(BSPOT29) Trends in the prescribing of controlled substances to children and young adults enrolled in Medicaid, 2001-2019

Background: Controlled substances are regulated by federal law and include prescription drugs given for medical indications that carry the potential for abuse or dependency. Although young people are a vulnerable age group with heightened risk for drug misuse and overdose, it is unclear how the prescribing of controlled substances to youth in the US has changed in the past two decades.

Objectives: To examine nationwide US trends in the prescribing of controlled substances to children and young adults enrolled in public insurance (Medicaid) from 2001-2019.

Methods: We utilized Medicaid Analytic eXtracts (MAX) and Transformed Medicaid Analytic Files (TAF) covering publicly insured enrollees from 43 US states with prescription data for 2001-2019. We included children (10-17 years) and young adults (18-29 years) with ≥10 months enrollment in each calendar year. For each calendar year, we identified individuals with 1+ dispensed prescription for benzodiazepines (BZD), stimulants, Z-hypnotics, barbiturates, opioids, and gabapentin (controlled in selected states). We estimated the annual prevalence for each controlled substance, and any controlled substance. Secondary analyses restricted to states with recognized higher quality Medicaid data.

Results: In 2019, 52.9% of the study population was female and 41.3% aged 18-29 years (N=19,698,680). 31% of young adults had at least one controlled substance prescription dispensed in 2001, peaking at 38.4% in 2010 and declining to 18.7% by 2019. In children, the prevalence of any controlled substance prescription in these data was also highest in 2010 at 19.7% and declined to 11.9% by 2019.

In young adults, opioid (33.6%), BZD (7.0%), and Z-hypnotic (2.0%) prevalence peaked in 2010 with substantial declines through 2019 to 13.5%, 3.3%, and 0.3%, respectively. In contrast, stimulant (0.6% to 2.8%) and gabapentin (1.0% to 1.7%) prevalence increased from 2001 to 2019, while barbiturates declined (2.2% to 0.7%).

In children, BZD ( < 1.0%), Z-hypnotic ( < 0.2%), barbiturate ( < 0.6%), and gabapentin ( < 0.3%) prevalence remained low from 2001-2019. Pediatric opioid prevalence was highest in 2003 at 12.4% and declined to 3.2% by 2019; stimulant prevalence rose from 6.0% in 2001 to 10.0% in 2013, followed by a decline to 8.4% in 2019.

Conclusions: The prescribing of controlled substances to child and young adult Medicaid enrollees varied over the past two decades, with overall declines in opioid, BZD, Z-hypnotic, and barbiturate prevalence and increases in stimulant prescriptions. The opioid epidemic, increasing knowledge and concern on the adverse effects of controlled substances, and availability of alternative treatments likely contributed to the overall decline in controlled substance prescribing in this young population.