure statement

America’s Poison Centers maintains the National Poison Data System (NPDS), which houses de-identified records of self-reported information from callers to the country’s Poison Centers (PCs). The NPDS data do not reflect the entire universe of U.S. exposures and incidences related to any substance(s). Exposures do not necessarily represent a poisoning or overdose and America’s Poison Centers is not able to completely verify the accuracy of every report. National Poison Data System data do not necessarily reflect the opinions of America’s Poison Centers.

Data availability statement

The America’s Poison Centers (APC) releases the National Poison Data System (NPDS) to investigators following a review of data request. The authors do not have permission to make the NPDS data set use in this study available to other investigators.

Additional information

Funding

This research was supported by grant, P30AG066614, awarded to the Center on Aging and Population Sciences at The University of Texas at Austin by the National Institute on Aging. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health and National Institute on Aging - U.S. (Maryland).