Anti-anxiety medications are fast becoming one of the leading contributors to overdoses and are involved in more accidental deaths than alcohol, heroin or cocaine.
One in 20 Australians are prescribed benzodiazepines, such as Xanax and Valium. The Penington Institute’s Annual Overdose Report, set to be released this week, found there were 544 unintentional drug-induced deaths involving benzodiazepines in 2021, making them the second-most common drug involved in an accidental overdose death behind opioids.
The benzodiazepine medication known as Xanax.Credit: Jennifer Soo
The proportion of accidental overdose deaths due to benzodiazepines has doubled in the past 20 years, making up 32.5 per cent of fatalities in 2021.
Benzodiazepines are used for anxiety, insomnia, stress, and occasionally, back pain.
Less than one per cent of all deaths were due to benzodiazepines alone. But they are the type most commonly found in deaths involving multiple drugs, frequently combined with anticonvulsants, methadone, anti-psychotics and pharmaceutical opioids.
Penington Institute chief executive John Ryan said when benzodiazepines were involved in drug deaths, the sedatives were “always the bridesmaid, never the bride”.
“They’re rarely the single drug in relation to an overdose, but they’re very frequently the companion drug,” he said.
1.4 million Australians were prescribed 5.1 million scripts of benzodiazepines in 2020-21, with Ryan warning an overstretched health system meant doctors were not discussing the dangers of combining the drug with other substances with patients.
“We’ve been too easily seduced by the idea that a pill can solve our problems, whether it’s anxiety, insomnia, or pain. It’s quick and easy to write a script rather than delve deeply into the issues,” Ryan said.
Royal Australian College Of General Practitioners Alcohol and Other Drugs expert Dr Hester Wilson said benzodiazepines had a wide range of uses and could be prescribed at high doses without a significant risk of overdose – but this changed when mixed with other medications, especially opioids.
“In many ways, it mirrors opioids in that it’s an essential medication, but we’ve become over-reliant on it by prescribing it long-term,” she said.
Dependency was a major issue, she said, while severe withdrawal effects meant long-term users had to be slowly transitioned off the medication.
Non-prescribed benzodiazepines are also increasingly entering the black market along with counterfeit knockoffs.
A July study found that 70 per cent of illicit drug users who obtained non-prescribed benzodiazepines got them via diverted prescriptions, mostly from friends, relatives and partners.
“We’re seeing increasing numbers of people using them and using them with other medication. [The benzodiazepines black market] has become quite lucrative,” Wilson said.
There have been 37,000 drug-induced deaths since 2001, the Penington Institute found, with 2231 deaths in 2021 though this figure is projected to rise to 2358 as data is finalised and coronial findings are handed down.
Since 2014, unintentional drug-induced deaths have overtaken the road toll, with the gap getting wider every year.
Accidental overdoses make up three-quarters of all drug-induced deaths, with this figure increasing by 71 per cent since 2001, far surpassing Australia’s 33 per cent population growth.
Indigenous Australians are more than three times more likely to die from an accidental overdose than non-Indigenous Australians, while males accounted for seven in 10 unintentional drug-induced deaths in 2021.
Despite a raft of regulatory measures to limit availability, opioids still remain the number one killer for accidental overdoses, accounting for nearly half of all deaths.
Ryan said Australia’s responses to overdose rates were insufficient and not rooted in evidence.
“The data shows we’re failing to address a very significant health problem. This is one of the reasons we do the report because it can feel like if you don’t count it, it doesn’t matter. [Australia] is very uncomfortable talking about it,” Ryan said.
“The last significant change in drug policy and funding was circa 2000. We haven’t had politicians who are willing to step up and address it.”
A spokesperson for Health Minister Mark Butler referred questions to the Therapeutic Goods Administration.
“Doctors must use their knowledge of the patient’s unique circumstances and the medicine being considered to provide sufficient information about the risks that are relevant to that individual,” a TGA spokesperson said. “When used appropriately, the benefits of using these medicines outweigh the potential risks.”
The spokesperson said warning labels, smaller pack sizes, and changes to when certain opioids can be prescribed were implemented in 2020 to address Australia’s overdose rates, and that work to address opioid use was ongoing.
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