Assessing the Role of Benzodiazepines in US Fatal Overdoses

The epidemiology of fatal overdoses involving benzodiazepines has received less attention than those involving opioids. This cross-sectional study used death record data from the US National Vital Statistics System to examine benzodiazepine-involved overdoses between 2000 and 2019 with attention to time trends, race/ethnicity, other substances used concomitantly with benzodiazepines, and suicide intentionality.

• From 2000 to 2019, 118,208 overdose deaths involved benzodiazepines; 84% of these also involved an opioid.
• 10,677 (9%) of benzodiazepine-involved overdose deaths did not involve an opioid, cocaine, other psychostimulant, barbiturate, or alcohol.
• Most overdose deaths were accidental, but 9% of benzodiazepine plus opioid-involved cases and 36% of cases without an opioid were intentional (i.e., suicides).
• In 2019, there were 9731 benzodiazepine-involved cases, which was an almost 20% reduction from 2017.
• After large increases from 2000 to 2017, benzodiazepine-involved overdose death rates (with and without an opioid) decreased between 2017 and 2019, but these reductions were mostly in non-Hispanic White individuals.

Comments: These data reinforce known risks of concomitant benzodiazepine and opioid use, but, strikingly, they also highlight the role of benzodiazepines in intentional overdose or suicide. Standard reporting on cause of death is unlikely to fully capture suicidal intent, which implies that these numbers are underestimates. This study did not include prescribing data, but based on accrued knowledge, clinicians should avoid co-prescribing benzodiazepine and opioid medications when possible, prescribe naloxone when patients are taking benzodiazepines and opioids, and better screen for and address suicidality.

Aaron D. Fox, MD

Reference: Kleinman RA, Weiss RD. Benzodiazepine-involved overdose deaths in the USA: 2000-2019. J Gen Intern Med. 2022;37(8):2103–2109.