Global prevalence and patterns of benzodiazepine use among adolescents and young adults: A systematic review and meta-analysis.

OBJECTIVES: To synthesise global evidence on the prevalence, patterns of use, and clinical correlates of benzodiazepine (BZD) use among adolescents and young adults aged 16-30 years, and to identify methodological sources of heterogeneity in prevalence estimates across international settings. STUDY DESIGN: Systematic review and meta-analysis of observational studies. METHODS: PubMed, Scopus, and Web of Science were searched for observational studies published between January 2015 and October 2025 reporting BZD use in individuals aged 16-30 years. Pooled prevalence was estimated using a random-effects model with Freeman-Tukey double arcsine transformation. Predefined exploratory subgroup analyses examined type of consumption, geographic region, data source, population type, and study size. Univariable meta-regression explored potential sources of heterogeneity. Risk of bias was assessed using the Hoy et al. tool. The protocol was registered in PROSPERO (CRD1230633). RESULTS: Fifteen studies (N = 7,235,912) were included. The pooled overall prevalence estimate was 4.4% (95% CI: 1.8 to 8.2%). Mixed medical/non-medical use yielded the highest estimate (5.9%), followed by medical use (3.6%) and misuse (3.3%). Exploratory subgroup analysis suggested differences by study size (p = 0.012), with small studies reporting higher prevalence estimates than medium-sized studies. Key correlates included female sex, psychiatric comorbidity (ADHD, depression), and polydrug use. CONCLUSIONS: Benzodiazepine exposure is common among adolescents and young adults. Prevalence appears context-dependent, likely reflecting differences in prescribing practices, access pathways, and exposure measurement across settings. These findings highlight the importance of developmentally tailored prescribing guidelines and suggest that expanding non-pharmacological alternatives may be warranted in this population.