Medical use of tranquilizers and sedatives by 13-19-year-old adolescents in Estonia, 2012–2024

Abstract Background Understanding prescribing patterns is key to improving adolescent mental health care and safe medication use. This study explored trends in medical use of tranquilizers and sedatives/hypnotics (TS) among Estonian adolescents aged 13-19 from 2012 to 2024. Methods A nationwide cross-sectional study used data from Estonian Prescription Database, covering all outpatient-dispensed TS prescriptions (ATC codes N05B, N05C). Annual prevalence per 1000, defined daily doses (DDDs) per user, and long-term use (≥180 DDD/year) were calculated by age and sex. Joinpoint regression was used to estimate annual percent change (APC). Results From 2012 to 2024, 6950 adolescents (63% girls) received 26,191 TS prescriptions. Among boys, TS prevalence increased from 7.9 to 9.9 during 2012-2018 (APC 2.8%, p < 0.05), then declined to 7.3 by 2024 (APC -3.6%, p < 0.05). In girls, prevalence rose from 11.6 to 17.9 during 2012-2021 (APC 3.7%, p < 0.05), then declined to 13.6 (APC -7.8%, p < 0.05). In 13-17-year-olds, TS use declined in boys throughout (APC -3.2%, p < 0.05), while in girls it remained stable until 2021, then declined (APC -9.2%, p < 0.05). In 18-19-year-olds, TS use rose until 2021 (boys: APC 5.8%; girls: APC 7.4%, p < 0.05), then declined-significantly in boys (APC -8.5%) and non-significantly in girls (APC -7.1%). In 2012-2024 TS DDDs/user significantly increased 1.4-fold in boys (APC 4.0%) and 1.8-fold in girls (APC 5.0%). Long-term use increased (APC 10.7%, p < 0.05). Most used substances were alprazolam (29.6%), diazepam (22.4%) and zopiclone (12.4%). Main diagnoses were anxiety (21.0%) and depression (18.4%). Psychiatry (50.1%) and primary care (36.4%) were key prescribers. Conclusions TS use increased until 2021, especially in girls and 18-19-year-olds, then declined, while intensity and long-term use continued to rise. These findings highlight the need to monitor treatment duration and dosage and to reinforce non-pharmacological mental health support. Key messages • TS use among Estonian adolescents increased during 2012–2021, then declined, especially in girls, while use intensity and long-term use continued to increase through 2024. • Findings underscore the need for cautious prescribing and expanded access to non-pharmacological mental health care.