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We aimed to measure risks of drug overdose following BZD treatment initiation, and simultaneous BZD and SSRI initiation, compared with SSRI treatment alone in young adults with depression or anxiety.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design, Setting, Participants<\/jats:title><jats:p>The cohort study used administrative databases covering privately (MarketScan, 1\/1\/2009\u201312\/31\/2018) and publicly (Medicaid, 1\/1\/2015\u201312\/31\/2016) insured young adults (18\u201329\u2009years) in the United States. Those with depression or anxiety diagnoses newly initiating BZD or SSRI treatment (without BZD or SSRI prescriptions in prior year) were included. Simultaneous \u201cBZD\u2009+\u2009SSRI\u201d initiation was defined as starting BZD and SSRI treatment on the same day. The cohorts included 604\u2009664 privately insured young adults (BZD\u2009=\u200922%, BZD\u2009+\u2009SSRI\u2009=\u200910%, SSRI\u2009=\u200968%) and 110\u2009493 publicly insured young adults (BZD\u2009=\u200923%, BZD\u2009+\u2009SSRI\u2009=\u20095%, SSRI\u2009=\u200972%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements<\/jats:title><jats:p>Incident medically treated drug overdose events were identified from emergency department and inpatient encounters (ICD poisoning codes) within 6\u00a0months of treatment initiation. Crude and propensity\u2010score adjusted cumulative incidence and hazard ratios (HR) were estimated. Sub\u2010analyses evaluated drug overdose intent.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>Adjusted HRs of drug overdose for BZD vs. SSRI treatment was 1.36 (95% confidence interval [CI]:1.23\u20131.51) in privately and 1.59 (95%CI:1.37\u20131.83) in publicly insured young adults. The adjusted HRs of drug overdose for BZD\u2009+\u2009SSRI treatment vs. SSRI treatment were 1.99 (95%CI:1.77\u20132.25) in privately and 1.98 (95%CI:1.47\u20132.68) in publicly insured young adults.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Among young adults in the United States, initiating benzodiazepine treatment for anxiety and depression, alone or simultaneously with selective\u2010serotonin reuptake inhibitors (SSRI), appears to have an increased risk of medically treated drug overdose compared with SSRI treatment alone. These associations were observed in publicly and privately insured individuals.<\/jats:p><\/jats:sec>","DOI":"10.1111\/add.16359","type":"journal-article","created":{"date-parts":[[2023,10,12]],"date-time":"2023-10-12T04:25:44Z","timestamp":1697084744000},"page":"356-368","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Drug overdose risk with benzodiazepine treatment in young adults: Comparative analysis in privately and publicly insured individuals"],"prefix":"10.1111","volume":"119","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4056-8405","authenticated-orcid":false,"given":"Greta A.","family":"Bushnell","sequence":"first","affiliation":[{"name":"Center for Pharmacoepidemiology and Treatment Sciences Rutgers Institute for Health, Health Care Policy and Aging Research  New Brunswick NJ USA"},{"name":"Department of Biostatistics and Epidemiology Rutgers University School of Public Health  Piscataway NJ USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moira A.","family":"Rynn","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences Duke University School of Medicine  Durham NC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Gerhard","sequence":"additional","affiliation":[{"name":"Center for Pharmacoepidemiology and Treatment Sciences Rutgers Institute for Health, Health Care Policy and Aging Research  New Brunswick NJ USA"},{"name":"Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy Rutgers University  New Brunswick NJ USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine M.","family":"Keyes","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Columbia University Mailman School of Public Health  New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6533-7021","authenticated-orcid":false,"given":"Deborah S.","family":"Hasin","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Columbia University Mailman School of Public Health  New York NY USA"},{"name":"Columbia University Irving Medical Center  New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8441-7046","authenticated-orcid":false,"given":"Magdalena","family":"Cerd\u00e1","sequence":"additional","affiliation":[{"name":"Center for Opioid Epidemiology and Policy, Department of Population Health New York University School of Medicine  New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abner","family":"Nyandege","sequence":"additional","affiliation":[{"name":"Center for Pharmacoepidemiology and Treatment Sciences Rutgers Institute for Health, Health Care Policy and Aging Research  New Brunswick NJ USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Olfson","sequence":"additional","affiliation":[{"name":"Department of Epidemiology Columbia University Mailman School of Public Health  New York NY USA"},{"name":"Columbia University Irving Medical Center  New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,10,10]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.15620\/cdc:106058"},{"key":"e_1_2_9_3_1","unstructured":"Centers for Disease Control and Prevention National Center for Injury Prevention and Control.WISQARS\u2014web\u2010based injury statistics query and reporting system. 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