Increase and fatal and nonfatal overdoses involving benzodiazepines

Yes there is more than just Covid19 going on out there.

From the CDC:

This is the first multistate report to examine recent trends in both nonfatal and fatal benzodiazepine overdoses. Three concerning trends during 2019–2020 were identified: 1) increases in both nonfatal and fatal overdoses involving benzodiazepines and opioids; 2) marked increases in illicit benzodiazepine deaths, although overdose deaths involving prescription benzodiazepines still far outnumber those involving illicit benzodiazepines; and 3) increases in nonfatal benzodiazepine overdoses not involving opioids. In 2016, the CDC Opioid Prescribing Guideline discouraged co-prescribing opioids and benzodiazepines,**** and the Food and Drug Administration imposed its most prominent warning on all benzodiazepine medications,†††† describing the risks of use with opioids. Despite progress in reducing co-prescribing before 2019 (2), this study suggests a reversal in the decline in benzodiazepine deaths from 2017 to 2019,§§§§ driven in part by increasing involvement of IMFs in benzodiazepine deaths and influxes of illicit benzodiazepines, likely indicating simultaneous use of nonprescribed opioids and benzodiazepines.

During 2019–2020, benzodiazepine deaths (both prescription and illicit) were characterized by high and increasing co-involvement of IMFs, a trend documented as early as during 2017–2018 (3). Substantial increases in the supply of IMFs during January 2013–June 2020,¶¶¶¶ coupled with the high potency and rapid absorption of IMFs (4), which increase overdose risk above that of heroin and prescription opioids, is likely a principal driver of fatal benzodiazepine and IMF overdose. The largest increase in IMF involvement among benzodiazepine deaths occurred in 2020 between Q1 and Q2, possibly reflecting altered drug use patterns that increased overdose risk (e.g., decreased naloxone access); and possible drug supply disruptions; during the COVID-19 pandemic (5). Although the much greater involvement of opioids in benzodiazepine deaths (91.4%) compared with benzodiazepine overdose ED visits (21.9%) underscores the dangers of co-use, increases in opioid involvement among benzodiazepine ED visits (34.4% increase) throughout 2020 might be an early indicator of continued and amplified increases in morbidity and mortality related to benzodiazepine and opioid co-use.

Other factors accelerating increases in benzodiazepine deaths involving opioids are rapid increases in supply and co-use of illicit benzodiazepines among persons using illicit opioids, especially IMFs. Whereas law enforcement reports of diverted prescription benzodiazepines declined from 2015 through June 2020, reports of illicit benzodiazepines (particularly etizolam and flualprazolam) surged during that period, indicating increased availability (6).***** Reductions in benzodiazepine and opioid co-prescribing must be coupled with efforts to disrupt and reduce the availability of and harms associated with concurrent use of illicit benzodiazepines and IMFs. (more…)


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