Benzodiazepine use - current trends: evidence review

Key Findings

• Motivations for benzodiazepine use among people who use drugs are wide-ranging and have been evidenced to include a range of psychological, social, economic, and supply-driven factors. Motivations often include the self-management of psychiatric disorders and adverse experiences; their pleasurable effects, and affordability/ease of access.
• In 2020, benzodiazepines were implicated in 73% of drug-related deaths (DRDs), or 974 out of 1,339, continuing the steep rise in benzodiazepine deaths since 2016. Deaths from 'street' benzodiazepines accounted for 66% of drug-related deaths in 2020, the majority of which were related to etizolam.
• There is evidence of high benzodiazepine use and harms among people who use opioids, in addition to high frequency of use and consumption of high doses. In 2020, opioids were implicated in 94% of benzodiazepine-implicated deaths, while heroin/morphine were implicated in 49%.
• Numbers of benzodiazepine-implicated deaths in 2020 were highest for those in the 35-44 year age bracket, closely followed by the 45-54 year age bracket; and higher among men, who accounted for 74% of benzodiazepine-related deaths.
• Hospital stays for sedative/hypnotics (including benzodiazepines) have increased sharply since the mid-2010s to 54 stays per 100,000 in 2020/21, the highest recorded rate across the time series.
• Etizolam was the second most commonly seized drug after cannabis in Scotland in 2019/20, with approximately 5.3 million benzodiazepine tablets seized by Police Scotland, compared with 2.1 million tablets seized in 2018/19. Etizolam accounted for 94% of benzodiazepine seizures in 2019/20.
• Diazepam prescriptions for specialist drug treatment have decreased by 67% since 2006/07.
• In 2019/20, 2,495 people out of 10,900 individuals recorded on the Scottish Drug Misuse Database (SDMD) (29%) used diazepam in the month before entering treatment.
• In 2019/20, 882 of 8,573 individuals assessed for a new specialist drug treatment episode (10%) recorded diazepam as the main drug for which they were seeking treatment.
• Current UK guidelines for the treatment of substance dependency recommend minimising long-term prescription of benzodiazepines, while recent guidelines published by the Drug Deaths Taskforce advocate for some benzodiazepine prescribing in a harm reduction framework.