Over the last year, there have been numerous reports of benzodiazepine-adulterated opioids (also referred to as “benzo-dope”) in Canada’s illicit drug supply. According to new reports, benzodiazepines have been detected in as many as 60% of overdose deaths in British Columbia.

The benzodiazepines detected in illicit opioids in Canada are not pharmaceutical drugs, such as Xanax and Valium. Although the drugs being detected in the illicit supply are in the benzodiazepine drug class, because they are not pharmaceuticals their potency and side effects are currently unknown. Since benzodiazepines slow down nervous system activity, combining them with opioids significantly increases the risk of overdose.

A recent opinion article published in The Conversation suggests that the increasing supply of “benzo-dope” in the illicit drug market would saturate the opioid supply in a similar way fentanyl has saturated the heroin drug market, creating “a new normal” for the unregulated drug supply. The article discusses the potential of benzodiazepines to replace fentanyl in Canadian illicit drug supply and was co-authored by Dr. Lianping Ti, Research Scientist and Health Administrative Data Lead for the BC Centre on Substance Use, and Samuel Tobias, Research Data Coordinator at the British Columbia Centre on Substance Use.

Since most people do not intend to consume benzodiazepines with their opioids, their presence significantly increases the risk of overdose from benzodiazepine adulteration.

In addition, since benzodiazepines take longer to take effect compared to opioids, they can lead to delayed overdose symptoms, while thefts and sexual assaults have also been reported after people were given benzodiazepine-adulterated opioids without their knowledge and consequently entered an unresponsive state.

Adding yet another layer of complexity to the issue, since benzodiazepine use can lead to withdrawal, many addiction treatment providers do not admit individuals who test positive for benzodiazepine use. As a result, some individuals may not be able to access substance use treatment because of the presence of an added adulterant in their drugs.

Although drug checking services can be used to monitor the presence of additives in illicit drug supply and provide information about the contents of drugs, the technology used is not always sufficient to detect the presence of benzodiazepines.

Specifically, etizolam, the most common benzodiazepine-like compound found in opioids, can be particularly difficult to detect using point-of-care drug-checking technologies due to its molecular structure. As a result, its presence may be under-reported across Canada.

Despite the implementation of life-saving initiatives to address the fentanyl-driven overdose epidemic, including supervised consumption sites and distribution of naloxone, the emergence of “benzo-dope” carries an additional risk.

“As long as there remains a lack of any legal framework to promote a safer supply of drugs (safe supply and decriminalization), there will always be a level of unpredictability in the unregulated opioid supply that can harm people’s health.”