Benzodiazepines in apparent drug toxicity deaths in Canada, 2018 to 2024:

What are benzodiazepines?

Benzodiazepines are a class of substances that slow down brain activity and are used to treat conditions such as anxiety, sleep disorders and seizures. Benzodiazepines are only legally available by prescription and should be consumed as recommended by a physician. Their use can lead to substance use disorder, overdose and death, especially when consumed with alcohol or other drugs.

Benzodiazepines contributing to more deaths in Canada

The rate of apparent benzodiazepine toxicity deaths increased by approximately 3 times from 2018 to 2024, peaking in 2023 at 3.5 per 100,000 population (1,360 deaths):

• 1.1 per 100,000 population in 2018 (405 deaths)
• 2.9 per 100,000 population in 2024 (1,155 deaths)

Over the same period, the rate of apparent opioid toxicity deaths decreased by approximately 1.4 times.

34% of opioid-related deaths in 2024 also had benzodiazepines contributing to death, compared to 8% in 2018.

Figure 1. Crude rate (per 100,000 population) of apparent opioid and benzodiazepine toxicity deaths in Canada, 2018 to 2024

Table 1. Crude rate (per 100,000 population) of apparent benzodiazepine and apparent opioid toxicity deaths in Canada, 2018 to 2024

Figure 1: Text description

Year	Apparent benzodiazepine toxicity deaths	Apparent opioid toxicity deaths
2018	1.1	10.8
2019	0.9	8.6
2020	1.3	13.5
2021	1.8	14.4
2022	1.5	12.4
2023	3.5	12.1
2024	2.9	8.0

Figure 1: Notes

1. Data were available for 11-12 provinces and territories, depending on the year.
2. Manitoba data are not available across all years, while Nunavut data was not available from 2023 onwards.
3. British Columbia data were included, but substance-level information is limited across the analyzed period.

Increasing presence in toxic drug supply

Identifications of benzodiazepines in seized samples in Canada rose to a peak in 2023, then declined through 2024, but remained more than 3 times higher than in 2018.

Identifications of opioids in seized samples in Canada rose to a peak in 2021 and remained high.

The percentage of opioid samples containing at least one benzodiazepine increased from 0.2% in 2018 to a peak of 33% in 2023, before declining to 27% in 2024.

Figure 2. Number of identifications including benzodiazepines and opioids in Canada, 2018 to 2024, from samples analyzed by Health Canada's Drug Analysis Service.

Table 2. Number of identifications including benzodiazepines and opioids in Canada, 2018 to 2024, from samples analyzed by Health Canada's Drug Analysis Service

Figure 2: Text description

Year	Benzodiazepines	Opioids
2018	2,698	13,340
2019	2,926	17,949
2020	4,166	18,270
2021	9,473	22,949
2022	10,014	22,792
2023	10,322	21,420
2024	8,481	21,625

Figure 2: Notes

1. Multiple substances from the benzodiazepine subclass may be identified in a same sample, therefore the number of identifications does not correspond to the number of samples in which at least one benzodiazepine is identified.
2. Data from Manitoba are excluded for all years to align with mortality data.
3. No benzodiazepine was identified in samples submitted to DAS laboratories from Nunavut during the analyzed time period.

Data Considerations and Sources

The information presented on substance-related toxicity deaths in this report was obtained from death investigation data from the Canadian Coroner and Medical Examiner Database (CCMED). CCMED includes all deaths that are investigated by coroners and medical examiners in Canada. CCMED data were available for 11-12 provinces and territories, depending on the year. Only deaths for which the death investigation was completed were included in this analysis. Manitoba data are not available in the database across all years, while Nunavut data was not available from 2023 onwards. British Columbia data were included, but substance-level information is limited across the analyzed period. For additional information visit the Canadian Coroner and Medical Examiner Database (CCMED).

The information presented on identifications and samples seized from the unregulated drug supply were obtained from Health Canada’s Drug Analysis Service (DAS), who operate laboratories across Canada that analyze suspected illicit drugs samples submitted by law enforcement agencies and public health partners. Identification of benzodiazepines in samples was not reported by Nunavut during the analyzed time period. Data were aligned with CCMED, such that Manitoba data was excluded from totals across all years, while Nunavut data, where available, were excluded from opioid samples from 2023 onwards. Findings presented here may differ from other data from the Health Canada DAS as these data are presented and analyzed in a different manner. Additional information about the work of the Health Canada Drug Analysis Service can be found on the Drug Analysis Service and Cannabis Laboratory Analyzed Drug Report.

Acknowledgements

• Access to the information in this report would not be possible without the collaboration and dedication of P/T offices of Chief Coroners and Chief Medical Examiners as well as P/T public health and health partners and Public Health Officers.