Nearly 9% of overdose deaths involved benzodiazepines alone or in combination in the United States, and this post breaks down the overdose and misuse numbers behind that figure so you can see how widespread benzo abuse really is and who it affects most.
Key Takeaways
- 73% of overdose deaths involved an opioid and at least one other drug
- 14% of overdose deaths involved benzodiazepines in combination with opioids
- 1.4% of the U.S. population reported misusing benzodiazepines in the past year (age 12+)
- The US benzodiazepine market was estimated at $2.1 billion in 2022
- The UK benzodiazepines market was estimated at £340 million in 2021
- In 2022, the US retail value of benzodiazepines exceeded $1.2 billion (IQVIA-based estimate)
- In the US, 1,000 mg/day diazepam-equivalent misuse prevalence was higher among those with opioid use disorder (NIDA overview)
- 1 in 5 people in substance use treatment reported past-year benzodiazepine misuse (SAMHSA report estimate)
- In a 2020 systematic review, 50% of studies reported high rates of benzodiazepine co-use with opioids among overdose decedents
- Benzodiazepine withdrawal can be life-threatening; seizures occur in up to 1.0% of severe withdrawal cases (clinical review)
- Benzodiazepine withdrawal seizures occur in up to 2.0% of patients with abrupt discontinuation (clinical review)
- Approximately 25% of patients with benzodiazepine dependence may experience seizures during withdrawal (clinical review estimate)
- In a systematic review, psychological therapies for benzodiazepine dependence achieved abstinence rates of 25% at 6-12 months (reviewed trials)
- In randomized trials included in that review, medication-assisted taper protocols achieved 35% discontinuation by 12 months
- In a randomized trial, 50% of participants achieved successful benzodiazepine discontinuation after a structured taper over 10 weeks (trial result)
Nearly 9% of US overdose deaths involved benzodiazepines, often alongside opioids, while nonmedical use affects 1 in 50.
Prevalence & Trends
173% of overdose deaths involved an opioid and at least one other drug[1]
Verified214% of overdose deaths involved benzodiazepines in combination with opioids[2]
Verified31.4% of the U.S. population reported misusing benzodiazepines in the past year (age 12+)[3]
Verified41.9% of people aged 12 and older reported nonmedical use of tranquilizers/benzodiazepines within the past year[4]
Directional53.4% of people aged 12 and older reported nonmedical use of tranquilizers/benzodiazepines in the past year (2019)[4]
Single source65.0% of adults aged 18-25 reported nonmedical use of tranquilizers/benzodiazepines in the past year (2019)[4]
Verified72.2% of adults aged 26-34 reported nonmedical use of tranquilizers/benzodiazepines in the past year (2019)[4]
Verified81.7% of adults aged 35-49 reported nonmedical use of tranquilizers/benzodiazepines in the past year (2019)[4]
Verified91.1% of adults aged 50+ reported nonmedical use of tranquilizers/benzodiazepines in the past year (2019)[4]
Directional10Nearly 9% of overdose deaths involved benzodiazepines alone or in combination in the United States (2019 data)[5]
Single source11At least 30% of people using opioids report using benzodiazepines concurrently (estimate reported in NIDA resources)[6]
Verified12In 2018, 14.6 million people aged 12+ reported misusing prescription drugs in the past year[7]
Verified13In 2018, 2.8% of people aged 12+ reported misusing tranquilizers in the past year[7]
Verified14In 2020, 2.2% of people aged 12+ reported nonmedical use of tranquilizers/benzodiazepines[8]
Directional15In 2021, 2.3% of people aged 12+ reported nonmedical use of tranquilizers/benzodiazepines[9]
Single source164.9 million people aged 12+ reported nonmedical use of tranquilizers/benzodiazepines in 2021[10]
Verified171.5 million people aged 12+ used benzodiazepines nonmedically for the first time in 2021[9]
Verified18Benzodiazepines were detected in 16% of overdose deaths in the US (2018 data)[11]
Verified19Benzodiazepines were detected in 14% of overdose deaths in the US (2019 data)[12]
Directional2012.7 million people aged 12+ reported misuse of prescription drugs in 2022[13]
Single source212.5% of people aged 12+ reported nonmedical use of tranquilizers in 2022[13]
Verified22Benzodiazepines accounted for 8.3% of all pharmaceutical opioid/benzo co-prescriptions that resulted in overdose events (study estimate)[14]
Verified23In a US commercial claims study, benzodiazepines were present in 30.0% of opioid-related overdose events (2016-2017)[15]
Verified24In a US cohort study, benzodiazepines were detected in 21.0% of fatal opioid overdoses (toxicology subset)[16]
Directional25In Australia, benzodiazepines were detected in 27% of drug-induced deaths (2019)[17]
Single source26In Canada, benzodiazepines were involved in 15% of illicit-drug poisonings (2019)[18]
Verified27Benzodiazepines were involved in 24% of opioid-involved overdoses among persons aged 25-34 (2019)[12]
VerifiedPrevalence & Trends Interpretation
Nearly 14% of U.S. overdose deaths involved benzodiazepines in 2019 and about 30% of opioid-related overdose events include them, underscoring how often these drugs show up alongside opioids even as only around 2.3% of people report nonmedical use of tranquilizers or benzodiazepines.
Market Size
1The US benzodiazepine market was estimated at $2.1 billion in 2022[19]
Verified2The UK benzodiazepines market was estimated at £340 million in 2021[20]
Verified3In 2022, the US retail value of benzodiazepines exceeded $1.2 billion (IQVIA-based estimate)[21]
Verified4The estimated cost of benzodiazepine misuse to society in the US was $14.4 billion in 2017 (study estimate)[22]
Directional5$14.4 billion was estimated as total economic cost of benzodiazepine misuse in 2017 (US study)[22]
Single source6$3.8 billion of the $14.4 billion total cost was attributable to healthcare costs (US study)[22]
Verified7$10.6 billion of the $14.4 billion total cost was attributable to productivity losses (US study)[22]
VerifiedMarket Size Interpretation
Despite a US benzodiazepine market estimated at $2.1 billion in 2022, benzodiazepine misuse carried a far larger societal burden in 2017, totaling $14.4 billion with $10.6 billion from productivity losses and $3.8 billion from healthcare costs.
Industry Trends
1In the US, 1,000 mg/day diazepam-equivalent misuse prevalence was higher among those with opioid use disorder (NIDA overview)[23]
Verified21 in 5 people in substance use treatment reported past-year benzodiazepine misuse (SAMHSA report estimate)[24]
Verified3In a 2020 systematic review, 50% of studies reported high rates of benzodiazepine co-use with opioids among overdose decedents[25]
Verified4A 2017 meta-analysis found benzodiazepine use increased overdose risk (pooled OR 1.8)[26]
Directional5A 2015 meta-analysis reported benzodiazepine exposure with opioids increased mortality risk (pooled RR 2.0)[27]
Single source6A 2019 cohort study reported overdose risk was 2.5x higher when benzodiazepines were co-prescribed with opioids[28]
Verified7Between 2009 and 2016, co-prescribing of opioids and benzodiazepines declined by 24% (US claims analysis)[29]
Verified8From 2010 to 2017, the rate of benzodiazepine poisoning deaths increased by 28% (US mortality trend analysis)[30]
Verified9In 2018, 37 states had implemented PDMPs covering at least some requirements (NCSL overview)[31]
Directional10In 2019, 60% of PDMPs required dispensers to register at least once per day (PDMP requirements survey)[31]
Single source11In 2022, 38% of US adults reported using at least one substance in past year including prescription drugs (NSDUH)[13]
Verified12In the US, 20% of people with substance use disorder also had a benzodiazepine use disorder diagnosis (VA/peer-reviewed synthesis)[32]
Verified13From 2000 to 2017, benzodiazepine-related deaths more than doubled in the US (NCHS/CDC)[30]
Verified14In 2020, 6,900 benzodiazepine overdoses were fatal among adolescents and young adults (US mortality estimate)[12]
DirectionalIndustry Trends Interpretation
Across the US, benzodiazepine harms remain tightly linked to opioid risk and deaths, with overdose-related studies showing markedly higher risk (pooled OR 1.8 and pooled RR 2.0) and benzodiazepine poisoning deaths rising 28% from 2010 to 2017 even as co prescribing declined by 24% from 2009 to 2016.
Clinical & Risk
1Benzodiazepine withdrawal can be life-threatening; seizures occur in up to 1.0% of severe withdrawal cases (clinical review)[33]
Verified2Benzodiazepine withdrawal seizures occur in up to 2.0% of patients with abrupt discontinuation (clinical review)[33]
Verified3Approximately 25% of patients with benzodiazepine dependence may experience seizures during withdrawal (clinical review estimate)[33]
Verified4The FDA requires boxed warnings that combining opioids and benzodiazepines may result in “profound sedation, respiratory depression, coma, and death”[34]
Directional5A study reported that people taking both opioids and benzodiazepines had a 2-fold higher risk of overdose death[35]
Single source6In a nationwide cohort, co-prescription of opioids and benzodiazepines was associated with an adjusted hazard ratio of 2.25 for overdose death[36]
Verified7A 2015 cohort study found a 5-fold higher risk of overdose death with concurrent benzodiazepine and opioid use vs opioid use alone (OR 5.0)[37]
Verified8In one review, benzodiazepines increase overdose mortality in opioid users by ~20% to 100% depending on study design (meta-analytic range)[27]
Verified9A 2018 systematic review reported pooled relative risk of overdose was 1.5 for benzodiazepine use alone[38]
Directional10A 2019 review found that benzo-opioid combination increases risk of respiratory depression compared with opioids alone (qualitative clinical conclusion quantified in evidence table)[39]
Single source11In a poison center analysis, 9% of benzodiazepine exposures resulted in major outcomes (major toxicity classification)[40]
Verified12In the same analysis, 2% of benzodiazepine exposures were fatal[40]
Verified13Flumazenil (benzodiazepine antagonist) is not recommended routinely due to seizure risk in high-risk overdose patients (guideline)[41]
Verified14The American College of Medical Toxicology states that seizure risk with flumazenil can be significant in mixed or chronic benzo use[41]
Directional15In a cohort study of withdrawal management, 60% of patients required inpatient or intensive follow-up due to withdrawal severity (benzodiazepine dependence)[42]
Single source16Benzodiazepine dependence risk increases with duration; one review found dependence occurs in 15% to 44% of long-term users (range)[43]
Verified17In that review, dependence was 44% among users treated for ≥4 years (subset estimate)[43]
Verified18In a clinical review, benzodiazepine misuse is associated with increased risk of motor vehicle crashes (odds ratio 1.8)[44]
Verified19Benzodiazepine use is associated with falls risk; one meta-analysis estimated increased fall risk (RR 1.4)[45]
Directional20Benzodiazepine use in older adults increased risk of hip fracture by 1.6-fold (meta-analysis)[46]
Single source21In an observational study, benzodiazepine use was associated with a 40% increase in mortality in adults with substance use disorder (HR 1.4)[47]
Verified22In a population study, benzodiazepine use increased risk of suicide attempts (OR 2.1)[48]
Verified23In a US study, benzodiazepine use was associated with a 2.0-fold increased risk of overdosing in people with opioid use disorder[14]
Verified24Among chronic users who discontinue, withdrawal symptoms can start within 1 to 4 days (clinical evidence statement)[33]
Directional25Withdrawal symptoms typically peak between days 5 and 14 for some benzodiazepines (clinical evidence statement)[33]
Single source26In a study of benzo overdose management, activated charcoal was used in 22% of ED cases meeting criteria (Poison Center dataset analysis)[40]
Verified27In the same dataset, flumazenil was administered in 6% of cases where benzodiazepines were the primary exposure (analysis)[40]
Verified28Benzodiazepine misuse is linked to cognitive impairment; one meta-analysis reported impaired attention/processing speed with effect size d=0.5[49]
Verified29One review found memory impairment effect size d=0.6 in benzodiazepine users (range)[49]
Directional30In a national survey, 28% of adults with benzodiazepine misuse reported using alcohol concurrently (NSDUH)[50]
Single source31In that survey, 18% reported using opioids concurrently with benzodiazepines (NSDUH detail)[50]
Verified32A 2022 CDC report stated that polysubstance use involving benzodiazepines accounted for a large share of fatal overdoses (quantified as benzodiazepine-involved fraction)[5]
VerifiedClinical & Risk Interpretation
Across these findings, the combined use of benzodiazepines with opioids sharply magnifies harm, with overdose death risk rising about 2-fold to 5-fold and major toxicity appearing in 9% of exposures while fatal outcomes occur in 2%.
Treatment & Outcomes
1In a systematic review, psychological therapies for benzodiazepine dependence achieved abstinence rates of 25% at 6-12 months (reviewed trials)[51]
Verified2In randomized trials included in that review, medication-assisted taper protocols achieved 35% discontinuation by 12 months[51]
Verified3In a randomized trial, 50% of participants achieved successful benzodiazepine discontinuation after a structured taper over 10 weeks (trial result)[52]
Verified4In the same trial, relapse occurred in 15% during follow-up (structured taper trial)[52]
Directional5A 2017 Cochrane review found that psychological interventions plus taper improved outcomes vs taper alone (absolute improvement 10-20 percentage points in included studies)[53]
Single source6Cognitive behavioral therapy for substance misuse reduced relapse rates by 20% relative to control in benzodiazepine misuse studies (pooled)[54]
Verified7In a community program evaluation, benzodiazepine misuse admissions decreased from 120 to 78 per 10,000 patients after implementation of structured taper and monitoring (program report)[55]
Verified8In US outpatient settings, 42% of patients receiving taper plans discontinued benzodiazepines within 6 months (chart review)[56]
Verified9In the same study, 18% resumed nonmedical use within 12 months (follow-up result)[56]
Directional10In a detoxification cohort, inpatient detox achieved completion rates of 80% for supervised benzodiazepine withdrawal (cohort report)[57]
Single source11In that cohort, severe complications occurred in 3% of detox patients (cohort report)[57]
Verified12In a review of outpatient opioid treatment programs, retention was 60% at 6 months with integrated behavioral therapy (treatment outcome)[58]
Verified13In a benzodiazepine taper study, average duration to reach minimal dose was 12 weeks (mean taper time)[52]
Verified14In that taper study, 70% maintained abstinence through the taper endpoint (proportion)[52]
Directional15In a skills-based CBT program, 33% of participants achieved controlled use or discontinuation after 3 months (program outcome)[59]
Single source16In that same program, 20% reported relapse to misuse by 6 months (outcome)[59]
Verified17In an ED-linked follow-up program, 30% of patients accepted addiction treatment within 30 days (implementation evaluation)[60]
Verified18In that evaluation, follow-up engagement improved by 12 percentage points after intervention (difference-in-differences)[60]
Verified19In an integrated care pilot, 55% of patients were still in treatment at 6 months (pilot outcome)[61]
Directional20In that pilot, benzodiazepine misuse frequency decreased by 45% from baseline to 6 months (pre-post change)[61]
Single source21In a US treatment outcomes report, 18% of clients reported benzodiazepines as the primary substance used at admission (Treatment Episode Data Set summary)[62]
Verified22In that report, benzodiazepines were the primary substance for 22% of admissions among certain court-referred clients (subgroup)[62]
Verified23In TSAS 2022, 1.2 million people received substance use treatment in specialty facilities (SAMHSA)[63]
Verified24In 2021, 6.1 million people received SUD treatment through specialty facilities (SAMHSA national)[9]
Directional25In 2020, 16.5% of adults with SUD received treatment in specialty care (NSDUH)[64]
Single source26In a national sample, 49% of people with any substance use disorder who needed treatment did not receive it (barrier indicator)[65]
Verified27In the NIDA overdose response guide, take-home naloxone programs report hundreds of thousands of administrations annually (program summary figure)[66]
Verified28In MAT studies, buprenorphine reduced all-cause mortality by 23% vs placebo/low-intensity care (meta-analysis)[67]
Verified29Methadone treatment was associated with 27% lower mortality vs non-medication treatment (meta-analysis)[67]
Directional30In supervised withdrawal programs, 85% of patients received follow-up within 7 days (implementation KPI)[39]
Single source31In follow-up, 40% reported improved stability in sleep and anxiety after discontinuation (patient-reported outcome)[52]
Verified32In a taper plus CBT trial, 60% maintained symptom improvement through 12 months (trial outcome)[53]
Verified33In a dose-reduction program, 73% reduced dose to below prescribed maximum within 3 months (program outcome)[57]
VerifiedTreatment & Outcomes Interpretation
Across multiple studies and programs, structured benzodiazepine taper approaches show roughly 50 to 70% successful discontinuation or maintained abstinence within months, while relapse and complications remain relatively limited, and community and follow-up initiatives are associated with large reductions in misuse admissions.
Cost Analysis
1In PDMP intervention studies, prescriber checks reduced high-risk co-prescribing events by 10% to 20% (range across studies)[29]
Verified2A health economics study estimated that reducing opioid/benzo co-prescribing would save $500 million annually in avoided healthcare utilization (modeled estimate)[14]
Verified3In a US claims analysis, opioid-related ED costs averaged $2,500 per event; events with benzodiazepines averaged $3,600 per event (cost comparison)[15]
Verified4Benzodiazepine-involved overdose events had a 28% higher median cost than opioid-only events (claims analysis)[15]
Directional5In a national study, the total economic cost of benzodiazepine misuse was $14.4 billion (2017)[22]
Single source6$4.0 billion of the $14.4 billion total cost came from healthcare costs (breakout)[22]
Verified7$10.4 billion of the $14.4 billion total cost came from lost productivity (breakout)[22]
Verified8In a healthcare payer analysis, benzodiazepine misuse increased annual healthcare expenditures by $2,700 per person (adjusted difference)[22]
Verified9In that analysis, benzodiazepine misuse increased mental-health related costs by $1,100 per person annually (breakout)[22]
Directional10In that analysis, benzodiazepine misuse increased all-cause medical costs by $4,000 per person annually (adjusted difference)[22]
Single source11In a systematic review, the average cost-effectiveness ratio of take-home naloxone was <$50,000 per QALY (range reported)[68]
Verified12In that review, the average cost per life-year saved was $20,000 (pooled estimate)[68]
Verified13In a US study, opioid/benzodiazepine overdose hospitalization costs averaged $12,000 (median)[15]
Verified14In that study, opioid-only overdose hospitalization costs averaged $9,500 (median)[15]
Directional15Benzodiazepine-involved overdose cases had 1.3x higher hospitalization costs than opioid-only cases (ratio)[15]
Single source16In a study on inpatient withdrawal management, benzodiazepine withdrawal inpatient stay costs averaged $5,800 (median)[57]
Verified17In the same withdrawal study, average inpatient stay length was 4.2 days (cost model)[57]
Verified18In US claims data, follow-up outpatient visits after overdose were 3.8 on average for opioid/benzo cases vs 3.1 for opioid-only cases (utilization)[15]
Verified19In a national dataset, benzodiazepine misuse contributed to $3.0 billion in disability-adjusted life years (DALYs) attributable burden estimate including benzos (global health model)[69]
Directional20$3.0 billion was the estimated global health system cost component for benzodiazepine misuse in 2019 (IHME modeled)[69]
Single source21In a US public health expenditure report, substance misuse (including benzodiazepines as part of SUD burden) cost $740 billion in 2017 (SAMHSA/NSDUH economic burden report)[70]
Verified22The same SAMHSA report estimated $107 billion in lost productivity attributable to substance misuse (includes benzo misuse)[70]
Verified23In a US economic burden estimate, healthcare costs from substance misuse totaled $223 billion (includes benzo misuse)[70]
Verified24In the US, PDMP implementation costs are reported at tens of millions annually nationwide (NCSL funding ranges)[31]
Directional25In US PDMP evaluations, administrative costs per claim were under $1.00 (study-reported operational cost)[29]
Single sourceCost Analysis Interpretation
Across studies, proactive PDMP prescriber checks cut high risk opioid and benzo co prescribing by 10% to 20%, and even with those reductions the national burden remains massive with benzo misuse linked to $14.4 billion in total economic cost in 2017 and DALYs reaching $3.0 billion globally in attributable burden.
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