Characterizing trends and patterns in benzodiazepine-related toxicity deaths in Ontario: A descriptive cross-sectional study
12 affiliations
- 1MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Ontario, Canada
- 2Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- 3Epidemiology Research Unit, Caribbean Institute for Health Research, The University of the West Indies, Mona, Kingston, Jamaica
- 4Public Health Ontario, Toronto, ON, Canada
- 5Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- 6Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- 7ICES, Toronto, Ontario, Canada
- 8Faculty of Medicine, Memorial University, St. John’s, NL, Canada
- 9Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada
- 10Ottawa Inner City Health Inc., Ottawa, ON, Canada
- 11Northern Ontario School of Medicine, Sudbury, ON, Canada
- 12Ontario Drug Policy Research Network Lived Experience Advisory Group, Toronto, ON, Canada
Abstract
Objectives: The unregulated drug supply in Canada increasingly contains benzodiazepines, particularly those not approved for medical use, raising concerns about toxicity risk, especially when combined with opioids. Therefore, we aimed to describe trends in benzodiazepine-related toxicity deaths and compare their characteristics and circumstances by benzodiazepine type. Methods: We conducted a descriptive cross-sectional study of accidental benzodiazepine-related toxicity deaths in Ontario between January 1, 2018 and June 30, 2022, using linked administrative healthcare at ICES including coroner’s investigation records from the Drug and Drug/Alcohol Related Death Database. We measured monthly crude rates of benzodiazepine toxicity deaths and summarized characteristics (age, sex, region of residence, etc.) and circumstances (number and types of substances involved, healthcare encounters for toxicities and substance use disorders, etc.) of decedents and compared these by benzodiazepine type (approved vs. not approved for medical use in Canada). Results: Between January 2018 and June 2022, 782 Ontarians died of benzodiazepine-related toxicity (median age of 40 years), of which 70.5% were male and 88.6% resided in Southern Ontario The rate of benzodiazepine toxicity death peaked in December 2020 (0.27 per 100,000; N = 40). Overall, 98.1% of benzodiazepine deaths involved another substance, most commonly opioids (91.2%). Moreover, one-fifth (22.6%) of decedents had experienced a hospital-treated substance toxicity in the year prior to death, and almost two-thirds (64.1%) had a healthcare encounter with a substance use disorder diagnosis in the prior five years. Conclusion: Benzodiazepines remain an important contributor to substance-related mortality in Ontario, with nearly 800 benzodiazepine-related toxicity deaths observed over a four-and-a-half-year period. As almost all deaths involved multiple substances, most commonly opioids, harm reduction and treatment programs must adapt to the evolving needs of people who use drugs who may experience both intentional and unintentional benzodiazepine exposure.
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BibTeX
@article{campbell2026characterizing,
title = {{Characterizing trends and patterns in benzodiazepine-related toxicity deaths in Ontario: A descriptive cross-sectional study}},
author = {Tonya Campbell and Shaleesa Ledlie and Pamela Leece and Joanna Yang and Bisola Hamzat and Gillian Kolla and Nikki Bozinoff and Rob Boyd and Mike Franklyn and Ashley Smoke and Dana Shearer and Tara Gomes},
journal = {PLOS One},
year = {2026},
month = sep,
doi = {10.1371/journal.pone.0355210},
url = {https://doi.org/10.1371/journal.pone.0355210},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Characterizing trends and patterns in benzodiazepine-related toxicity deaths in Ontario: A descriptive cross-sectional study
AU - Tonya Campbell
AU - Shaleesa Ledlie
AU - Pamela Leece
AU - Joanna Yang
AU - Bisola Hamzat
AU - Gillian Kolla
AU - Nikki Bozinoff
AU - Rob Boyd
AU - Mike Franklyn
AU - Ashley Smoke
AU - Dana Shearer
AU - Tara Gomes
PY - 2026
DA - 2026/09/15
JO - PLOS One
DO - 10.1371/journal.pone.0355210
UR - https://doi.org/10.1371/journal.pone.0355210
AB - Objectives: The unregulated drug supply in Canada increasingly contains benzodiazepines, particularly those not approved for medical use, raising concerns about toxicity risk, especially when combined with opioids. Therefore, we aimed to describe trends in benzodiazepine-related toxicity deaths and compare their characteristics and circumstances by benzodiazepine type. Methods: We conducted a descriptive cross-sectional study of accidental benzodiazepine-related toxicity deaths in Ontario between January 1, 2018 and June 30, 2022, using linked administrative healthcare at ICES including coroner’s investigation records from the Drug and Drug/Alcohol Related Death Database. We measured monthly crude rates of benzodiazepine toxicity deaths and summarized characteristics (age, sex, region of residence, etc.) and circumstances (number and types of substances involved, healthcare encounters for toxicities and substance use disorders, etc.) of decedents and compared these by benzodiazepine type (approved vs. not approved for medical use in Canada). Results: Between January 2018 and June 2022, 782 Ontarians died of benzodiazepine-related toxicity (median age of 40 years), of which 70.5% were male and 88.6% resided in Southern Ontario The rate of benzodiazepine toxicity death peaked in December 2020 (0.27 per 100,000; N = 40). Overall, 98.1% of benzodiazepine deaths involved another substance, most commonly opioids (91.2%). Moreover, one-fifth (22.6%) of decedents had experienced a hospital-treated substance toxicity in the year prior to death, and almost two-thirds (64.1%) had a healthcare encounter with a substance use disorder diagnosis in the prior five years. Conclusion: Benzodiazepines remain an important contributor to substance-related mortality in Ontario, with nearly 800 benzodiazepine-related toxicity deaths observed over a four-and-a-half-year period. As almost all deaths involved multiple substances, most commonly opioids, harm reduction and treatment programs must adapt to the evolving needs of people who use drugs who may experience both intentional and unintentional benzodiazepine exposure.
SN - 1932-6203
ER -