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BMC Pediatrics
Published in: BMC Pediatrics 1/2023

Open Access 01-12-2023 | Research

Impact of a publicly-funded pharmacare program policy on benzodiazepine dispensing among children and youth: a population-based natural experiment

Authors: Tony Antoniou, Daniel McCormack, Sophie Kitchen, Kathleen Pajer, William Gardner, Yona Lunsky, Melanie Penner, Mina Tadrous, Muhammad Mamdani, David N. Juurlink, Tara Gomes

Published in: BMC Pediatrics | Issue 1/2023

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Abstract

Background

In January 2018, the Government of Ontario, Canada, initiated a universal pharmacare program (OHIP+) for all individuals aged 24 years and younger. In April 2019, the program was amended to cover only children and youth without private insurance. Because benzodiazepines are commonly prescribed to children and youth despite their potential hazards, we examined whether changes in publicly-funded drug coverage influenced benzodiazepine dispensing trends in this demographic.

Methods

We conducted a population-based natural experiment study of benzodiazepine dispensing to children and youth in Ontario between January 2013 and March 2020. We used interventional autoregressive integrated moving average models to estimate the impact of OHIP + and its subsequent modification on these trends.

Results

The implementation of OHIP + was associated with an immediate increase in the monthly rate of benzodiazepine dispensing of 12.9 individuals per 100,000 population (95% confidence interval [CI]; 7.5 to 18.3 per 100,000). Benzodiazepine dispensing rates rose from 214.2 to 241.5 per 100,000 from December 2017 to March 2019, a 12.8% (95% CI 9.6–16.0%) increase. In stratified analyses, increases were most pronounced among females, children and youth living in the lowest income neighbourhoods and individuals aged 20 to 24. The April 2019 modification to OHIP + was not associated with changes in monthly benzodiazepine dispensing trends (0.39 individuals per 100,000; 95% CI -1.3 to 2.1 per 100,000). However, rates remained elevated relative to the period preceding OHIP + implementation.

Conclusions

Implementation of a publicly-funded pharmacare program resulted in more children and youth being prescribed benzodiazepines.
Appendix
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Literature
1.
Piovani D, Clavenna A, Bonati M. Prescription prevalence of psychotropic drugs in children and adolescents: an analysis of international data. Eur J Clin Pharmacol. 2019;75:1333–46.PubMedCrossRef
2.
O’Sullivan K, Reulbach U, Boland F, Motterlini N, Kelly D, Bennett K, et al. Benzodiazepine prescribing in children under 15 years of age receiving free medical care on the General Medical Services scheme in Ireland. BMJ Open. 2015;5:e007070.PubMedPubMedCentralCrossRef
3.
Bénard-Laribière A, Noize P, Pambrun E, Bazin F, Verdoux H, Tournier M, et al. Trends in incident use of benzodiazepines and Z-drugs in France from 2006 to 2012: a population-based study. Pharmacoepidemiol Drug Saf. 2017;26:162–9.PubMedCrossRef
4.
Sidorchuk A, Isomura K, Molero Y, Hellner C, Lichtenstein P, Chang Z, Franck J, de la Fernández L, Mataix-Cols D. Benzodiazepine prescribing for children, adolescents, and young adults from 2006 through 2013: a total population register-linkage study. PLoS Med. 2018;15:e1002635.PubMedPubMedCentralCrossRef
5.
Hugtenburg JG, Heerdink ER, Egberts AC. Increased psychotropic drug consumption by children in the Netherlands during 1995–2001 is caused by increased use of methylphenidate by boys. Eur J Clin Pharmacol. 2004;60:377–9.PubMedCrossRef
6.
Huerta C, Abbing-Karahagopian V, Requena G, Oliva B, Alvarez Y, Gardarsdottir H, et al. Exposure to benzodiazepines (anxiolytics, hypnotics and related drugs) in seven european electronic healthcare databases: a cross-national descriptive study from the PROTECT-EU Project. Pharmacoepidemiol Drug Saf. 2016;25(Suppl 1):56–65.PubMedCrossRef
7.
Alessi-Severini S, Bolton JM, Enns MW, Dahl M, Collins DM, Chateau D, et al. Use of benzodiazepines and related drugs in Manitoba: a population-based study. CMAJ Open. 2014;2:E208–16.PubMedPubMedCentralCrossRef
8.
Nielsen ES, Rasmussen L, Hellfritzsch M, Thomsen PH, Nørgaard M, Laursen T. Trends in off-label prescribing of sedatives, hypnotics and antidepressants among children and adolescents - a danish, Nationwide Register-Based study. Basic Clin Pharmacol Toxicol. 2017;120:360–7.PubMedCrossRef
9.
10.
Patel DR, Feucht C, Brown K, Ramsay J. Pharmacological treatment of anxiety disorders in children and adolescents: a review for practitioners. Transl Pediatr. 2018;7:23–35.PubMedPubMedCentralCrossRef
11.
Witek MW, Rojas V, Alonso C, Minami H, Silva RR. Review of benzodiazepine use in children and adolescents. Psychiatr Q. 2005;76:283–96.PubMedCrossRef
12.
Walter HJ, Bukstein OG, Abright AR, Keable H, Ramtekkar U, Ripperger-Suhler J, et al. Clinical practice Guideline for the Assessment and treatment of children and adolescents with anxiety Disorders. J Am Acad Child Adolesc Psychiatry. 2020;59:1107–24.PubMedCrossRef
13.
14.
Bushnell GA, Compton SN, Dusetzina SB, Gaynes BN, Brookhart MA, Walkup JT, et al. Treating Pediatric anxiety: initial use of SSRIs and other Antianxiety prescription medications. J Clin Psychiatry. 2018;79:16m11415.PubMedPubMedCentralCrossRef
15.
Braüner JV, Johansen LM, Roesbjerg T, Pagsberg AK. Off-label prescription of Psychopharmacological Drugs in Child and Adolescent Psychiatry. J Clin Psychopharmacol. 2016;36:500–7.PubMedCrossRef
16.
Smogur M, Onesanu A, Plessen KJ, Eap CB, Ansermot N. Psychotropic drug prescription in children and adolescents: approved Medications in European Countries and the United States. J Child Adolesc Psychopharmacol. 2022;32:80–8.PubMedCrossRef
17.
McCabe SE, West BT. Medical and nonmedical use of prescription benzodiazepine anxiolytics among U.S. high school seniors. Addict Behav. 2014;39:959–64.PubMedPubMedCentralCrossRef
18.
Boyd CJ, Austic E, Epstein-Ngo Q, Veliz PT, McCabe SE. A prospective study of adolescents’ nonmedical use of anxiolytic and sleep medication. Psychol Addict Behav. 2015;29:184–91.PubMedCrossRef
19.
20.
Ross-Degnan D, Simoni-Wastila L, Brown JS, Gao X, Mah C, Cosler LE, et al. A controlled study of the effects of state surveillance on indicators of problematic and non-problematic benzodiazepine use in a Medicaid population. Int J Psychiatry Med. 2004;34:103–23.PubMedCrossRef
21.
Bijlsma MJ, Hak E, Bos J, De Jong-van den Berg LT, Janssen F. Assessing the effect of a guideline change on drug use prevalence by including the birth cohort dimension: the case of benzodiazepines. Pharmacoepidemiol Drug Saf. 2013;22:933–41.PubMedCrossRef
22.
Pearson SA, Soumerai S, Mah C, Zhang F, Simoni-Wastila L, Salzman C, et al. Racial disparities in access after regulatory surveillance of benzodiazepines. Arch Intern Med. 2006;166:572–9.PubMedCrossRef
23.
24.
25.
26.
Helfenstein U. The use of transfer function models, intervention analysis and related time series methods in epidemiology. Int J Epidemiol. 1991;20:808–15.PubMedCrossRef
27.
Schaffer AL, Dobbins TA, Pearson SA. Interrupted time series analysis using autoregressive integrated moving average (ARIMA) models: a guide for evaluating large-scale health interventions. BMC Med Res Methodol. 2021;21:58.PubMedPubMedCentralCrossRef
28.
Dickey DA, Fuller WA. Distribution of the estimators for autoregressive time series with a unit root. J Am Stat Assoc. 1979;74:427–31.
29.
Ljung GM, Box GEP. On a measure of lack of fit in time series models. Biometrika. 1978;65:297–303.CrossRef
30.
Austin PC, Grootendorst P, Anderson GM. A comparison of the ability of different propensity score models to balance measured variables between treated and untreated subjects: a Monte Carlo study. Stat Med. 2007;26:734–53.PubMedCrossRef
31.
Solmi M, Radua J, Olivola M, Croce E, Soardo L, Salazar de Pablo G, et al. Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studies. Mol Psychiatry. 2022;27:281–95.PubMedCrossRef
32.
Lijster JM, Dierckx B, Utens EM, Verhulst FC, Zieldorff C, Dieleman GC, et al. The age of onset of anxiety Disorders. Can J Psychiatry. 2017;62:237–46.PubMedCrossRef
33.
Merikangas KR, He JP, Burstein M, Swanson SA, Avenevoli S, Cui L, et al. Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey replication–adolescent supplement (NCS-A). J Am Acad Child Adolesc Psychiatry. 2010;49:980–9.PubMedPubMedCentralCrossRef
34.
Edinoff AN, Nix CA, Hollier J, Sagrera CE, Delacroix BM, Abubakar T, et al. Benzodiazepines: uses, Dangers, and clinical considerations. Neurol Int. 2021;13:594–607.PubMedPubMedCentralCrossRef
35.
Bushnell GA, Gerhard T, Crystal S, Olfson M. Benzodiazepine Treatment and Fracture Risk in Young persons with anxiety Disorders. Pediatrics. 2020;146:e20193478.PubMedCrossRef
36.
37.
38.
Friedrich JM, Sun C, Geng X, Calello DP, Gillam M, Medeiros KL, et al. Child and adolescent benzodiazepine exposure and overdose in the United States: 16 years of poison center data. Clin Toxicol (Phila). 2020;58:725–31.PubMedCrossRef
39.
Kansagra S. Sleep Disorders in adolescents. Pediatrics. 2020;145(Suppl 2):204–S209.CrossRef
40.
Ophoff D, Slaats MA, Boudewyns A, Glazemakers I, Van Hoorenbeeck K, Verhulst SL. Sleep disorders during childhood: a practical review. Eur J Pediatr. 2018;177:641–8.PubMedCrossRef
41.
Ipser JC, Stein DJ, Hawkridge S, Hoppe L. Pharmacotherapy for anxiety disorders in children and adolescents. Cochrane Database Syst Rev. 2009;3:CD005170.
42.
Sateia MJ, Buysse DJ, Krystal AD, Neubauer DN, Heald JL. Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2017;13:307–49.PubMedPubMedCentralCrossRef
43.
Myers KM, Valentine JM, Melzer SM. Child and adolescent telepsychiatry: utilization and satisfaction. Telemed J E Health. 2008;14:131–7.PubMedCrossRef
44.
Gloff NE, LeNoue SR, Novins DK, Myers K. Telemental health for children and adolescents. Int Rev Psychiatry. 2015;27:513–24.PubMedCrossRef
45.
46.
47.
48.
Kuang H, Johnson JA, Mulqueen JM, Bloch MH. The efficacy of benzodiazepines as acute anxiolytics in children: a meta-analysis. Depress Anxiety. 2017;34:888–96.PubMedPubMedCentralCrossRef
49.
The Mental Health and Addictions Scorecard and Evaluation Framework Research Team. The mental health of children and youth in Ontario: 2017 scorecard. Toronto, ON: Institute for Clinical Evaluative Sciences; 2017.
50.
Fride Tvete I, Bjørner T, Skomedal T. Risk factors for excessive benzodiazepine use in a working age population: a nationwide 5-year survey in Norway. Scand J Prim Health Care. 2015;33:252–9.PubMedPubMedCentralCrossRef
51.
Sjöstedt C, Ohlsson H, Li X, Sundquist K. Socio-demographic factors and long-term use of benzodiazepines in patients with depression, anxiety or insomnia. Psychiatry Res. 2017;249:221–5.PubMedCrossRef
52.
Taipale H, Särkilä H, Tanskanen A, Kurko T, Taiminen T, Tiihonen J, et al. Incidence of and characteristics Associated with Long-term Benzodiazepine Use in Finland. JAMA Netw Open. 2020;3:e2019029.PubMedPubMedCentralCrossRef
Metadata
Title
Impact of a publicly-funded pharmacare program policy on benzodiazepine dispensing among children and youth: a population-based natural experiment
Authors
Tony Antoniou
Daniel McCormack
Sophie Kitchen
Kathleen Pajer
William Gardner
Yona Lunsky
Melanie Penner
Mina Tadrous
Muhammad Mamdani
David N. Juurlink
Tara Gomes
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Pediatrics / Issue 1/2023
Electronic ISSN: 1471-2431
DOI
https://doi.org/10.1186/s12887-023-04331-4

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