Prescribing of controlled substances to adolescents and young adults enrolled in Medicaid, 2001-2019.

OBJECTIVE

To examine nationwide trends in the prescribing of controlled medications to early adolescents, adolescents, and young adults enrolled in public insurance (Medicaid) from 2001 to 2019.

METHODS

The study utilized US Medicaid data covering publicly insured enrollees from 43 states (2001-2019). Early adolescents (10-12y), adolescents (13-17y), and young adults (18-24y, 25-29y) with ≥ 10 months enrollment in each calendar year were included. Filled prescription for opioids, stimulants, benzodiazepines, Z-hypnotics, barbiturates, and gabapentin were identified. In each calendar year, annual proportions with 1 +  controlled medication, 2 +  classes of controlled medications, and each controlled medication were estimated.

RESULTS

In 2019, the sample included 17.9 million enrollees (53 % female). The annual proportion prescribed any controlled medication peaked at 17.5 % in early adolescents (2003), 20.6 % in adolescents (2009), and 34.1 % (18-24y) and 47.0 % (25-29y) in young adults (2010). By 2019, the proportions declined to 11.7 % (early adolescents), 12.6 % (adolescents), 16.2 % (18-24y), and 23.9 % (25-29y). Trends varied by medication and age. The largest absolute decline was in the proportion with an opioid filled (2010 =29.8 %, 2019 =11.2 %, young adults 18-24y; 2003 =14.3 %, 2019 =4.4 %, adolescents). In contrast, the proportion with a stimulant fill increased, with eight-fold increases in young adults 25-29y (2001 =0.3 %, 2019 =2.6 %). Benzodiazepine and Z-hypnotic use peaked in 2010 and declined through 2019.

CONCLUSIONS

In the past two decades, there were increases in stimulant prescriptions among young Medicaid enrollees. The declines in opioid, benzodiazepines, barbiturate and Z-hypnotic prescribing are encouraging and may indicate more cautious prescribing related to greater awareness of harms such as misuse and overdose, along with policy initiatives.