Insomnia May Predict Future Opioid or Benzodiazepine Misuse

Insomnia symptoms are associated with prescription opioid and benzodiazepine misuse, according to study results published in Addictive Behaviors.

Researchers conducted a log-binomial regression analysis of longitudinal data sourced from the National Longitudinal Study of Adolescent to Adult Health. Participants (N=10,685; mean age, 28 [95% CI, 28.4-29.1] years; 50.3% men; 66.4% White) were asked whether they had taken prescription opioids or benzodiazepines that were not prescribed to them. Symptoms of insomnia were evaluated for whether they contributed to longitudinal trends in prescription misuse.

Among the study population, 28.3% had a lifetime diagnosis of alcohol use disorder, 16.5% of depression, 12.9% of anxiety, 7.5% of substance use disorder, and 50.9% experienced childhood abuse.

At wave 4 in 2008, 14.9% reported prescription opioid misuse and 9.6% reported prescription benzodiazepine misuse. The average insomnia symptom score at wave 4 was 1.6 (95% CI, 1.6-1.7). At wave 5 from 2016 to 2018, fewer individuals reported opioid (7.6%) and benzodiazepine (3.5%) misuse and insomnia scores were higher (mean, 1.7; 95% CI, 1.7-1.8).

In the fully adjusted model, insomnia symptoms at wave 4 was associated with opioid misuse at wave 4 (adjusted RR [aRR], 1.08; 95% CI, 1.01-1.15), but not associated with benzodiazepine misuse at wave 4 (aRR, 1.09; 95% CI, 0.99-1.21). Insomnia at wave 4 was a significant predictor for both opioid (adjusted β, 0.20; 95% CI, 0.09-0.31) and benzodiazepine (adjusted β, 0.21; 95% CI, 0.10-0.33) misuse at wave 5.

The study is limited by the reliance on self-reported data and the fact that insomnia was evaluated using only a single question about difficulty falling asleep.

Study authors concluded, “Results from the current study support the hypothesis that there are prospective associations between insomnia symptoms and prescription opioid and benzodiazepine misuse. Considering the major public health impacts of prescription medication misuse, and the prevalence of insomnia symptoms, future research should continue to attend to these associations, evaluate possible mechanisms underlying their relationships, and work toward identifying possible intervention strategies to avoid this vicious cycle from developing.”