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Benzodiazepine-Involved Overdose Deaths in the USA: 2000–2019

Abstract

Background

Despite the focus on overdose deaths co-involving opioids and benzodiazepines, little is known about the epidemiologic characteristics of benzodiazepine-involved overdose deaths in the USA.

Objective

To characterize co-involved substances, intentionality, and demographics of benzodiazepine-involved overdose deaths in the USA from 2000 to 2019.

Design

Cross-sectional study using national mortality records from the National Vital Statistics System.

Subjects

US residents in the 50 states and District of Columbia who died from a benzodiazepine-involved overdose from 2000 to 2019.

Main Measures

Demographic characteristics, intention of overdose, and co-involved substances

Key Results

A total of 118,208 benzodiazepine-involved overdose deaths occurred between 2000 and 2019 (median age, 43 [IQR, 32–52]; male, 58.6%; White, 93.3%; Black, 4.9%; American Indian and Alaska Native, 0.9%; Asian American and Pacific Islander, 0.9%; Hispanic origin, 6.4%). Opioids were co-involved in 83.5% of the deaths. Nine percent of benzodiazepine-involved overdose deaths did not involve opioids, cocaine, other psychostimulants, barbiturates, or alcohol. Overdose deaths were classified as suicides in 8.5% of cases with benzodiazepine and opioid co-involvement and 36.2% of cases with benzodiazepine but not opioid involvement. Rates of benzodiazepine-involved overdose deaths increased from 0.46 per 100,000 individuals in 2000 to 3.55 per 100,000 individuals in 2017 before decreasing to 2.96 per 100,000 individuals in 2019. Benzodiazepine-involved overdose mortality rates increased from 2000 to 2019 among all racial groups, both sexes, and individuals of Hispanic and non-Hispanic origin. Rates of benzodiazepine-involved overdose deaths decreased among White individuals, but not Black individuals, from 2017 to 2019.

Conclusions

Interventions to reduce benzodiazepine-involved overdose mortality should consider the demographics of, co-involved substances in, and presence of suicides among benzodiazepine-involved overdose deaths.

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Funding

This work was supported by the Research in Addiction Medicine Scholars Program (National Institute on Drug Abuse R25DAO33211).

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Correspondence to Robert A Kleinman MD.

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Conflicts of Interest

Dr. Weiss has served as a consultant to Astellas Pharmaceuticals, Cerevel Therapeutics, Analgesic Solutions, Takeda Pharmaceuticals, and Janssen Pharmaceuticals. Dr. Kleinman has received funding from the Centre for Addiction and Mental Health Discovery Fund and the Research in Addiction Medicine Scholars Program (National Institute on Drug Abuse R25DAO33211) and travel awards from the American Psychiatric Association and the American Academy on Addiction Psychiatry.

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Kleinman, R.A., Weiss, R.D. Benzodiazepine-Involved Overdose Deaths in the USA: 2000–2019. J GEN INTERN MED 37, 2103–2109 (2022). https://doi.org/10.1007/s11606-021-07035-6

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