Calming the Brain with sleeping pills: You Can Have Too Much Of A Good Thing

A new study shows a staggering increase in benzodiazepine-related toxicity rates among young adults and youth in Ontario.

Between 2013 and 2020, hospital visits due to benzodiazepine-associated toxicity saw a significant increase, up by 67% among individuals aged 19 to 24 and 44% among those aged 18 or younger in Ontario, reveals recent research by ICES and Unity Health Toronto.

Despite a 7% overall reduction in benzodiazepine toxicity incidents at the provincial level, this drop was primarily due to lowered rates in those aged 35 and above.

Benzodiazepines, often used for managing anxiety and insomnia, have started to surface in the unauthorized and illegal opioid drug market in the recent past.

The study, which came into existence thanks to the Ontario Drug Policy Research Network (ODPRN) based at St. Michael’s Hospital (part of Unity Health Toronto), was published in the Canadian Journal of Public Health. A group of 25 volunteer citizens comprising the Citizens’ Panel identified this issue as a public concern and were actively involved in all stages of the research endeavor.

“Outside of the older adult population, studies were nonexistent specific to the younger age group. Our interest was further peaked by the significant increase in prescribing rates among this younger population and especially among the female population within this segment,” comments panel member Josephine Quercia.

“What initially started as a potentially positive outcome with the ‘7% reduction in the provincial rate of benzodiazepine toxicity between 2013 – 2020’, once unpacked, pivoted quickly to a very different outcome – one where focus is needed on reducing the risks to our youth and young adult population.”

The study looked at 25,979 Ontario people who went to the emergency room or were hospitalized because of benzodiazepine poisoning between January 1, 2013, and December 31, 2020.

The researchers also looked at how often the subjects had been prescribed opioids and benzodiazepines and how often they had been to the doctor for mental health and drug use problems in the past.

“Importantly, we also found that fewer encounters were with patients who had an active prescription for benzodiazepines, adds lead author Tonya Cambell, “however, there was greater involvement of other substances, such as opioids, stimulants, and alcohol, with rates of those incidents reaching almost 30% in 2020.

“This is likely driven by the increasing presence of non-pharmaceutical benzodiazepines in the unregulated drug supply in Ontario.”

Study results indicate:

• Young adults aged 19 to 24 saw a 67% rise in benzodiazepine toxicity, from 40 to 67 cases per 100,000 people, while children and adolescents aged 18 and younger experienced a 44% increase, from 11 to 16 cases per 100,000 people.
• Over the course of the trial, the percentage of interactions, when patients had an active benzodiazepine prescription, fell from 61% in 2013 to 49% in 2020.
• In 2020, opioid, alcohol, or stimulant-related toxicity was present in 29% of benzodiazepine poisoning events, with opioid involvement being the most prevalent (17%).
• Nearly 50% of those who suffered benzodiazepine toxicity had a hospitalization the year before for a mental health or drug use illness, with anxiety disorders (19%) and mood disorders (19%) being the most frequent causes.

“Taken together, these trends are concerning,” adds senior author Dr. Tara Gomes, “and likely reflect the continued risks for youth and young adults prescribed benzodiazepines as well as the recent arrival of these drugs in the unregulated opioid supply in Ontario.”

Therefore, the authors say, “We need a comprehensive response that includes improved access to community-based mental health services, a focus on the safe use of prescription benzodiazepines, and alternatives to the unpredictable unregulated opioid drug supply.”

One constraint of the research was the absence of data regarding incidents that did not receive treatment or were managed outside a hospital setting. Moreover, the inconsistency in drug screening practices across various emergency departments indicates that the benzodiazepine toxicity rates may have been underrepresented in this study. The research also did not delve into the specifics or patterns of intent, such as differentiating between accidental incidents or those linked to self-harm.

Despite these limitations, this research stands as the first study to investigate the long-term trends and patterns of benzodiazepine-related toxicity in Ontario. It aligns with the broader body of evidence indicating a surge in benzodiazepine-related harm across North America.

Image Credit: Getty